These drugs, test have been dropped for Covid-19 treatment. Details here

The Directorate General of Health Services (DGHS) under the health ministry has stressed the importance of following Covid-19 appropriate behaviour.

In revised guidelines for managing patients of the coronavirus disease (Covid-19), the Union ministry of health and family welfare has dropped all medicines, except those for fever and cold, for asymptomatic and mild cases. The Directorate General of Health Services (DGHS) under the health ministry has stressed the importance of following Covid-19 appropriate behaviour—wearing of a mask and following physical distancing, hand hygiene and cough etiquettes— and said they must be followed by asymptomatic, mild, moderate and severe patients.

The Directorate General of Health Services (DGHS) under the Union health ministry has issued several guidelines to manage patients of the coronavirus disease (Covid-19). (PTI Photo)

Drugs dropped

DGHS in the revised guidelines, issued on May 27, has dropped all drugs including hydroxychloroquine, ivermectin, doxycycline, zinc, multivitamins, etc prescribed by the doctors to asymptomatic or mildly symptomatic Covid-19 patients. Doctors have also been asked not to prescribe unnecessary tests to Covid-19 patients such as CT scans.

In mild cases, the guidelines said, patients should self-monitor for fever, breathlessness, oxygen saturation (SpO2) or worsening of any symptoms. It said people may take antipyretic and anti-tussive for symptomatic relief, and inhalation of budesonide at a dose of 800mcg twice daily for five days for a cough. “No other Covid-19 specific medication required. The patient may have to be investigated further if symptoms persist or deteriorate.”

No medication is required for asymptomatic cases and those with comorbidities who need to continue taking their prescribed medicines, the guidelines said. DGHS has advised people experiencing symptoms of the coronavirus disease to follow a healthy, balanced diet and keep themselves hydrated. 

Guidelines for use of remdesivir

1. Remdesivir is to be used only in select moderate or severe hospitalised Covid-19 patients on supplemental oxygen within 10 days of onset of disease. 

2. It is not for mild Covid-19 patients who are at home or in Covid Care Centres. 

3. It must be advised by senior faculty members or specialists directly involved in patient’s care. 

4. If it has to be advised or ordered during odd hours, it should be done by the duty doctor after telephonic consultation with a senior faculty member/specialist/ unit in - charge.

Guidelines for use of tocilizumab in severe and critically ill patients

1. If the patient shows no signs of improvement in terms of oxygen requirement even after 24-48 hours of administration of steroids, tocilizumab can be prescribed.

2. It can also be prescribed when the patient has significantly raised inflammatory markers (C-Reactive Protein≥75 mg/L) 

3. However, it must be ensured that the patient is free of any bacterial/fungal/ tuberculous infection at the time of administration of Tocilizumab. 

Guidelines for use of steroids

1. Steroids are harmful in asymptomatic and mild cases of Covid-19. 

2. Steroids are indicated in only hospitalised, moderately severe and critically ill Covid-19 cases. 

3. Self-medication of steroids must be avoided. 

4. Monitoring of blood glucose is mandatory in all patients put on steroids as it may precipitate hyperglycaemia.

Guidelines for use of anti-coagulants

1. Prophylactic doses to be used in moderate cases of Covid-19 with un-fractionated heparin or low molecular weight heparin.

2. There should be no contraindication or high risk of bleeding. 

3. Doses to be used in severe cases with un-fractionated heparin or low molecular weight heparin.

4. Therapeutic dose to be used only if there is evidence of thromboembolism or obstruction of a blood vessel by a blood clot that has become dislodged from another area in the circulation. 

5. There should be no contraindication or high risk of bleeding.

Guidelines on high-resolution CT (HRCT) scan

1. Nearly two-thirds of those with asymptomatic Covid-19 have abnormalities on HRCT chest imaging which are nonspecific. Most of them do not progress clinically. 

2. HRCT imaging of the chest done in the first week of Covid-19 might often underestimate the extent of lung involvement, giving a false sense of security. 

3. Correlation between extent of lung involvement by HRCT and hypoxia—when the body or a particular region is deprived of adequate oxygen supply at the tissue level—is imperfect. 

4. The guidelines said that often, young people with extensive lung involvement will not develop hypoxia but elderly individuals with minimal or less extensive lung involvement may develop hypoxia. 

5. Radiation exposure due to repeated HRCT imaging may be associated with risk of cancer later in life.

(Source: DGHS statement)