As India continues to report large number of daily Covid cases, the Centre on Monday issued revised guidelines for the clinical management of Covid treatment in the country.
As per the new guidelines, Remdesivir and Tocilizumab have been included in the clinical management of Covid treatment with restrictions and conditions. However, Molnupiravir has not been included in the new guidelines as a drug to be used for Covid treatment.
The new guidelines prescribe Remdesivir (EUA) to be considered only in patients within 10 days of onset of symptoms to those having moderate to severe disease (requiring supplemental oxygen), but who are not on IMV or ECMO.
Consider Remdesivir for 5 days to treat hospitalised patients with Covid-19, the new guidelines said. The guidelines clearly outlined that the drug should not be used in patients who are not on oxygen support or in home setting. The recommended dose for this drug is 200 mg IV on day 1 followed by 100 mg IV OD for next 4 days.
Tocilizumab may be considered in case of rapidly progressing Covid-19 needing oxygen supplementation or IMV and not responding adequately to steroids (preferably within 24-48 hours of onset of severe disease/ICU admission), as per the guidelines.
It should preferably be given with steroids. The drug may be considered when there is no active TB, fungal, systemic bacterial infection. The recommended single dose for the drug is 4 to 6 mg/kg (400 mg in 60 kg adult) in 100 ml NS over 1 hour.
As per the new guidelines, Covid-19 patients showing mild symptoms without shortness of breath and hypoxia are required to observe home isolation.
Those suffering from mild Covid should seek medical attention only if they are having difficulty in breathing, or have high fever or severe cough lasting for more than 5 days.
People suffering from moderate Covid symptoms, those undergoing breathlessness or with SP02 levels fluctuating between 90 and 93 per cent at room air, can get admitted to the clinical ward for Covid treatment.
According to the new guidelines, such patients should be given oxygen support.
Covid patients with SP02 levels lower than 90 per cent should be admitted to the ICU. Such patients should be put on respiratory support.
The guidelines underlined to consider use of NIV (helmet or face mask interface depending on availability) in patients with increasing oxygen requirements if work of breathing is low.
HFNC should be used in patients with increasing oxygen requirements. Intubation should be prioritised in patients with high work of breathing/if NIV is not tolerated.
Other treatments include anti-inflammatory therapy (Inj Methylprednisolone 1 to 2mg/kg IV in 2 divided doses or an equivalent dose of dexamethasone) usually for duration of 5 to 10 days.
After clinical improvement, a patient should be discharged as per the revised discharge criteria, said the guidelines.