With Remdesivir and Tocilizumab cited as the ultimate cure for the Covid-19 patients, the PGIMER on Thursday gave details of the usage of drugs in the patients and emphasised on its rational use.
In a statement, Prof. GD Puri, Dean (Academic) & Head, Dept. of Anaesthesia & Intensive Care, PGIMER said Remdesivir is an antiviral drug and it was the first drug to be approved by FDA USA for treatment of covid 19.
Various studies have found that Remdesivir given in patients of moderate covid 19 disease (Covid 19 patients developing hypoxia at room air), reduces the duration of hospitalization, only if started within the first 8 days of symptom onset.
He said it doesn't have any effect in reducing mortality and it is not effective in patients requiring high oxygen support or ventilation. "So, if it has to be rationally used, use it within the first 7 to 8 days, in patients developing room air hypoxia (oxygen saturation < 94%)," he said in the statement.
The Dean said it is not likely to be beneficial after 10 days, in patients already on ventilator. It is also not indicated in patients with raised liver enzymes. It has a potential to worsen renal functions and may cause arrhythmia, so needs to be used with caution and under monitoring. There are very limited indications for using Remdesivir and a very narrow therapeutic window, so it should be judiciously used.
Prof Puri said the only medicine with definite effect on reducing mortality in critically ill patients is steroids (dexamethasone), which is beneficial only when covid positive patients develop hypoxia at room air. Use of steroids in patients not having room air hypoxia is associated with increased risk of mortality. So steroids have to be used under medical supervision, judiciously.
He said Tocilizumab is a strong immune system suppressant and is indicated to control "cytokine storms" rapidly. Its use has to be guided by the clinical condition of the patient. Since it can increase the incidence of secondary bacterial infections in the patients, it should be used only after ruling out significant bacterial or fungal infections. Various studies have not shown any mortality benefit in critically ill patients.
"In case it is not available, good supportive care, steroids and ventilation may be tried. Off label use of any other experimental agent should only be exercised under trial setting. Only after obtaining permission from requisite authorities and informed consent from patients and relatives," he added.
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