A day after Maharashtra government announced that the state would procure 10,000 vials of remdesivir from a company based in Bangladesh, the Union Health Ministry on Saturday (June 13) recommended the use of the antiviral drug in the moderate stage of COVID-19.
It had also approved the usage of the off-label application of tocilizumab, a drug that modifies the immune response, and convalescent plasma for treating coronavirus-infected patients in the moderate stage of the illness.
In the revised clinical management protocol for COVID-19, the ministry said remdesivir should be given at a dosage of 200 mg IV on day one, followed by 100 mg IV daily for five days. However, those with severe renal impairment, pregnant and lactating women and children, under 12 years, must avoid the drug, it said.
The ministry also dropped the use of azithromycin in combination with hydroxychloroquine (HCQ) in severe cases and requiring ICU management. “…the evidence base behind its (hydroxychloroquine) 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,” it said.
According to the protocol, convalescent plasma therapy may be considered for patients with moderate illness with no improvement in condition despite the usage of steroids. The therapy involves taking antibodies from the blood of a person who had recovered from COVID-19 and transfusing those into a patient to help kickstart the immune system to fight the infection.
The recipient should be closely monitored for several hours after transfusion for any adverse events and its use should be avoided in patients with immunoglobulin A deficiency or immunoglobulin allergy, it added. “The dose is variable ranging from 4 to 13 ml/kg—usually 200 ml single dose given slowly over not less than two hours,” it said.
Also, the guidelines state that tocilizumab may be considered in patients with moderate illness with progressively increase in oxygen requirement and in mechanically ventilated patients not improving despite the use of steroids. Long term safety data in COVID-19 remains largely unknown, the ministry said.
(With agency inputs)