DGHS issues COVID-19 treatment guidelines: Here is what document recommends on Remdesivir, Tocilizumab

The Union health ministry has issued guidelines on management of COVID-19 patients, dropping many drugs which have been widely used for treatment until now. Among the drugs and treatment methods that have been removed from the recommendations are Ivermectin, Azithromycin, Doxycycline, Zinc, Favipiravir, and plasma therapy. The guidelines have been framed by the Director General for Health Services in the Union health ministry.

Comprehensive Guidelines for Management of #COVID19 patients has been released by Director-General for Health Services (#DGHS), @MoHFW_INDIA.

Depending upon the severity of symptoms, it guides how to treat, investigate & monitor patients.

Guideline: https://t.co/Ng8RKEAC2Q pic.twitter.com/8cjW2aw3QX

— Office of Principal Scientific Adviser to the GoI (@PrinSciAdvOff) June 7, 2021

The government has also advised physicians to exercise extreme caution with Remdesivir and Tocilizumab, both of which have been widely used, and have also been in short supply in some cases. While Remdesivir has been granted Emergency Use Authorisation (EUA), Tocilizumab has been approved for off-label use only (when the medication is used for a disease that is not approved to treat.) FOLLOW LIVE UPDATES ON CORONAVIRUS HERE On Remdesivir, the guidelines state, “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 hospitalised Covid-19 patients on supplemental oxygen within 10 days of onset of disease.” The document asks doctors to note that Remdesivir is an experimental drug with the ‘potential to cause harm.’ The drug should be provided by the hospitals, and a patient’s relatives should not be asked to procure it from the retail market, it said. To stop the misuse of Remdesivir, the government further recommended that if the drug is to be advised or ordered during odd hours, it should be done by the duty doctor after a telephonic consultation with a senior faculty member, specialist or a unit in-charge, and that advise or order must be written and it should bear the name, signature and stamp of the doctor concerned. On Tocilizumab, the guidelines have said, “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.” The document notes that steroids are harmful in asymptomatic and mild cases of COVID-19. Steroids are indicated in only hospitalised moderately severe and critically ill COVID-19 cases. For asymptomatic patients, the revised guidelines have said that no medication is required. In the cases of mildly symptomatic patients, self-monitoring for fever, breathlessness and oxygen saturation (SpO2) have been recommended. For these two categories, the guidelines have also suggested that patients should do a six-minute walk test. In the six-minute walk test, patients should walk continously for six minutes with a pulse oximeter attached to a finger. If oxygen saturation falls below 94 percent or if the reading varies by 3 to 5 percentage points, admission to a hospital for observation may be required. While these guidelines have been announced by the Director General for Health Services, they have not yet received the approval of the Indian Council for Medical Research (ICMR), as noted by India Today. These guidelines have come as India reported less than one lakh new coronavirus infections after a gap of 63 days. A single day rise of 86,498 cases were registered, the lowest in 66 days, taking the total tally of COVID-19 cases to 2,89,96,473, The COVID-19 death toll climbed to 3,51,309 with 2,123 daily deaths, the lowest in around 47 days, the data updated at 8 am showed. With inputs from PTI