Covid medicines

*Which medicines to give in COVID-19 and why?*

1. Antimicrobials- Post viral pneumonias have about 20% co-infection with bacteria. Give Gram negative and cover staph.

2. Paracetamol- The range of temperature in COVID was recorded as 37.8–38.9C. Paracetamol is effective antipyretic without almost any harm upto a dose of 4 gm/day in adults. Besides fever it also helps relieve other symptoms, myalgia and fatigue. The incidence of ARF in COVID-19 is upto 9%. Any other NSAIDs should not be used.

3. Intravenous immunoglobulin (IVIG)- It should not be used since the source of plasma is not from COVID19 infected persons.

4. Convalescent plasma (Plasma obtained from patients who recovered from COVID19)- This should not be used for two reasons- 1. After entering the body patients remain asymptomatic for 3-4 days- by the time they become symptomatic they already have enough antibodies of their own. 2. Transfusing convalescent plasma has its own risks.

5. Lopinavir/Ritonavir – do not use. We are going through the second phase of COVID19 which China completed during December 26, 2019 to January 8, 2020. Study conducted in China disproved any role of any antiviral drugs. Recent media reports of Jaipur doctors are media hype only. Results already published (Ref below)

6. Recombinant rIFNs- Don’t use- It can theoretically be effective if given before infection. But you will see the patient first on day 4 or 5.

7. Chloroquine or Hydroxychloroquine- This has been loosely recommended for the prophylaxis of definite exposed persons

Tab Lariago DS 500 mg BD for day 1 then OD for 3 days

8. Tocilizumab- it is used to treat moderate to severe rheumatoid arthritis in adults. Its cost in india is Rs 40,600 (Actemra 400mg Injection 1’S). It cannot be effective for the same reason as stated above.

9. Nafamostat is a synthetic serine protease- was tried with no effect.

*10. Immune system boosters-* There is no recommendation in relation to COVID19. But there are three vitamins known for decades which boost immunity.

*Only your innate immunity can save you.*

• Vitamin C- upto 3000mg per day

• Vitamin B6 (Pyridoxine)- 50 mg per day

• Vitamin E- 400 to 800 mg per day

11. Vaccine- No vaccine is expected in the market before 8 months to 12 months.

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Cao B, Wang Y, Wen D, Liu W, Wang J, Fan G, Ruan L, Song B, Cai Y, Wei M, Li X, Xia J, Chen N,

Xiang J, Yu T, Bai T, Xie X, Zhang L, Li C, Yuan Y, Chen H, Li H, Huang H, Tu S, Gong F, Liu Y,

Wei Y, Dong C, Zhou F, Gu X, Xu J, Liu Z, Zhang Y, Li H, Shang L, Wang K, Li K, Zhou X, Dong

X, Qu Z, Lu S, Hu X, Ruan S, Luo S, Wu J, Peng L, Cheng F, Pan L, Zou J, Jia C, Wang J, Liu X,

Wang S, Wu X, Ge Q, He J, Zhan H, Qiu F, Guo L, Huang C, Jaki T, Hayden FG, Horby PW,

Zhang D, Wang C, (2020) A Trial of Lopinavir–Ritonavir in Adults Hospitalized with Severe Covid-

19. New England Journal of Medicine;doi: 10.1056/NEJMoa2001282

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