Variation in therapeutic strategies for the management of severe COVID‐19 in India: A nationwide cross‐sectional survey
Bharat Jagiasi, Prashant Nasa, Gunjan Chanchalani, Ahsan Ahmed, Ajith Kumar Ak, Kanwalpreet Sodhi, Kishore Mangal, Manoj K Singh, Nitesh Gupta, Prasanna U Bidkar, Ranvir S Tyagi, Reshu G Khanikar, Swagata Tripathy, Swapna Khanzode, Kesavarapu Subba Reddy, Saurabh Saigal, Vijay Anand Sivakumar, Yash Javeri, Seema S Tekwani
International Journal of Clinical Practice, doi:10.1111/ijcp.14574
Aim: During the pandemic of coronavirus disease 2019 (COVID-19), the physicians are using various off-label therapeutics to manage COVID-19. We undertook a crosssectional survey to study the current variation in therapeutic strategies for managing severe COVID-19 in India. Methods: From January 4 to January 18, 2021, an online cross-sectional survey was conducted among physicians involved in the management of severe COVID-19. The survey had three sections: 1. Antiviral agents, 2. Immunomodulators, and 3. Adjuvant therapies. Results: 1055 respondents (from 24 states and five union territories), of which 64.2% were consultants, 54.3% working in private hospitals, and 39.1% were from critical care medicine completed the survey. Remdesivir (95.2%), antithrombotics (94.2%),
prescribed antibiotics with severity of COVID-19 (58.3%) or increased inflammatory markers (56.4%) were preferred indications. There was significant variation in the use of adjuvant therapies with specialists from critical care medicine preferred use of antibiotics in severe and critical COVID-19, while anaesthesiologists preferred vitamins in all patients of COVID-19. Bacterial co-infections are uncommon in COVID-19 and vary from 3.5% at the time of admission to 15% among hospitalised patients. 28 A recent guideline on antimicrobials in COVID-19, recommended a restrictive approach and empirical antibiotics to be considered only if clinical, imaging and biochemical markers suggest a bacterial co-infection. The de-escalation of antibiotics within 48 hours is suggested if representative cultures or antigen tests excluded bacterial co-infection. 29 The authors did not recommend any empirical antibiotic regimen and advised to use community or hospital-acquired pneumonia guidelines while starting antibiotics and using local antimicrobial surveillance. 29 Recently, the RECOVERY trial found no role of azithromycin in the treatment of hospitalised COVID-19 patients. 30 The prepublication release from the PRINCIPAL trial using azithromycin or doxycycline for 14 days showed no significant benefit in time to recovery or hospitalisation. 31 NIH does not recommend vitamin C in COVID-19 because of insufficient data. 32 There are ongoing trials on intravenous vitamin C in..
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