Variation in therapeutic strategies for the management of severe COVID‐19 in India: A nationwide cross‐sectional survey

Abstract

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 cross‐sectional 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%), corticosteroids (90.3%), vitamins (89.7%) and empirical antibiotics (85.6%) were the commonly used therapeutics. Ivermectin (33%), convalescent plasma (28.6%) and favipiravir (17.6%) were other antiviral agents used. Methylprednisolone (50.2%) and dexamethasone (44.1%) were preferred corticosteroids and at a dose equivalent of 8 mg of dexamethasone phosphate (70.2%). There was significant variation among physicians from different medical specialities in the use of favipiravir, corticosteroids, empirical antibiotics and vitamins. Conclusion There is a considerable variation in the physicians’ choice of therapeutic strategies for the management of severe COVID‐19 in India, as compared with the available evidence.

Factors associated with invasive fungal sinusitis in patients with COVID‐19: A systematic review and single‐center case series

“… 7 , 25 Furthermore, variations in steroid dosing has been reported during the pandemic, which may lead to certain populations having a greater risk of incurring IFSAC. 26 , 27 Overall, these findings support that the well‐established IFS risk factors of diabetes and prolonged steroid therapy are frequently present in the subset of IFSAC.…”

“…Steroid‐induced hyperglycemia can even progress into diabetic ketoacidosis (DKA), which was observed in at least two of the cases involved in the systematic review 7,25 . Furthermore, variations in steroid dosing has been reported during the pandemic, which may lead to certain populations having a greater risk of incurring IFSAC 26,27 . Overall, these findings support that the well‐established IFS risk factors of diabetes and prolonged steroid therapy are frequently present in the subset of IFSAC.…”

Epidemiological Characteristics, Pathogenesis and Clinical Implications of Sinusitis in the Era of COVID-19: A Narrative Review

“… 86 , 87 However, it should be noted that steroid dosing was remarkably variable during the COVID-19 pandemic, explaining why some populations might be at more risk of developing secondary infections and adverse events than others. 88 , 89 …”

Is there any prophylactic role for ivermectin in COVID‐19—A literature summary

“…3 While purists wait for a double-blind randomized control trial (DB RCT), this is difficult in real-life practice where multiple drugs are administered to patients in real-life settings. 5 We would like to counter the persistent refrain that echoes the belief that there are no enough data on IVM, 3 and our exhaustive search for the published data on PubMed has found numerous drug-dosed studies in COVID-19 using ivermectin (IVM), which decry this constant refrain. 4 (Table 1).…”

“…In real-life management protocols, the co-administration with azithromycin would increase the serum levels and may achieve the virological effect as demonstrated in-vivo. 5 Also, a high dose (0.6 mg/kg/day for 5 days) or a nasal route of delivery may help to deliver a higher dose of the drug. 10 While there are various dosimetry studies for prophylaxis and therapy of COVID-19 (Table 1), 1-4 the drug still has not satisfied the rigors of a DB RCT needed for its approval.…”