New Health Ministry guideline drops use of ivermectin, HCQ, favipiravir from Covid-19 treatment

The Union Health Ministry on Sunday dropped the use of ivermectin, hydroxychloroquine and the anti-viral favipiravir from its Covid-19 treatment guideline after a section of doctors and medical researchers questioned the absence of any scientific evidence of such drugs benefitting Covid patients.

The 9-page guidelines for the management of Covid-19 patients, released by the Directorate General of Health Services, don’t mention ivermectin and favipiravir — two widely prescribed medicines by doctors across the country, as well as hydroxychloroquine which was sought after during the first wave. It also doesn’t suggest the use of antibiotics.

“A typical prescription for Covid-19 in India includes azithromycin, doxycycline, ivermectin, hydroxychloroquine, vitamin C, vitamin D, zinc, acetylcysteine, and inhaled budesonide, or dexamethasone. The antiviral favipiravir became the top-selling drug in India in April 2021 despite not being recommended for Covid-19 by any major guidelines,” researchers from George Institute of Medical Sciences wrote recently in a commentary in the Lancet. There was a similar editorial in British Medical Journal as well.

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The DGHS guidelines, however, contradict the Indian Council of Medical Research (ICMR) guidelines that recommend the use of both ivermectin and hydroxychloroquine, even though it dropped convalescent plasma from its treatment. The ICMR guideline was released on May 17 after the council reviewed the scientific evidence on the use of plasma

The new guideline also lists the diagnostic tests to be carried out and advises against indiscriminate use of high-resolution CT, which is to be done only in worsening conditions.

On the use of experimental drug remdesivir, it says, “The medicine is to be used only in select moderate or severe hospitalised Covid-19 patients, who are on supplemental oxygen within 10 days of onset of disease.”

“It is not indicated in mild Covid-19 patients who are in home care or Covid care centres. Physicians are advised to exercise extreme caution in using remdesivir as this is only an experimental drug with potential to harm.”

“Also every hospital needs to set up a Special Drug Committee to review the use of Remdesivir in their hospital periodically. The medicine should be procured and provided by the hospitals. The patient’s attendants/ relatives should not be asked to procure Remdesivir from the retail market,” it notes. Similarly, clear instructions have been given on the use of Tocilizumab.

“David Sackett, the father of Evidence-Based Medicine would have been so happy! Very impressive and the authors deserve high praise for sticking to EBM in the national guideline- conscientious, explicit and judicious use of current best evidence in making decisions for treating Covid19,” tweeted S P Kalantri, a veteran physician and director of Mahatma Gandhi Institute of Medical Sciences, Sevagram.