Treatment guideline for COVID-19

Treatment guideline for COVID-19:



WARNING!!!: 

• THIS POST IS ONLY FOR DOCTORS & This is not a substitute of standard medical CONSULTATION.
• TREATMENT IS CONTINUOUSLY CHANGING & GETTING UPDATED, AND VARY AMONG DIFFERENT COUNTRIES & INSTITUTION.

Step1: Mild symptoms: 

• Symptomatic Treatment
• Started at Home
• Before getting report of Covid PCR result.

1. Tab Paracetamol 500 mg (If temperature>100)
2. ‌Tab. Fexo 120mg 0+0+1 (antihistamine)
3. Tab. Montair 10 mg 0+0+1
4. ORS and water as much as can drink to maintain hematocrit level normal
5. Tab. Vitamin C 1+1+1 ( It may increase immunity)
6. ‌Tab. Zinc 1+0+1 to  ( It may increase immunity)
7. Blackberries (oral+Nasal drop)

Step 2: After getting report of Covid PCR result:

1. ‌Tab Faviparvir 8+0+8 on first day then 3+0+3 on subsequent days.
2. ‌Cap Doxicap 100mg 1+0+1 for preventing atypical Pneumonia

For hospitalized: further tests necessary:

• CBC, ESR, CRP:
• Liver function test ( ALT)
• RFTs: Blood urea, S.creatinine, S. electrolytes 
• LDH 
• Serum Ferritin
• D-dimer : 
• Troponin/ CPK
• Baseline ECG (Monitor QTc)
• If clinically indicated:
•  Routine blood cultures (2 sets)
• For acute kidney injury- send urinalysis and spot urine protein: creatinine
• Procalcitonin (if available)

Step-3: Breathlessness: 
Check O2 saturation with Pulse oxymeter  regularly/continuously.

1. O2 to keep saturation>94% (Hypoxia may cause raised Hb & thromboembolism)
2. Do HRCT: Any groundglass opacity/pneumonia: If yes start:
3.  Inj Meropenam 1 gm IV TDS
4. .Inj Moxaquine 400mg OD
5. Inj Enoxaparin (Clexane)40 mg for thromboprophylaxis.
6.  Prone Ventilation..
7. Keep negative fluid balance of lung crepitation:
8.  Inj  Actemra (tocilizumab): if  condition was detoriates fast. (Two dose in a subsequence day.)

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Step-4: Other advance Rx may be considered

1. If ARDS: Tab Methylprednisolone 40mg 1+0+1 (or injection)
2. If LFTs impaired- consider: 

• Inj Hepaclin(L-Ornithine L-Aspartate)
  (in infusion; 5 gm/h at maximum)up to 20 gm (4 ampoules daily)
• Tab Ursocal 300mg 1+1+1
• Tab Mucomist DT 600mg 1+1+1 (LFTs+Thinning of lung secretion)

1. If ferritin level very high: (>1000?) Inj Desferal (Desferioxime) 500 mg/vial (<15 mg/kg/h, SC or IV)

Indications of NIV:

Indications of intubation:

• After starting improving: Breath hold exercise ( Breath hold exercise , Spirometer  exercise)

Referrences:

1.  https://journals.lww.com/anesthesia-analgesia/Fulltext/2020/05000/Recommendations_for_Endotracheal_Intubation_of.1.aspx
2.