ICMR Guidelines for COVID 19 Treatment Latest update 2021

ICMR Guidelines for COVID 19 Treatment

ICMR Guidelines for COVID 19 Treatment. You are informed that AIIMS and ICMR have given new guidelines to identify Covid-19 treatment which is as follows.

ICMR Guidelines for COVID 19 Treatment

All India Institute of Medical Sciences and Indian Council of Medical Research (ICMR) have issued new guidelines for the identification of Covid-19 treatment. ICMR Guidelines for COVID 19 Treatment

Which are based on three levels of severity – mild, moderate and severe. A look at the new protocol. ICMR Guidelines for COVID 19 Treatment

AIIMS/ ICMR-COVID-19 National Task Force/Joint
Monitoring Group (Dte. GHS)
Ministry of Health & Family Welfare, Government of India
CLINICAL GUIDANCE FOR MANAGEMENT OF ADULT COVID-19 PATIENTS

COVID-19 patient – Mild disease (ICMR Guidelines for COVID 19 Treatment)

Upper respiratory tract symptoms
(&/or fever) WITHOUT shortness
of breath or hypoxia

Home Isolation & Care

MUST DOs
✓ Physical distancing, indoor mask
use, strict hand hygiene.
✓ Symptomatic management
(hydration, anti-pyretics, antitussive, multivitamins).
✓ Stay in contact with the treating
physician.
✓ Monitor temperature and oxygen
saturation (by applying a SpO2
probe to fingers).

Seek immediate medical attention if:

  • Difficulty in breathing
  • High-grade fever/severe cough, particularly if lasting for >5 days
  • A low threshold to be kept for those with any of the high-risk features

MAY DOs
Therapies based on low certainty of
evidence
➢ Tab Ivermectin (200 mcg/kg once
a day for 3 days). Avoid in
pregnant and lactating women.
OR
➢ Tab HCQ (400 mg BD for 1 day f/b
400 mg OD for 4 days) unless
contraindicated.
❖ Inhalational Budesonide (given
via Metered-dose inhaler/ Dry
powder inhaler) at a dose of 800
mcg BD for 5 days) to be given if
symptoms (fever and/or cough)
are persistent beyond 5 days of
disease onset.

COVID-19 patient- Moderate disease (ICMR Guidelines for COVID 19 Treatment)

Any one of:

  1. Respiratory rate > 24/min, breathlessness
  2. SpO2: 90% to < 93% on room air

ADMIT IN WARD


Oxygen Support:
➢ Target SpO2: 92-96% (88-92% in patients with COPD).
➢ Preferred devices for oxygenation: the non-rebreathing face
mask.
➢ Awake proning encouraged in all patients requiring
supplemental oxygen therapy (sequential position
changes every 2 hours).


Anti-inflammatory or immunomodulatory therapy
➢ Inj. Methylprednisolone 0.5 to 1 mg/kg in 2 divided
doses (or an equivalent dose of dexamethasone) usually
for a duration of 5 to 10 days.
➢ Patients may be initiated or switched to the oral route if
stable and/or improving.


Anticoagulation
➢ Conventional dose prophylactic unfractionated heparin
or Low Molecular Weight Heparin (weight-based e.g.,
enoxaparin 0.5mg/kg per day SC). There should be no
contraindication or high risk of bleeding.


Monitoring
➢ Clinical Monitoring: Work of breathing, Hemodynamic
instability, Change in oxygen requirement.
➢ Serial CXR; HRCT chest to be done ONLY If there is
worsening.
➢ Lab monitoring: CRP and D-dimer 48 to 72 hrly; CBC,
KFT, LFT 24 to 48 hrly; IL-6 levels to be done if
deteriorating (subject to availability).

COVID-19 patient- Severe disease (ICMR Guidelines for COVID 19 Treatment)

Any one of:

  1. Respiratory rate >30/min, breathlessness
  2. SpO2 < 90% on room air

ADMIT IN ICU

Respiratory support
• Consider use of NIV (Helmet or face mask interface
depending on availability) in patients with increasing
oxygen requirement, if work of breathing is LOW.
• Consider use of HFNC in patients with increasing oxygen
requirement.
• Intubation should be prioritized in patients with high
work of breathing /if NIV is not tolerated.
• Use conventional ARDSnet protocol for ventilatory management.


Anti-inflammatory or immunomodulatory therapy
• Inj Methylprednisolone 1 to 2mg/kg IV in 2 divided
doses (or an equivalent dose of dexamethasone) usually
for a duration of 5 to 10 days.


Anticoagulation
• Weight based intermediate-dose prophylactic
unfractionated heparin or Low Molecular Weight
Heparin (e.g., Enoxaparin 0.5mg/kg per dose SC BD).
There should be no contraindication or high risk of
bleeding.


Supportive measures
• Maintain euvolemia (if available, use dynamic measures
for assessing fluid responsiveness).
• If sepsis/septic shock: manage as per existing protocol
and local antibiogram.


Monitoring
• Serial CXR; HRCT chest to be done ONLY if there is
worsening.
• Lab monitoring: CRP and D-dimer 24-48 hourly; CBC,
KFT, LFT daily; IL-6 to be done if deteriorating (subject to availability).

  • After clinical improvement, discharge as per revised discharge criteria.

*High-risk for severe disease or mortality
✓ Age > 60 years
✓ Cardiovascular disease, hypertension, and CAD
✓ DM (Diabetes mellitus) and other immunocompromised
states
✓ Chronic lung/kidney/liver disease
✓ Cerebrovascular disease
✓ Obesity

EUA/Off label use (based on limited available evidence and only in specific circumstances) (ICMR Guidelines for COVID 19 Treatment)

  1. Remdesivir (EUA) may be considered ONLY in patients with
    • Moderate to severe disease (requiring SUPPLEMENTAL OXYGEN), AND
    • No renal or hepatic dysfunction (eGFR <30 ml/min/m2; AST/ALT >5 times ULN (Not an absolute contradiction), AND
    • Who are within 10 days of onset of symptom/s.
      • Recommended dose: 200 mg IV on day 1 f/b 100 mg IV OD for next 4 days. o Not to be used in patients who are NOT on oxygen support or in-home settings
  2. Tocilizumab (Off-label) may be considered when ALL OF THE BELOW CRITERIA ARE MET
    • Presence of severe disease (preferably within 24 to 48 hours of onset of severe disease/ICU admission).
    • Significantly raised inflammatory markers (CRP &/or IL-6).
    • Not improving despite use of steroids.
    • No active bacterial/fungal/tubercular infection.
      • Recommended single dose: 4 to 6 mg/kg (400 mg in 60kg adult) in 100 ml NS over 1 hour.
  3. Convalescent plasma (Off label) may be considered ONLY WHEN FOLLOWING CRITERIA ARE MET
    • Early moderate disease (preferably within 7 days of symptom onset, no use after 7 days).
    • Availability of high titre donor plasma (Signal to cut-off ratio (S/O) >3.5 or equivalent depending on the test kit being used).
ICMR Guidelines for COVID 19 Treatment(governmentupdates.in)

Official ICMR Guidelines for COVID 19 Treatment PDF

  • Official ICMR Guidelines for COVID 19 Treatment PDFClick here

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