What to and shouldn’t do with Covid therapy, drugs in the Center’s revised guidelines

New Delhi:

According to the revised Clinical Guidance for the Management of Adult COVID-19 Patients, there is no evidence that injectable steroids benefit Covid patients in the absence of oxygen supplementation or in the continuation after discharge.

According to the revised guidelines issued by AIIMS, ICMR-COVID-19 National Task Force, and the Joint Monitoring Group (DGHS) of the Union Health Ministry, anti-inflammatory or immunomodulatory therapies such as steroids are at risk of secondary infections such as invasiveness. It also states that it may be. Mucormycosis is too early, at high doses, or when used longer than necessary.

According to the guidelines, methylprednisolone 0.5-1 mg / kg can be injected in two divided doses, or an equivalent dose of dexamethasone can usually be injected for 5-10 days in moderate cases. In severe cases, the same drug can be given in 2 divided doses of 1-2 mg / kg for the same period.

“If symptoms (fever and / or cough) persist for more than 5 days after onset, in mild cases, administer via inhaled budesonide (quantitative inhaler / dry powder inhaler) at a dose of 800 mcg BD for 5 days. ) Can be administered. ”As stated in the guidelines.

They say that if the cough lasts for more than a few weeks, you should choose to investigate tuberculosis and other symptoms.

The revised guidelines provide Emergency Use Authorization (EUA) or off-label use remdesivir for patients with “moderate to severe” disease and patients without renal or hepatic dysfunction within 10 days of onset of symptoms. We continue to recommend it.

It warned against the use of medications for patients who do not receive oxygen support or are not in the home environment.

According to the guidelines, EUA or off-label use of tocilizumab can be considered for use in the presence of severe illness, preferably within 24-48 hours of admission to the severe illness or intensive care unit (ICU).

Tocilizumab may be considered in patients with significantly elevated inflammatory markers and no improvement with steroid use, they said, with no active bacterial, fungal, or tuberculosis infections. Coronavirus patients are categorized as patients with mild, moderate, and severe illness, the guidelines say.

According to the guidance notes, upper respiratory tract symptoms without shortness of breath or hypoxia are classified as mild illnesses and are recommended for home isolation and care. People suffering from mild Covid should see a doctor if they have difficulty breathing, a high fever, or a severe cough that lasts for more than 5 days.

People with shortness of breath with SpO2 fluctuations of 90-93% can be admitted to the ward and are considered moderate cases. According to the guidelines, oxygen support should be provided to these patients and all patients in need of oxygen supplementation should be repositioned continuously every two hours to promote arousal propensity.

Respiratory rates above 30 per minute, shortness of breath or SpO2 less than 90% of the room air should be considered a serious illness and such patients need to be admitted to the ICU as they require respiratory assistance. They said.

Such patients should receive respiratory assistance. Non-invasive ventilation (NIV) (helmet or face mask interface depending on availability) may be considered for people with increased oxygen requirements if they have less breathing work.

High-flow nasal cannulas should be considered for patients with increased oxygen requirements. If NIV is unacceptable, intubation should be prioritized in patients with high respiratory work and, if necessary, the institutional protocol for ventilator management should be used, the new guidelines say.

People over the age of 60, or suffering from cardiovascular disease, hypertension, coronary artery disease, true diabetes, or other immunodeficiency conditions (HIV, active tuberculosis, chronic lung, kidney, liver disease, cerebrovascular disease, obesity, etc.) People who have an increased risk of severe illness. Said the mortality rate, guidelines.

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