MUMBAI : Oral antivirals, antibiotics, monoclonal antibodies and vitamins have no place in India’s latest Covid management guidelines, which were put up on the Union health ministry website on Monday.
Antiviral remdesivir, which is given via an IV drip, is recommended for moderate to severely ill patients on oxygen support. Off-label use of the rheumatoid arthritis drug, tocilizumab, continues for severe patients who don’t improve with steroids. The guidelines come 10 days after ICMR chief Dr Balram Bhargav stated that a new oral antiviral, Molnupiravir, has “safety issues”.
Many doctors have a different opinion. “The general opinion among the medical community is that this omission is a mistake,” said infectious diseases specialist Dr Om Shrivastava, who is a member of the Maharashtra task force.
The task force’s guidelines allow Molnupiravir for patients who are over 50 years old and have at least two comorbidities and continuous fever for at least three days. “Doctors should have the discretionary right to prescribe Molnupiravir because there is a subset of patients that benefits from it,” said infectious diseases specialist Dr Anita Mathew.
The ICMR guidelines state that patients with mild illness need symptomatic treatment for fever and pain and, if needed, a nasal spray of corticosteroid (budesonide). CT scans and expensive blood tests are only recommended for moderate and severely-ill patients.
Last week, a group of 35 doctors wrote an open letter to the Indian health authorities asking for updated guidelines that clearly spell out the government stand on new anti-virals and monoclonal antibodies so that “unwarranted medication, testing and hospitalisation” stops.
Dr Satchit Balsari from Harvard School of Medicine and one of the letter’s signatories said, “It is reassuring to see that the new guidelines are evidence-based and eschew antibiotics. It is prudent from a public health standpoint that other drugs that have marginal benefit and are unavailable to most people are also not included. I hope state agencies that have distributed drugs en masse now abandon the practice.”
