Govt issues Clinical Guidance for Covid-19 treatment; know when to use Remdesivir, Tocilizumab
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New Delhi, April 23: Amid the increasing demands for Tocilizumab, Remdesivir, and plasma, Health Ministry issued a revised Clinical Guidance for Management of Adult COVID-19 Patients. The ministry has issued the guidelines, to specifies how and in what stages and doses should the drugs be used. The guidelines has classified Covid-19 patients into three broad groups of mild, moderate and severe.
Remdesivir (EUA)
The guidelines were jointly issued by AIIMS, ICMR-COVID-19 National Task Force, and the Joint Monitoring Group (DGHS). In the guidelines, the ministry stated, Remdesivir may be considered for only those patients with moderate to severe diseases (requiring supplemental oxygen) within 10 days of onset of symptoms, under emergency use authorization (EUA). The guidelines further warned that it is not recommended for those with severe renal impairment or hepatic dysfunction. It also ordered that Remdesivir not be used in patients who are not on oxygen support or in-home settings.
Methylprednisolone
Coovid-19 patients admitted in hospital with moderate symptoms with oxygen level between 90 per cent to 93 per cent on room air can be given injection Methylprednisolone 0.5 to 1 mg/kg in 2 divided doses (or an equivalent dose of dexamethasone) usually for a duration of 5 to 10 days
Serial CXR, HRCT chest can be done on these patients only if there is worsening.
Tocilizumab (off-label)
The guidelines further stated that Tocilizumab (a drug that modifies the immune system or its functioning) may be considered in patients with significantly raised inflammatory markers and not improving despite the use of steroids with there being no active bacterial/fungal/tubercular infection.
They also recommended off-label use of convalescent plasma only in the early moderate disease, preferably within seven days of symptom onset, stating that "no use after seven days" and only on the availability of high titer donor plasma. According to the guidance note, upper respiratory tract symptoms (or fever) without shortness of breath or hypoxia have been categorised as 'mild disease'' and people have been advised home isolation and care.
The guidelines advise physical distancing, indoor mask use, strict hand hygiene. symptomatic management (hydration, antipyretics, antitussive, multivitamins), staying in contact with treating physician, monitoring temperature and oxygen saturation (by applying a SpO2 probe to fingers) for such patients.
They should seek immediate medical attention if they develop difficulty in breathing, high-grade fever/severe cough, particularly if lasting for five days. A low threshold to be kept for those with any of the high-risk features such as 60 years of age, having cardiovascular disease, hypertension, chronic lung/kidney/liver disease or cerebrovascular disease, or obesity, the note stated.
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