When to use Remdesivir, Tocilizumab? When to do HRCT chest? Govt issues clinical guidance for Covid-19 treatment

Patients who are not on oxygen support or are in home settings should not be recommended Remdesivir, the latest clinical guidance for the management of adult Covid-19 patients says.

Classifying active Covid-19 patients into three broad groups of mild, moderate and severe, the Union health ministry has issued fresh clinical guidance for the management of adult Covid-19 patients, underlying which patients need which medication and what should not be done in a specific situation.

Tocilizumab is to be used in patients with moderate symptoms only when there is no improvement despite the use of steroids and only if there is no active bacterial/fungal/tubercular infection, the new guideline said.

Ivermectin or HCQ

Clarifying that this is based on low certainty of evidence, the guideline said that Tab Ivermectin (200 mcg/kg once a day for 3 days) may be given to patients who have mild symptoms and are being treated at home.

An alternative to Ivermectin is Tab HCQ (400 mg BD 1 day f/b 400 mg OD for 4 days) unless contraindicated.

For these mild patients, inhalational Budesonide (given via Metered dose inhaler/ Dry powder inhaler) at a dose of 800 mcg BD for 5 days) may be given if symptoms (fever and/or cough) are persistent beyond 5 days of disease onset.

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.

Remdesivir (EUA)

Remdesivir (EUA) may be considered only in patients with moderate to severe disease, requiring supplemental oxygen and who are within 10 days of the onset of symptoms. Patients who are not on oxygen support or are in home settings should not be recommended Remdesivir.

Recommended dose: 200 mg IV on day 1 f/b 100 mg IV OD for next 4 days.

Tocilizumab (off-label)

A severe Covid-19 patient admitted in ICU can be given this medication within 24 to 48 hours of the admission if the inflammatory markers are significantly raised if there is no improvement despite the use of steroids and only if there is no active bacterial/fungal/tubercular infection.

Recommended single dose: 4 to 6 mg/kg (400 mg in 60kg adult) in 100 ml NS over 1 hour.

Convalescent plasma (off label)

This may be considered only within seven days of the onset of the symptoms.