Restricted use of oral drugs, no place for Molnupiravir: Centre revises Covid treatment guidelines

The Covid National Task Force has released revised revised guidance for the management of Covid patients. Here's what they say.

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Molnupiravir
Molnupiravir, which received approval for emergency use by the DCGI only a fortnight ago, has been kept out of the revised guidelines. (Photo: Reuters)

The Covid National Task Force of the Union Health Ministry has issued fresh guidelines highlighting the usage of oral drugs such as Remdesivir and Tocilizumab and injectable steroids under certain conditions only.

In the revised guidelines, Molnupiravir, the antiviral drug that received approval for emergency use by the Drugs Controller General of India (DCGI) only a fortnight ago, has been kept out. This comes after the drug received a thumbs down from the Indian Council of Medical Research (ICMR).

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The guidelines state that those above 60 years of age, or those having health conditions like cardiovascular disease, hypertension, coronary artery disease, diabetes, HIV, active tuberculosis, chronic lung, kidney or liver disease, cerebrovascular disease or obesity are at high risk for severe disease.

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Here's what the revised guidelines say:

On Remdesivir and Tocilizumab

Under the revised guidelines, Remdesivir is to be prescribed only in patients with “moderate to severe” disease and those with no renal or hepatic dysfunction within 10 days of the onset of any symptom.

Though the off-label use of Remdesivir is recommended, the guidelines warn against its use for patients who are not on oxygen support or in home settings.

For Tocilizumab, the guidelines say that the drug may be considered for patients with significantly raised inflammatory markers, and not improving despite use of steroids with there being no active bacterial, fungal or tubercular infection.

Tocilizumab may be considered for use in the presence of severe disease, preferably within 24 to 48 hours of onset of severe disease or intensive care unit (ICU) admission, the guidelines say.

Usage of steroids

The guidelines state that use of steroids for anti-inflammatory therapy can have the risk of secondary infection like invasive mucormycosis, when used too early or at higher dose or for longer than required.

Injection methylprednisolone 0.5 to one mg/kg in two divided doses, or an equivalent dose of dexamethasone, can usually be given for a duration of five to 10 days in moderate cases, the guidelines stated. The same drug in two divided doses of one to two mg/kg can be given for same duration in severe cases.

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"Inhalational budesonide (given via metered dose inhaler/dry powder inhaler) at a dose of 800 mcg BD for five days can be given in mild cases if symptoms (fever and/or cough) are persistent beyond five days of disease onset,” it was stated in the guidelines.

Classification of patients

The guidelines have classified Covid-19 patients into three categories based on their symptoms -- mild, moderate and severe.

According to the guidelines, upper respiratory tract symptoms without shortness of breath or hypoxia has been categorised as mild disease. Such patients have been advised home isolation and care. If such patients experience difficulty in breathing, high grade fever, or severe cough lasting for over five days, they should consult a doctor.

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Those patients having breathlessness with oxygen saturation (SpO2) fluctuating between 90-93 per cent, will be considered as moderate cases. Such patients can get admitted to a ward and should be given oxygen support. Awake proning should be encouraged in all patients requiring supplemental oxygen therapy, in sequential position changes every two hours, the guidelines stated.

Patients with respiratory rate over 30 per minute, breathlessness or SpO2 lower than 90 per cent on room air should be considered as severe cases, the guidelines state. Such patients have to be admitted to an ICU as they will need respiratory support, the guidelines said.

(With inputs from PTI)