ICMR Drops Ivermectin & Hydroxychloroquine Drugs In Revised Clinical Guidance For Adult COVID Patients

The reasons behind dropping Hydroxychloroquine include its no mortality benefit and increased risk of address drug effect (ADE) when co-administered with Azithromycin, the report said.

Representative Photo

New Delhi: The All India Institute of Medical Sciences (AIIMS)/ Indian Council of Medical Research (ICMR)-COVID-19 National Task Force and the Joint Monitoring Group have excluded Ivermectin and Hydroxychloroquine (HCQ) drugs from its list of recommendations in the revised clinical guidelines for the management of adult COVID-19 patients. 

The fresh guidelines recommend the use of Remdesivir and Tocilizumab in specific circumstances, news agency ANI reported. 

The ICMR COVID-19 National Task Force Joint Monitoring Group has recommended a moderate use of drugs like Remedesivir for select moderate or severe COVID-19 patients on supplemental oxygen within 10 days of onset of symptom. 

It suggests the use of Tocilizumab medicine only for severe COVID-19 patients, preferably within 24 to 48 hours of the onset of severe disease or ICU admission.

Ivermectin & Hydroxychloroquine Removed

The AIIMS-ICMR national task force for COVID-19 and the Joint Monitoring Group recommended dropping the use of these two drugs in its revised guidelines.

The clinical guidance version dated May 19, 2021, jointly prepared by the AIIMS and ICMR national task force for COVID-19 and the Joint Monitoring Group, was reviewed on August 20 in the context of emerging evidence pertaining to the use of Ivermectin and hydroxychloroquine in treatment, news agency IANS reported. 

After review, the medicines were removed from the guidance document. The reasons behind dropping Hydroxychloroquine include its no mortality benefit and increased risk of address drug effect (ADE) when co-administered with Azithromycin.

“HCQ may be considered for removal from guideline, with recommendation to use with caution only in clinical trial setting (since there is some genuine uncertainty regarding the possible benefit for severe cases and in low dose). Many studies showing increased mortality risk (10/13) and low mortality benefit of HCQ(2/13). Considering evidence for increased ADE(6/13) , especially with azithromycin and only one study showed no increase in ADE(1/13),” said the revised guidelines for COVID management, as quoted by IANS.

In the case of Ivermectin, it informed, “Ivermectin may be considered for removal from guideline, with recommendation to use only in clinical trial setting until warranted by more conclusive large-scale randomized controlled trials due to the reason that many studies show mortality benefit, and no evidence for increased mortality. High risk of bias in many studies (especially with the ones showing benefit), level of certainty for mortality benefit is low”.

Treatment Recommended 

The key guidelines that are routinely emphasised, include wearing masks, adhereing to physical distancing, and hand hygiene. 

Those with mild infection need to maintain physical distancing, indoor mask use, strict hand hygiene. 

As per the guidelines, symptomatic patients can take antipyretic, antitussive and multivitamins and are asked to seek immediate medical attention if they experience difficulty in breathing or high-grade fever or severe cough, particularly if lasting for more than five days. 

People with moderate disease with SpO2 level 92-96 per cent (88-92 per cent in patients with Chronic obstructive pulmonary disease) may take Methylprednisolone injection and Anticoagulation medicine. 

Such persons should work on breathing, Hemodynamic instability, and change in oxygen requirement, it said. 

For severe infection cases, the guideline suggests using NIV (Helmet or face mask interface depending on availability) in patients with increasing oxygen requirement, if work of breathing is low. 

“Consider the use of HFNC in patients with increasing oxygen requirement, Intubation should be prioritized in patients with high work of breathing /if NIV is not tolerated and Use conventional ARDSnet protocol for ventilatory management,” the task force recommends. 

The guidelines also said to take Methylprednisolone injection of 1 to 2 mg divided into two doses usually for a duration of 5 to 10 days. 

The severe disease or mortality risk is informed to be higher in people above age 60, people with Cardiovascular disease, hypertension, Coronary artery disease (CAD), Diabetes mellitus, Chronic lung/kidney/liver disease, Cerebrovascular disease, Obesity, and other immunocompromised states.