India has discouraged the use of Remdesivir, Tocilizumab, multivitamins, steroids in covid-19 treatment. On Monday, the Indian Council of Medical Research (ICMR), released the new treatment guidelines for the management of Covid-19. Remdesivir may be considered only in patients who have completed 10 days since the start of the symptoms and require supplemental oxygen, but nor clarified whether the drug cannot be given to patients who are on a ventilator or extracorporeal membrane oxygenation (ECMO). 

Designed by AIIMS and ICMR-led Covid-19 National Task Force has waived off the use of multivitamin pills which was earlier advised for the treatment of mild cases. Under the management of mild Covid disease, where the patient suffers from mild symptoms with no shortness of breath or low oxygen in the blood (SpO2), the list of “must-do” activities includes hydration, consuming anti-fever medicines and medicines to suppress cough.

Further, the protocol states that steroids could increase the risk of secondary infection such as invasive mucormycosis when used too early, at a higher dose or for longer than required and hence discouraged the overuse of steroids.

Tocilizumab was allowed for patients who meet five criteria and do not have active tuberculosis, fungal or any systemic bacterial infection. It may be given to patients who are on oxygen therapy or on ventilators but not responding to steroids. It mentions that the drug should be given along with steroids and the inflammatory markers should be significantly raised. Long term follow up should be done for secondary infections such as reactivation of TB or flaring of herpes.

The latest guidelines include blood sugar test, in addition to the previous tests like CRP and D-dimer, complete blood count (CBC), kidney function test (KFT), liver function test (LFT) and IL-6 levels for both severe and moderate patients. It stated that if cough, in mild cases, persists for more than two to three weeks investigation for tuberculosis and other conditions should be done. The protocol also added people with “active tuberculosis” under the category of high risk for severe disease or mortality. Multivitamins were not included for the mild cases. 

Source: News 18