The Union Health Ministry has recommended the use of anti-malarial drug hydroxychloroquine in combination with azithromycin on those severely suffering from COVID-19 who require ICU management.
In its revised guidelines on the ‘ClinicalManagement of COVID-19’ issued on Tuesday, the ministry said the drug ispresently not recommended for children aged less than 12 and pregnant andlactating women.
“No specificantivirals have been proven to be effective as per currently available data.However, based on the available information (uncontrolled clinical trials), thefollowing drugs may be considered as an off–label indication in patients withsevere disease and requiring ICU management,” the ministry said whilerecommending the drug combination.
The ministry has removedits earlier recommendation of the use of anti-HIV drug combinations Lopinavirand Ritonavir on a case-to-case basis depending upon the severity of thecondition of a patient suffering from coronavirus infection.
“As per latestclinical data available from across the work, Lopinavir and Ritonavir drugcombination was not found to have significant benefit for patients of COVID-19so it has been discontinued,” a health ministry official said.
This document is intendedfor clinicians taking care of hospitalised adult and paediatric patients ofCOVID–19, the guidelines stated.
Best practices for COVID-19including infection prevention and control (IPC) and optimized supportive carefor severely ill patients are considered essential, it said, adding that thedocument aims to provide clinicians with updated interim guidance on timely,effective and safe supportive management of patients with COVID-19,particularly those who have severe acute respiratory illness and are criticallyill.
Theguidelines issued by the health ministry also state that COVID-19 patients mayhave mild, moderate, or severe illness — the latter includes severe pneumonia,acute respiratory distress syndrome (ARDS), sepsis and septic shock.
“Earlyidentification of those with severe manifestations allows for immediateoptimised supportive care treatments and safe, rapid admission (or referral) tointensive care unit according to national protocols,” the document states.
Theguidelines advise the treating doctors to closely monitor patients with severeacute respiratory infection for signs of clinical deterioration, such asrapidly progressive respiratory failure and sepsis, and apply supportive careinterventions immediately.
“Application oftimely, effective, and safe supportive therapies is the cornerstone of therapyfor patients who develop severe manifestations of COVID-19,” it said.
“Understand thepatient’s co-morbid condition to tailor the management of critical illness andappreciate the prognosis. During intensive care management of severe acuterespiratory infection, determine which chronic therapies should be continuedand which therapies should be stopped temporarily.”
The guidelines also recommend that the patients and their families must be communicated with pro-actively and provided support and prognostic information. They also recommend to medical practitioners to understand the patient’s “values and preferences” regarding life-sustaining interventions.