Centre revises its guidelines for adult Covid patients’ treatment
If cough persists for more than two-three weeks, investigate for tuberculosis and other conditions, the Union ministry of health and family welfare said in its revised clinical guidelines for management of adult Covid-19 patients issued on Monday.T
The guidelines, drafted by experts from the Indian Council of Medical Research-Covid19 Task Force, All India Institute of Medical Sciences (AIIMS), and Directorate General of Health Services under health ministry, continue to not recommend medicines such as antibiotics doxycycline and azithromycin, and antiparasitic Ivermectin for mild cases of Covid-19.
Mild diseases are those showing upper respiratory tract symptoms, with or without fever as long as there is no shortness of breath or hypoxia.
While such patients showing mild symptoms have been advised to stay in touch with their physician, they are also directed to go for symptom management by including adequate fluids, using anti-pyretics (anti-fever) and anti-tussive (cough suppressants) medicines for relief from sore throat, fever, congestion and cough.
Experts recommend monitoring fever and oxygen saturation at regular intervals.
“Seek immediate medical attention if: Difficulty in breathing or SpO2 <93%; and high grade fever or severe cough, particularly if lasting for >5 days (a low threshold to be kept for those with any of the high-risk features),” they said.
Among therapies at home based on low certainty of evidence, especially for those with high-risk of disease progression, the guidelines recommend inhalational budesonide (given via metered dose inhaler/dry powder inhaler) at a dose of 800 mcg BD (twice a day) for five days if symptoms (fever, and or, cough) persist more than five days.
Among those at high risk for developing severe disease or mortality include people aged 60 and above; those suffering from cardiovascular disease, hypertension and coronary artery disease; diabetes and other immunocompromised states such as HIV; chronic lung, liver or kidney disease; active tuberculosis; cerebrovascular disease; or obesity.
Among advanced medicines that have been granted emergency use authorisation based on limited available evidence, only injectibles remdesivir and tocilizumab have been included that too for select patients under strict medical supervision.
Moderate and severe disease cases are to be treated in a hospital.
Experts say in a pandemic, treatment protocols are modified frequently as data continuously evolves.
“When the list of drugs is updated it is usually based on the current evidence that is available globally as well as locally. Normally, drug trials take years but in a pandemic situation there is not that much time at our disposal so many drugs are repurposed and used because they show some benefit initially. However, as time passes, more information gets available on the effect of the drug on treatment outcome, many a times it is found that there isn’t much benefit, or risks far outweigh the benefits; therefore treatment protocol is modified accordingly,” said Dr Vikas Maurya, director, respiratory medicine department, Fortis Healthcare.