Each time a new guideline was issued \u2014 there have been five since April \u2014 the use of hydroxychloroquine<\/a> (HCQ) as the principal drug has come down, with those like remdesivir replacing it, especially in severe cases. Hundreds of mild or asymptomatic patients have recovered without any Covid-specific drug and have merely taken paracetamol, cough syrups and vitamins; some haven\u2019t even needed these. <\/p>\n
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<\/div>\n<\/div>\nEven as there was a scamper to prescribe and procure HCQ at the onset of the pandemic in March, its use has slid over the next four months. According to the latest government-recommended Covid-management protocol, HCQ is to be prescribed only for the \u2018high-risk group\u2019, while the mild cases are to be treated with paracetamol and oral fluids.
Again, a section of doctors is prescribing both azithromycin and HCQ for all mild to moderate patients. While the former is an antibiotic, anti-bacterial medicine, they point out that HCQ is not safe for certain cardiac patients.
\u201cThis combination is the most widely used so far, except in the case of patients with cardiac arrhythmia<\/a> and similar diseases. It has worked and is a safe mode of treatment, though mild patients are likely to recover even without them,\u201d said Arindam Biswas, a consultant at RN Tagore International Institute of Cardiac Sciences (RTIICS).
Yet others are prescribing favipiravir \u2014 an anti-viral drug \u2014 as a first-line medicine for mild to moderate patients, along with vitamin supplements. For the high-risk group (elderly, with co-morbidities), HCQ and azithromycin are being used in combination. Alternatively, some are prescribing remdesivir and dexamethasone.
\u201cI am not a great fan of HCQ and in my opinion it doesn\u2019t work. For moderate to severe patients, I recommend remdesivir. It is an effective drug for patients who require oxygen,\u201d said Fortis Hospital pulmonologist Raja Dhar. He also recommends drugs to prevent cytokine storm in case a severe patient suffers a violent immune response. \u201cThat apart, blood thinners or anti-coagulants are also used for severe patients and these are there in the government guidelines,\u201d said Dhar.
While mild and asymptomatic patients were prescribed HCQ till May, they are now recovering with just paracetamol and vitamins, said Belle Vue Clinic internal medicine<\/a> consultant Rahul Jain. \u201cOnly the moderate to severe cases need HCQ and azithromycin. I have come across many mildly symptomatic patients who have recovered in home quarantine even without these. Our knowledge of Covid<\/a> is still evolving and I guess we are yet to hit upon the right combination of drugs,\u201d said Jain. He, however, added that those with severe symptoms needed remdesivir and dexamethasone.
Dhar agreed, saying very mild or asymptomatic patients needed nothing. \u201cThey should treat Covid like common cold unless the symptoms start turning severe,\u201d he said.
Broadly, two drugs are being used for mildly symptomatic and severe patients, said Apollo Gleneagles Hospital consultant Shyamashish Bandopadhyay. \u201cThe first group should be given favipiravir and the other remdesivir. But the latter should be prescribed only to patients on oxygen support,\u201d said Bandopadhyay. <\/div>\n