Avoid HCQ in COVID-19 patients suffering with severe disease. | Chronicleplanet.com

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Avoid HCQ in COVID-19 patients suffering with severe disease.

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Avoid HCQ in COVID-19 patients suffering with severe disease.

The Union Health Ministry has recommended use of anti-viral drug remdesivir under emergency use authorization, off-label application of immunomodulator tocilizumab and convalescent plasma therapy for treating COVID-19 patients in moderate stage of criticality.

Backtracking from its earlier stance, the ministry in its revised ”Clinical Management Protocols for COVID-19”, released on Saturday, said anti-malarial drug hydroxychloroquine (HCQ) should be used in the early course of the disease to achieve any meaningful effect and should be avoided in severe cases.

India’s new protocol now includes use of remdesivir and off-label use of tocilizumab and convalescent plasma therapy on very specific groups of patients. Also while HCQ will continue to be in use, antibiotic azithromycin is no longer a part of the treatment protocol.

Nonetheless, several large observational studies with severe methodologic limitations have shown no effect on mortality or other clinically meaningful outcomes.

“As such, the evidence base behind its use remains limited as with other drugs and should only be used after shared decision making with the patients while awaiting the results of ongoing studies,” the revised document stated.

“Nonetheless, several large observational studies with severe methodologic limitations have shown no effect on mortality or other clinically meaningful outcomes. As such, the evidence base behind its use remains limited as with other drugs and should only be used after shared decision-making with the patients while awaiting the results of ongoing studies. As is the case with other antivirals, this drug should be used as early in the disease course as possible to achieve any meaningful effects and should be avoided in patients with severe disease. An ECG should ideally be done before prescribing the drug,” the protocol states.

The Health Ministry has added that as per current available evidence (SARS-CoV-2) has a zoonotic source closely related to bat-origin SARS-like coronavirus and persons infected by the novel coronavirus are the main source of infection.

It added that the median incubation period is 5.1 days (range 2–14 days) and that the precise interval during which an individual with COVID-19 is infectious is uncertain.

“As per the current evidence, the period of infectivity starts two days prior to onset of symptoms and lasts up to 8 days. The extent and role played by pre-clinical/ asymptomatic infections in transmission still remain under investigation,’’ noted the Ministry.