According to the revised guidelines issued by AIIMS, ICMR - COVID 19 National Task Force and Joint Monitoring Group (DGHS) under Union Health Ministry for management of adult COVID-19 patients, there is no evidence of injectable steroids in those who doesn't require oxygen supplementation or in continuation, after discharge, because that can lead to a risk of secondary infection like mucormycosis.
"There is no evidence for benefit for injectable steroids in those not requiring oxygen supplementation, or on continuation after discharge anti-inflammatory or immunomodulatory therapy (such as steroids) can have a risk of secondary infection such as invasive mucormycosis when used too early, at higher doses or for longer than required," the guidelines stated
In the guidelines, it is also mentioned that under Anti-inflammatory or immunomodulatory therapy, " Injection Methylprednisolone 0.5 to 1 mg/kg in two divided doses or equivalent dose of dexamethasone can be given usually for a duration of 5 to 10 days in those patients who are improving or moderate.
But if breathing is low and patients with increasing oxygen requirement intubation should be prioritized in patients with high work of breathing and Injection Methylprednisolone 1 to 2 mg/kg IV in 2 divided doses or an equivalent dose of dexamethasone usually for a duration of 5 to 10days, the guidelines stated.
The patient who tested positive has been divided into three categories: mild, moderate and severe disease, but none of the categories has been recommended for medicines like ivermectin, favipiravir and Doxycycline. Antivirals like Molnupiravir and monoclonal antibodies are also not included in the guidelines.
The HRCT chest has been recommended only if there is worsening. If cough persists for more than two-three weeks, tuberculosis and other conditions need to be investigated.
According to the revised guidelines continue to recommend EUA or off label use of Remdesivir in patients with 'moderate to severe' may be considered with 10 days of onset of symptoms.
Tocilizumab may be considered only with certain conditions severe conditions of COVID-19, those who are needing oxygen supplementation and do not respond adequately to steroids.
These medications are required only within 24-48 hours of the onset of severe disease hospitalised or in ICU admission.
In the guidelines, it has been mentioned that above 60 years patient those who Cardiovascular disease, hypertension, and CAD Diabetes mellitus and other immunocompromised states (such as HIV) Active tuberculosis Chronic lung/kidney/liver disease, Cerebrovascular disease, Obesity will be considered as high risk for severe disease or mortality.
( With inputs from ANI )
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