HOW TO FACE: EVIDENCE BASE

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.

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Informative and useful post
Any other antiviral drug instead of favipiravir?? Can oseltamivir helpful?? If yes, what is the indications and side. Effects
Impressive any role of ivermectol
Informative post sir
Informative Post.

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