Antiviral favipiravir, India’s largest selling drug in April, doesn’t find mention in the document put out on the website of the directorate general of health services (DGHS). The other antiviral remdesivir has been recommended for limited use — only on the prescription by a “senior doctor” — as it is an “experimental drug with a potential to harm”.
For the past 15 months, the majority of Covid patients in India got a prescription of six to eight medicines soon after diagnosis. “The poly-pharmacy phenomenon was irrational. We are extremely happy that these guidelines have been drawn up on robust evidence,” said Dr S P Kalantri from Mahatma Gandhi Institute of Medical Sciences, Wardha.
The guidelines only mention four medicines as necessary for severe Covid patients: oxygen, steroids, tocilizumab (not all but based on certain blood parameters) and anti-coagulants for patients with comorbidities like diabetes, hypertension, etc.
The guidelines make it clear that medicines are meant only for those moderate or severe Covid-19 patients who need hospitalisation. For people with mild Covid, only medicines to reduce fever and cough are advised.
Common antibiotics such as azithromycin and doxycycline are missing from the list. So is ivermectin, the antiparasitic drug for filariasis. Pharmacy best-sellers zinc supplement and vitamins A, B, C and D are also not mentioned. Previous protocols by the Union and state government always mentioned 15-30 day course of zinc and vitamin C and D.
WHO chief scientist Dr Soumya Swaminathan welcomed India’s “evidence-based guidelines”. A global health expert from McGill University in Canada, Dr Madhu Pai, said, “I am delighted to see these new evidence-based Covid guidelines. This will not only save lives, but also reduce costs for patients,” he added.
In Mumbai, pulmonologist Dr Lancelot Pinto said he could stop being “apologetic” to his patients. “I’ve never prescribed ivermectin, doxycycline or favipiravir to my Covid patients, but had to explain why,” he said.
A senior doctor from a BMC hospital said the guidelines don’t mention patients with comorbidities. Another doctor said while ICMR puts out treatment protocols (during Covid), this has come from DGHS. “A regular doctor could be confused about which agency to follow,” he said.