NEW DELHI: In what appears to be a bid to check arbitrary practices by doctors treating coronavirus patients across India, AIIMS-Delhi and Union health ministry have released a document detailing whether or not certain drugs should be used in Covid-19 patients.
A document called FAQs on Covid-19 by the AIIMS e-ICUs, a facility that has been started to guide clinicians in various parts of the country to manage severe Covid-19 patients has asked doctors not to use antifibrotics such as pirfenidone (to prevent lung fibrosis) and methylene blue, an oxidation-reduction agent.
Interestingly, the country’s top government medical institution has discouraged the use of favipiravir, an antiviral that has been approved by the Drug Controller General of India for use in mild to moderate cases and left out itolizumab, another anti-inflammatory drug approved by the DCGI for moderate to severe Covid-19 patients.
“Studies have used Favipiravir mainly in mild or asymptomatic Covid-19 patients, claiming to prevent progression, whereas the majority of this cohort recover with just supportive care and monitoring and usually require no specific therapy,” says the document. “Evidence is weak for the use of Favipiravir and is currently not recommended in national guidelines.”
Dr Anjan Trikha, professor of critical care medicine at the hospital said that in a pandemic condition, drug regulators approve medicines for emergency use.
“So, doctors are not doing anything illegal by prescribing these medicines but we are not using these medicines and are advocating the use of only those medicines for which robust scientific evidence is available,” he said.
Dr. Trikha also underlined that many doctors are prescribing medicines for Covid-19 patients based on just anecdotal evidence or personal experiences, a practice that should be discouraged.
On tocilizumab, another experimental drug approved by the DCGI for Covid-19, the document says that it has a limited role, and should be used only in patients with cytokine syndrome after ruling out active infections.
It also says that either tocilizumab or remdisivir should not be given to suspects who are not confirmed patients of Covid19 and anticoagulants should not be prescribed to patients after discharge.
Maintaining that corticosteroids are currently indicated in moderate to severe Covid-19 patients, the document by specialists at the AIIMS says that while the recovery trial (in the UK) had used dexamethasone, both dexamethasone or methylprednisolone can be used based on the availability.
Elaborating on sudden Covid19 deaths, the explainer by AIIMS says that such fatalities have been reported both at presentations to emergency departments as well as in hospitals.
“Reasons that have been proposed include a sudden cardiac event, preceding silent hypoxia that went unnoticed or due to a thrombotic complication such as pulmonary thromboembolism.”
Patients with risk factors to develop severe Covid-19 or with prior comorbid conditions such as coronary artery disease or chronic lung disease should be strictly monitored for their saturation,” it says. “They should not be allowed to move unattended. Anticoagulant should be used in all at-risk patients who do not have any risk factors of bleeding.”