Several COVID medicines delisted: Here is new list of treatment guidelines

The medicines dropped include antibiotics, anti-parasitic, plasma, and Favipiravir. Other drugs dropped include ivermectin, doxycycline, zinc, multivitamins. Doctors have been prescribing these medicines to asymptomatic or mildly symptomatic Covid-19 patients.

DGHS said that Remdesivir should be used only in select moderate/ severe hospitalized COVID-19 patients on supplemental oxygen within 10 days of onset of disease.

"Remdesivir is a reserved drug approved by DCG (I) under Emergency Use Authorization only based on limited scientific evidence globally. It is to be used only in select moderate/ severe hospitalized COVID-19 patients on supplemental oxygen within 10 days of onset of disease," said DGHS.

DGHS noted that Tocilizumab is an immunosuppressant drug and it has been approved by DCG (I) for use as an off-label drug only in severe and critically ill patients of COVID-19 who shows no signs of improvement in terms of oxygen requirement even after 24-48 hours of administration of steroids, and Has significantly raised inflammatory markers (C-Reactive Protein≥75 mg/L)

DGHS said steroids are harmful in asymptomatic and mild cases of COVID-19. Steroids should be used at the right time, in the right dose and for right duration

Guidelines for use of Anticoagulants, Prophylactic doses to be used in moderate cases of COVID-19 with unfractionated heparin or low molecular weight heparin (and there should be no contraindication or high risk of bleeding)

DGHS said that the High-resolution CT (HRCT) chest, should be done only if there is worsening of symptoms. "HRCT scan of the chest provides better visualization of the extent and nature of lung involvement in patients with COVID-19. However, any such additional information gained from HRCT scans of the chest often has little impact on treatment decisions. At present, treatment decisions are based almost entirely on clinical severity and physiological impairment. Therefore, treating physicians should be highly selective in ordering HRCT imaging of Chest in patients of COVID-19," said DGHS.

For the use of Liposomal Amphotericin B against black fungus cases, DGHS has advised it should be given over 2-3 hours and started with a full dose from day 1. "Monitoring for kidney function tests and serum electrolytes is recommended. It has to be continued till a favorable response is achieved and the disease is stabilized which may take 3-6 weeks. Later oral Posaconazole (300 mg delayed-release tablets twice a day for 1 day followed by 300 mg daily) or Isavuconazole (200 mg 1 tablet 3 times daily for 2 days followed by 200 mg daily) shall be taken for a prolonged period as per the advice of the physician," added DGHS.