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Government issues revised COVID-19 treatment guidelines

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Dr Veena Aggarwal, Consultant Womens’ Health, CMD and Editor-in-Chief, IJCP Group & Medtalks Trustee, Dr KK’s Heart Care Foundation of India    19 January 2022

The Health Ministry has advised against prescribing steroids to patients with Covid-19 not requiring oxygen supplementation in its updated guidelines for the treatment of Covid-19 citing lack of evidence showing beneficial effects of steroids in these patients. Prescribing high doses of steroids or using them for prolonged duration more than needed or starting steroids too early in the disease may increase the risk of secondary infections such as invasive mucormycosis.

Molnupiravir or monoclonal antibodies find no mention in these revised guidelines.

It further states that persistence of cough for more than 2-3 weeks should be investigated for tuberculosis (TB) and other conditions.

The guideline, devised by AIIMS and ICMR-COVID-19 National Task Force has retained the categorization of patients into mild, moderate and severe disease.

The “Must Dos” for patients with mild disease include physical distancing, hand hygiene, use of mask even when indoors, monitoring of body temperature and oxygen saturation, hydration, antipyretics and antitussives. No multivitamins have been advised for this group of patients.

Specific criteria have been defined for the use of remdesivir and Tocilizumab (EUA/off label).

According to the new guidelines, remdesivir is to be used only in patients with moderate to severe disease, within 10 days of onset of symptoms, who need oxygen supplementation, but are not on mechanical ventilation or extracorporeal membrane oxygenation (ECMO). It has cautioned against the use of remdesivir in home settings or in patients who are not on oxygen therapy.

Tocilizumab can be considered for use in severe disease, within 24 to 48 hours of the onset of severe illness or intensive care unit (ICU) admission, preferably with steroids. The inflammatory markers (CRP and/or IL-6) should be significantly raised. TB, fungal or systemic bacterial infection should be ruled out before administration. These patients should be followed up for secondary infections such as flaring of herpes or reactivation TB.

The lab parameters for monitoring include CRP, d-dimer, blood sugar and LFT (48-72 hours), CBC, KFT. Serial CXRs can be one; while HRCT chest is recommended for monitoring, it should be done only when there is worsening of symptoms.

Source: Clinical guidance for management of adult Covid-19 patients, Ministry of Health & Family Welfare, dated 17th January, 2022.

 

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