Drugs such as steroids can increase the risk of a secondary infection, the guidelines say.
New Delhi:
Doctors should avoid giving steroids to COVID-19 patients, the government said in its revised clinical guidelines for treating coronavirus, days after the task force chief expressed regret for overusing the drug during the second wave.
The revised guidelines state that drugs such as steroids can increase the risk of a secondary infection such as invasive mucormycosis or ‘black mold’ when used too early, at a higher dose or for longer than necessary.
The guidelines specify doses for the drugs as needed for three types of infections — “mild, moderate and severe,” the guidelines said if the cough lasts longer than two to three weeks, patients should be tested for tuberculosis and other conditions.
At a press conference last week, NITI Aayog (Healthcare) member and head of the Covid Task Force Dr VK Paul had expressed concern about the “overuse and abuse” of drugs such as steroids.
Under the revised guideline, upper respiratory symptoms without shortness of breath or hypoxia are categorized as mild illness and home isolation and care is advised.
Those suffering from mild Covid should seek medical attention if they have difficulty breathing, a high fever or a severe cough lasting more than five days.
Those who have shortness of breath with oxygen saturation fluctuating between 90-93 percent may be admitted and will be considered moderate cases. Such patients should receive oxygen support.
Respiratory rate of more than 30 per minute, shortness of breath or oxygen saturation below 90 percent of the air in the room should be considered a serious illness, and such patients should be admitted to an ICU because they require respiratory support, the note said.
Such patients should receive respiratory support. Non-invasive ventilation (NIV) – helmet or facemask interface, depending on availability – may be considered in those with increasing oxygen demand when work of breathing is low.
The revised guidelines continue to recommend emergency use of remdesivir (EUA) or off-label use of remdesivir in patients with “moderate to severe” disease and in patients without renal or hepatic dysfunction within 10 days of symptom onset .
It warned against using the drug for patients who do not have oxygen support or a home environment.
According to the guidelines, EUA or off-label use of the tocilizumab drug may also be considered for use in severe illness, preferably within 24 to 48 hours of the onset of the serious illness or admission to the intensive care unit (ICU).
Tocilizumab may be considered for patients who have significantly elevated markers of inflammation and who do not improve despite taking steroids without active bacterial, fungal or tubercular infection, they said.
Individuals over the age of 60 or individuals with cardiovascular disease, hypertension and coronary artery disease, diabetes mellitus, and other immunocompromised conditions, such as HIV, active tuberculosis, chronic lung, kidney, or liver disease, cerebrovascular disease, or obesity, are at high risk for serious illness and death, according to the guidelines.
