Doctors should avoid giving steroids to COVID-19 patients and advise tuberculosis tests if their cough persists, the government has said in its revised clinical guidelines for coronavirus treatment, days after its task force chief expressed regret for the overuse of the drug during the second wave.
The revised guidelines said that drugs like steroids can increase the risk of a secondary infection like invasive mucormycosis or 'black fungus', when used too early, at a higher dose or for longer than required.
Spelling out the doses for the drugs if necessary for three kinds of infections - "mild, moderate and severe", the guidelines said that if cough persists for more than two-three weeks, patients should be tested for tuberculosis and other conditions.
Addressing a news conference last week, NITI Aayog Member (Health) and chief of the Covid Task Force Dr V K Paul had expressed concerns over the "overuse and misuse" of drugs like steroids.
According to the revised guidance, upper respiratory tract symptoms without shortness of breath or hypoxia has been categorised as mild disease and have been advised home isolation and care.
Those suffering from mild Covid should seek medical attention if they have difficulty in breathing, high-grade fever, or severe cough lasting for more than five days.
Those having breathlessness with a fluctuating oxygen saturation between 90-93 per cent, can get admitted, and they will be considered moderate cases. Such patients should be given oxygen support.
Respiratory rate over 30 per minute, breathlessness or oxygen saturation lower than 90 per cent on room air should be considered a severe disease and such patients have to be admitted to an ICU as they will need respiratory support, the note said.
Such patients should be put on respiratory support. Non-invasive ventilation (NIV) - helmet or face mask interface depending on availability - may be considered in those with increasing oxygen requirements if work of breathing is low.
The revised guidelines continue to recommend emergency use authorization (EUA) or off-label use of remdesivir in patients with "moderate to severe" disease and those with no renal or hepatic dysfunction within 10 days of the onset of any symptom.
It warned against the use of the drug for patients who are not on oxygen support or in-home settings.
According to the guidelines, EUA or off-label use of the tocilizumab drug may also be considered for use in the presence of severe disease, preferably within 24 to 48 hours of the onset of severe disease or intensive care unit (ICU) admission.
Tocilizumab may be considered for patients with significantly raised inflammatory markers, and not improving despite the use of steroids with there being no active bacterial, fungal or tubercular infection, they said.
Those aged above 60 years, or those having cardiovascular disease, hypertension and coronary artery disease, diabetes mellitus and other immunocompromised states, such as HIV, active tuberculosis, chronic lung, kidney or liver disease, cerebrovascular disease or obesity are at high risk for severe disease and mortality, the guidelines said.