COVID-19: When to use Remdesivir, Tocilizumab? Here's clinical guidance for coronavirus treatment

Categorizing active coronavirus cases into three groups of mild, moderate and severe, the Ministry of Health and Family Welfare has put out fresh clinical instructions for the management of adult patients, emphasising which patients need which medication and what shouldn’t be done in a perticular condition.

Ivermectin or HCQ:

Elucidating that this is on the basis of low certainty of proof, the direction said that Tab Ivermectin (200 mcg/kg once a day for 3 days) may be given to patients who have mild symptoms and are being treated at home.

A substitute to Ivermectin is Tab HCQ (400 mg BD 1 day f/b 400 mg OD for 4 days) unless contraindicated.

For these mild manifestation, inhalational Budesonide (given via Metered dose inhaler/ Dry powder inhaler) at a dose of 800 mcg BD for 5 days) may be given if symptoms (fever and/or cough) are constant and more than 5 days of disease outset.

Methylprednisolone:

Coronavirus patients in a hospital with moderate symptoms with oxygen level 90 per cent to 93 per cent on room air can be given injection Methylprednisolone 0.5 to 1 mg/kg in 2 divided doses (or an equivalent dose of dexamethasone) generally for a span of 5-10 days

Serial CXR, HRCT chest can be done on these sick people if there is deterioration.

Remdesivir (EUA):

This drug may be considered only in patients with moderate to severe symptoms, needing supplemental oxygen and who are within 10 days of the outset of symptoms. Patients who are not on oxygen or are in home settings shouldn’t be advised Remdesivir.

Tocilizumab (off-label):

A patient with severe symptoms in ICU can be given this drug within 24-48 hours of the admission if the inflammatory markers are notably increased if there is no improvement regardless of the use of steroids and only if there is no active bacterial/fungal/tubercular infection.

Convalescent plasma (off label):

This may be taken into consideration only within 7 days of the outset of the symptoms.

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