Dr. Ramesh Patel (Obstetrics & Gynecology) needs a second opinion on this medical case.
COVID 19 Update
Points learnt today on video conference with Dr. Atul Patel and Dr. Tushar Patel -( Infectious Disease Specialist)
[ ] In mild or asymptomatic Covid positive patients, only treatment required is B-complex, zinc, vitamin c, and, Paracetamol SOS.
[ ] In moderately symptomatic pateints where oxygen saturation is low, four things are important -
• High flow oxygen via nasal prongs, mask, or masks with breathing/ non-breathing reservoir bag.
• Awake proning.
• Low dose steroids - Dexamethasone 6 tob8mg per day or methylprednisolone 40mg B.D. (preferably within 48 hours of admission or if o2 requirement is increasing and if inflammatory markers are increased)
• Anticoagulation with LMWH - in all patients where o2 requirement is high and D-dimer is high.
** Role of HCQS is doubtful but may be given in mild to moderate cases.
** There is no role of antibiotics.
** Few patients with covid-19 experience a secondary bacterial infection. Consider empiric antibiotic therapy as per local antibiogram and guidelines in older people, immune-compromised patients, and children < 5 years of age.
[ ] In severe cases,
• O2 support and medications as above.
• Management of septic shock with vasopressors, crystalloids, fluids.
[ ] Investigational therapies (with limited available evidence) -
1. Remdesivir (under Emergency Use Authorization) may be cinsidered in patients with moderate disease (those on oxygen) with none of the following contraindications :
• AST/ALT > 5 times the upper limit of normal.
• Severe renal impairment (i.e. eGFR<30ml/min/m2 or need for hemodialysis)
• Pregnancy or lactating females
• Children (<12 years of age)
• DOSE - 200 mg I.V. on day 1 followed by 100mg I.V. daily for 5 days.
2. Convalescent plasma (off label) may be considered in patients with moderate disease who are not improving on oxygen or steroids.
• DOSE - Usually 200ml single dose given slowly over not less than 2 hours.
3. Tocilizumab (off label) may be considered in patients with moderate disease with progressively increasing o2 requirements, and not improving despite use of steroids.
• DOSE - 8mg/kg (max. 800 mg at one time) given slowly in 100ml NS over one hour, dose can be repeated once after 12 to 24 hours if needed.
4 . Favipiravir - broad spectrum antiviral drug
• Indication - mild to moderate cases and can also be used in patients with co-morbid conditions such as diabetes and heart diseases.
• Contraindication - Pregnant and lactating women and in patients with severe renal and hepatic impairment.
• DOSE - For adults, 1800mg orally twice daily on day 1 followed by 800mg orally twice daily, upto a maximum of 14 days.