Health ministry cuts use of steroids, multivitamins, remdesivir, tocilizumab in new COVID-19 treatment guidelines
New Delhi: With the sharp increase in the COVID-19 cases across the country, the Ministry of Health and Family Welfare has recently issued the revised clinical guidance for the management of adult COVID-19 patients.
The guideline prepared by the All India Institute of Medical Sciences (AIIMS) and Indian Council of Medical Research (ICMR) National COVID-19 task force states that there is no evidence for benefit for injectable steroids in those NOT requiring oxygen supplementation, or on continuation after discharge.
The revised guideline further added that anti-inflammatory or immune-modulatory therapy (such as steroids) could have a risk of secondary infection such as invasive Mucormycosis when used too early, at a higher dose, or for longer than required. Along with this, it newly recommends the investigation for Tuberculosis and other conditions if cough persists more than 2- 3 weeks.
The removal of anticoagulant therapy for ICU patients also marks a change from the previous guidelines released by the said ministry.
Use of Remdesivir and Tocilizumab
The said guideline states that the use of Remdesivir (EUA) may be considered only in patients with moderate to severe disease (requiring supplemental oxygen), but who are not on Inter Module Ventilation or Extra Corporeal Membrane Oxygenation within 10 days of onset of symptoms. Also, the use of remdesivir may be considered for 5 days to treat hospitalized patients with COVID-19, while monitoring for Renal Functional Test and Liver Function Test. The guideline restricted the use of Remdesivir in patients who are not on oxygen support or in-home setting. And the recommended dose is 200 mg IV on day 1 followed by 100 mg IV OD for the next 4 days.
In the case of Tocilizumab, it may be considered to use with a condition such as: rapidly progressing of COVID-19 needing oxygen supplementation or IMV and not responding adequately to steroids (preferably within 24-48 hours of the onset of severe disease/ ICU admission), no active TB, fungal, systemic bacterial infection and with significantly raised inflammatory markers. The use of Tocilizumab is preferable to be given with steroids. The recommended single dose is 4 to 6 mg/kg (400 mg in 60 kg adult) in 100 ml NS over 1 hour.
