No Remdesivir, No Steroids: Centre Issues Guidelines

Centre has issued guidelines about the management of Covid-19 infection among children. “Steroids should be used at the right time, in the right dose and for the right duration. Self-medication of steroids must be avoided,” DGHS informed. Know more.

New Delhi: Comprehensive guidelines have been issued by the centre for Covid-19 management among children wherein Remdesivir has not been recommended and suggestions include rational use of HRCT imaging.

The Directorate General of Health Services (DGHS) under the health ministry which issued the advisory also stated that use of steroids is harmful in asymptomatic and mild cases of infection.

The use of steroids has only been recommended in hospitalised moderately severe and critically ill Covid-19 cases under strict supervision.

“Steroids should be used at the right time, in the right dose and for the right duration. Self-medication of steroids must be avoided,” DGHS stated.

The guidelines also informed that antiviral drug Remdesivir is not recommended for treatment of children. “There is lack of sufficient safety and efficacy data with respect to Remdesivir in children below 18 years of age,” the guidelines read.

The guidelines recommended rational use of High-resolution CT (HRCT) for seeing the extent and nature of lung involvement in patients with Covid-19.

“However, any additional information gained from HRCT scan of the chest often has little impact on treatment decisions, which are based almost entirely on clinical severity and physiological impairment. Therefore, treating physicians should be highly selective in ordering HRCT imaging of the chest in Covid-19 patients,” the guidelines stated.

According toDGHS, Covid-19 is a viral infection, and antimicrobials have no role in the prevention or treatment of uncomplicated Covid-19 infection.

For asymptomatic and mild cases, antimicrobials have not been recommended for therapy or prophylaxis while for moderate and severe cases antimicrobials should not be prescribed unless there is clinical suspicion of a superadded infection.

Hospital admission increases the risk of healthcare-associated infections with multidrug-resistant organisms.

For asymptomatic infection among children, the guidelines recommended no specific medication and promoted Covid-appropriate behaviour (mask, strict hand hygiene, physical distancing) and suggested giving nutritious diet.

In cases of mild infection, paracetamol 10-15mg/kg/dose may be given every 4-6 hours for fever and throat soothing agents and warm saline gargles in older children and adolescents have been recommended for cough.

In case of moderate infection, the guidelines suggested initiating immediate oxygen therapy.

“Corticosteroids are not required in all children with moderate illness; they may be administered in rapidly progressive disease and anticoagulants may also be indicated,” the guidelines informed.

If Acute Respiratory Distress Syndrome (ARDS) develops in cases of severe Covid-19 infection among children, necessary management needs to be initiated.

“In case shock develops, necessary management should be initiated. Antimicrobials to be administered if there is evidence/strong suspicion of superadded bacterial infection. May need organ support in case of organ dysfunction, e.g. renal replacement therapy,” it said.

The guidelines also recommended a six-minute walk test for children above 12 years under the supervision of parents/guardians. “It is a simple clinical test to assess cardiopulmonary exercise tolerance and is used to unmask hypoxia. Attach a pulse oximeter to his/her finger and ask the child to walk in the confines of their room for six minutes continuously,” the it read.

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