NEW DELHI: The Centre on Saturday recommended against using anti-malaria drug hydroxychloroquine for severely sick Covid-19 patients.
The Centre's revised clinical management protocol also dropped antibiotioc azithromycine which was earlier suggested along with HCQ for serious Covid-19 patients.
Importantly, the guidelines allow the off-label usage of Ebola drug Remdesivir, immune-suppressive drug tocilizumab, and convalescent plasma for moderately sick patients on compassionate grounds.
The advisory also recognized loss of smell and taste, diarrhoea and muscle pain apart from fever, cough, fatigue, and shortness of breath as signs of the disease.
The new guidelines admitted that the HCQ may not be helping in reducing the mortality in patients very sick with the infection. Earlier this drug was specifically recommended for Covid-19 patients in ICU.
“This drug has demonstrated in vitro activity against SARS-CoV2 and was shown to be clinically beneficial in several small single center studies though with significant limitations,” said the latest advisory by the Union Ministry of Health and Family Welfare.
“Nonetheless, several large observational studies with severe methodologic limitations have shown no effect on mortality or other clinically meaningful outcomes..As is the case with other antivirals, this drug should be used as early in the disease course as possible to achieve any meaningful effects and should be avoided in patients with severe disease.”
An official in the ICMR who helped frame the guidelines, meanwhile, said that the recommendation for azithromycine along with HCQ had been dropped as there was increasing evidence that the combination raised cardiac toxicity.
He also said that expansion of clinical criteria were a result of a significant number of Covid-19 patients being identified with aytipal symptoms—other than the most common signs like fever, cough and breathing issues.
"These symptoms could soon also reflect in our testing protocol which will be further amended," he said.
The new guidelines allow considering antiviral remdesivir, which is likely to be available in India in a a couple of weeks, under emergency use uuthorization for patients with moderate disease - those on oxygen but say that the intravenous medicine cannot be given to those with severe kidney disease, pregnant or breastfeeding women and kids under 12.
Another drug mentioned in the advisory is tocilizumab - already being given to a large number of Covid-19 patients to suppress the acute inflammatory response, known as cytokine storm, but now formalized through the protocol.
About convalescent plasma, the guidelines say that they may be considered in patients with moderate disease who are not improving or in cases where oxygen requirement is progressively increasing despite the use of steroids.