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In a sweeping shift in the treatment of covid-19 patients, the Union health ministry has removed usage of popular drugs such as Ivermectin, Azithromycin, Doxycycline, Zinc, Favipiravir and plasma therapy.

The Government on Monday also advised physicians to exercise extreme caution with Emergency Use Authorisation (EUA) drug Remdesivir and Off-label drug Tocilizumab, the Directorate General of Health Services (DGHS) under the union health ministry recently issued “evidence-based" --comprehensive guidelines for the management of covid-19 patients.

“Remdesivir is to be used only in select moderate/ severe hospitalised Covid - 19 patients on supplemental oxygen as it is a reserve drug approved under Emergency Use Authorization only based on limited scientific evidence globally. It is not indicated in mild Covid – 19 patients who are in home care/ Covid Care Centres. Physicians/ Doctors are advised to exercise extreme caution in using this reserve/ experimental/ emergency use authorisation drug Remdesivir to stop it’s misuse as this is only an experimental drug with potential to harm, has relatively high cost and has limited availability," the government said.

For mild covid-19 cases the DGHS guidelines issued on May 27, recommended “no investigation" and “no medication" for mild cases, use of steroids on SpO2 levels falling below 92% and usage of anticoagulants, steroids for moderate cases and immediate oxygen therapy, intubation and ventilation, steroid usage, anti-coagulants, immune-modulators etc for only severe cases. The guidelines have been issued depending upon the severity of symptoms, it guides how to treat, investigate & monitor patients.

As per the guidelines, rational use of a High-Resolution CT (HRCT) scan of chest is recommended. “HRCT chest scan should not be done for the purpose of diagnosing/ screening Covid-19 infection, the advisory said cautioning radiation exposure due to repeated HRCT imaging may be associated with risk of cancer later in life.

“Evidence-based guidelines from @mohfw DGHS - simple, rational and clear guidance for physicians. Should be translated and disseminated in all Indian languages. Can be updated as and when new evidence becomes available," tweeted, Soumya Swaminathan, Chief Scientist, World Health Organization (WHO).

While WHO has been warning against used of ivermectin, Indian scientists have also come in favour of the removal of the drugs. “I hope this will put an end to irrational overtreatment, and focus on what we know helps--ventilation, supportive therapy, steroids, tocilizumab etc at the right time in the right patients. All other drugs should be used only in the context of a clinical trial, if there is potential utility," said Dr Gagandeep Kang, the vice chair, Coalition for Epidemic Preparedness Innovations (CEPI), a global non-profit aiding vaccine development platform for the covid-19 pandemic, and professor at the Christian Medical College (CMC), Vellore, Tamil Nadu.

Off late, while there were long queues for CT Scans in the hospital and overuse of the above-mentioned drugs led to their shortage and black marketing. “With no effective treatment Covid-19 has presented one of the biggest challenges of modern times to manage patients. Emergency use authorization was given to drugs on basis of small studies. There was unprecedented demand for drugs with doubtful efficacy. Some of the drugs had political backing as well," Lalit Kant, a scientist and former head of epidemiology and communicable diseases at the Indian Council of Medical Research (ICMR) said.

“Many have bought these medicines in black market after paying hefty price. Hopefully all that would come to an end. And medicines which have a proven beneficial effect would remain on the treatment list. Now platforms exist to do random controlled trials (the gold standard) at multiple sites using standard protocol, where the results can be available in comparatively short time. These should be used to study any new drug or repurposed drugs before adding to the treatment protocol," he said.

Goa government last month prescribed ivermectin to all persons above 18 years of age as a prophylactic treatment of covid-19. Almost all the patients of covid-19 mild, moderate or severe have been prescribed with vitamin D, zinc, vitamin C and antibiotics etc.

In a stark contrast of the voices against Ivermectin, a latest peer-reviewed research published recently had said that immediate global ivermectin use will end the covid-19 pandemic. Peer reviewed by medical experts that included three U.S. government senior scientists and published in the American Journal of Therapeutics, the research is a comprehensive review of the available data taken from clinical, in vitro, animal, and real-world studies. Consistent with numerous meta-analyses of ivermectin RCT's since published by expert panels from the UK, Italy, Spain, and Japan, they found large, statistically significant reduction in mortality, time to recovery and viral clearance in covid-19 patients treated with ivermectin.

Some members of the medical fraternity have come forth in favour of some drugs such as colchicine--a medication used to treat gout-- in treatment of covid-19. "I strongly believe that colchicine is a very useful drug in mild covid19 since it will lead to decrease hospitalisation and death in these patients. It should be included in all treatment advisories," said Anoop Misra, chairman of Fortis Centre for Diabetes, Obesity and Cholesterol.

There have been some studies regarding antifungal drugs too being effective in covid-19 treatment.

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