The Union health ministry on Monday issued revised guidelines for the treatment of coronavirus patients. It advised patients to test for tuberculosis and other conditions if cough persists for more than two to three weeks.
The guidelines continued to not recommend medicines such as antibiotics doxycycline and azithromycin and antiparasitic ivermectin for mild cases of the disease, according to the Hindustan Times.
The guidelines has been drafted by experts from All India Institute of Medical Sciences, the Indian Council of Medical Research-Covid19 Task Force, and the Directorate General of Health Services under the health ministry.
The ministry advised administering antiviral medication remdesivir to patients suffering from moderate and severe cases who need oxygen support. It warned against giving the medication in patients who are not on oxygen support or in a home setting.
It also advised the use of immunosuppressive drug tocilizumab to patients with rapidly progressing Covid-19 case, who need oxygen support or were not responding adequately to steroids.
It said that high-resolution computed tomography (HRCT) should be done only if the condition of the patient is worsening. The test is usually used in the diagnosis of lung diseases.
Mild cases
The guidelines suggested that patients who have mild cases of Covid-19 to isolate themselves, monitor their temperature and oxygen saturation level and stay in contact of a physician. It defined mild cases as people suffering from upper respiratory tract symptoms and/or fever without shortness of breath.
The guidelines advised such patients to maintain physical distancing, wear masks even when indoors and maintain strict hand hygiene.
It asked the patients to immediately seek medical attention when their oxygen saturation level fell below 93%, have difficulty in breathing or if high fever and cough remains for more than five days.
Moderate cases
The guidelines said that patients suffering from moderate cases of the disease should be admitted to a hospital. A moderate case is when either the person’s oxygen saturation level falls below 93% or when the respiratory rate in more than 24 per minute and there is breathlessness, according to the guidelines.
It said that such patients should be given oxygen support. These patients can be given doses of 0.5 mg or 1 mg of anti-inflammatory drugs methylprednisolone or dexamethasone for five to 10 days. The guidelines said that there was no evidence showing benefits for injectable steroids in patients not needing oxygen supplementation.
“Anti-inflammatory or immunomodulatory therapy [such as steroids] can have risk of secondary infection such as invasive mucormycosis [black fungus] when used too early, at higher dose or for longer than required,” it said.
Severe cases
In cases of severe Covid-19 cases, the ministry advised admitting the patient to high-dependency units or intensive care units. It defined severe cases either when the patient’s respiratory rate was more than 30 per minute and has breathlessness or when oxygen saturation level was 90%.
The guidelines suggested use of non-invasive ventilation in patients with increasing oxygen requirement.
“Intubation [inserting a flexible plastic tube down a person’s throat] should be prioritized in patients with high work of breathing/if NIV [non-invasive ventilation] is not tolerated,” it said.
The guidelines said that patients can be given 1 mg or 2 mg of methylprednisolone or dexamethasone for five to 10 days and that anti-inflammatory therapy should be avoided.
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