The ministry also gave the green signal for the use of off-label application of tocilizumab, a drug that boosts and modifies the immune system or its functioning, and convalescent plasma for treating coronavirus-infected patients in moderate stage of the illness.
In its revised 'Clinical Management Protocols for COVID-19' the ministry dropped the use of azithromycin in combination with hydroxychloroquine (HCQ) in critical cases and requiring ICU management.
Hydroxychloroquine has demonstrated in-vitro activity against SARS-CoV2 and was shown to be clinically beneficial in several small single-centre studies though with significant limitations, stated the Health Ministry statement.
"Nonetheless, several large observational studies with severe methodologic limitations have shown no effect on mortality or other clinically meaningful outcomes.
"As such, the evidence base behind its use remains limited as with other drugs and should only be used after shared decision making with the patients while awaiting the results of ongoing studies," the revised document stated.
As is the case with other antivirals, this drug should be used as early in the disease course as possible to achieve any meaningful effects and should be avoided in patients with severe disease, the health ministry said, adding an ECG should ideally be done before prescribing the drug.
Under emergency use authorization, remdesivir may be considered for patients in moderate stage requiring oxygen support. It is not recommended for those with severe renal impairment and high level of liver enzymes, pregnant and lactating women, and those below 12 years, the document stated. ?
The drug, administered in the form of injection, should be given at a dose of 200 mg on day one followed by 100 mg daily for five days.
According to the revised protocols, convalescent plasma therapy may be considered for patients with moderate illness with no improvement in condition despite the use of steroids.
(With agency inputs)