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    Revised COVID 19 SARS-COV2 Treatment Protocol - Final

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    upsahu
    This document outlines treatment protocols for COVID-19 patients with mild, moderate, or severe symptoms. It recommends various tests, medications, and oxygen support depending on the severity of the case. General investigations and treatments include antibiotics, antivirals, steroids, anticoagulants, and supportive care tailored to any comorbidities. For severe cases it suggests proning, cytokine-blocking drugs, and intensive monitoring while hospitalized.

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    Revised COVID 19 SARS-COV2 Treatment Protocol - Final

    Uploaded by

    upsahu
    76 views6 pages
    This document outlines treatment protocols for COVID-19 patients with mild, moderate, or severe symptoms. It recommends various tests, medications, and oxygen support depending on the severity of the case. General investigations and treatments include antibiotics, antivirals, steroids, anticoagulants, and supportive care tailored to any comorbidities. For severe cases it suggests proning, cytokine-blocking drugs, and intensive monitoring while hospitalized.

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    Revised COVID 19 SARS-COV2 Treatment Protocol- Final copy

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    This document outlines treatment protocols for COVID-19 patients with mild, moderate, or severe symptoms. It recommends various tests, medications, and oxygen support depending on the severity of the case. General investigations and treatments include antibiotics, antivirals, steroids, anticoagulants, and supportive care tailored to any comorbidities. For severe cases it suggests proning, cytokine-blocking drugs, and intensive monitoring while hospitalized.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    76 views6 pages

    Revised COVID 19 SARS-COV2 Treatment Protocol - Final

    Uploaded by

    upsahu
    This document outlines treatment protocols for COVID-19 patients with mild, moderate, or severe symptoms. It recommends various tests, medications, and oxygen support depending on the severity of the case. General investigations and treatments include antibiotics, antivirals, steroids, anticoagulants, and supportive care tailored to any comorbidities. For severe cases it suggests proning, cytokine-blocking drugs, and intensive monitoring while hospitalized.

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    COVID – 19/SARS-COV2 Treatment Protocol

    MILD MODERATE SEVERE


    Clinical Criteria

    SPO2 > 94 % in Room Air 90 - 94 % in Room Air < 90 % in Room Air


    RR < 24 / min 24 – 30 > 30
    No Pneumonia Pneumonia ++ Pneumonia +++
    CT Scoring < 10 CT Scoring > 10
    General Investigations to be advised for any COVID Patient
    1. CBC
    2. CRP
    3. Serum Ferritin
    4. LDH level
    5. LFT
    6. Serum Creatinine
    7. Blood Urea
    8. Serum electrolytes
    9. Serum IL-6 levels
    10. Plasma D- Dimer level
    11. Blood grouping & Typing

    If patient has Hypertension, Diabetes, CAD, Dyslipidaemia, Asthma, COPD & Other Ailments
    1. Serum Troponin – I levels
    2. Serum NT Pro BNP
    3. HBA1C
    4. Lipid Profile
    5. ECG (If Needed)
    6. Serum Procalcitonin
    7. HRCT Chest
    CT Chest Criteria

    Normal or < 25 % 25 % - 75 % 75 % to 100 %


    Grade I Grade II / III Grade IV
    COVID – 19/SARS-COV2 Treatment Protocol

    Laboratory Findings (Expected)

    NLR < 3.2 > 3.2 > 5.5

    CRP < 10 10 – 100 > 100


    Ferritin < 500 > 500 > 800

    D-Dimer < 0.5 > 0.5 > 1.0

    LDH < 300 300 – 400 > 400

    IL6 < 4.8 5 – 50 > 80

    LFT Normal Slight Derangement Moderate Derangement


    COVID – 19/SARS-COV2 Treatment Protocol

    Treatment

    Routine T. Paracetamol 500 mg T. Paracetamol 500 mg TDS T. Paracetamol 500 mg TDS


    TDS
    Anti-tussives SOS Anti-tussives SOS Anti-tussives SOS
    T. Vitamin C 500 mg BD T. Vitamin C 500 mg BD T. Vitamin C 500 mg BD
    T. Zinc 50 mg BD T. Zinc 50 mg BD T. Zinc 50 mg BD
    C. Omeprazole 20 mg C. Omeprazole 20 mg BD Inj. Pantoprazole 40 mg IV OD
    BD (or) Pan 40 mg OD (or) Pan 40 mg OD
    Fluids Adequate Hydration - Adequate Hydration - NS Conservative Fluids
    Oral
    Antibiotics T. Azithromycin 500 mg T. Azithromycin 500 mg OD x T. Azithromycin 500 mg OD x 5
    OD x 5 Days (or) 5 Days Days
    T. Amoxiclav 625 mg BD + Inj. Ceftriaxone 1 gm IV BD +
    x 5 Days (or) if secondary bacterial Inj. Piptaz 4.5 mg/ Inj meropenam
    T. Doxy 100 mg BD x 5 infection suspected 500mg IV TDS if secondary
    Days bacterial infection suspected

    Anticoagulation T. Eliquis 2.5 mg BD for 7 Inj. Enoxaparin 40 mg SC OD Inj. Enoxaparin 40 mg SC BD x 7


    days (or) T. Clopitab-A x 7 Days (can be started as Days (can be started as
    OD for 7 days prophylactic without D prophylactic without D DIMER)
    DIMER) (Contraindicated in ESRD, active
    (Contraindicated in ESRD, bleeding, emergency surgery,
    active bleeding, emergency platelets < 20,000/mm3, BP >
    surgery, platelets < 200/120) Inj. Dalteparin 5000 IU
    20,000/mm3, BP > 200/120) SC OD × 7 day In ESRD, UH –
    Inj. Dalteparin 2500 IU SC 5000U SC BD can be used
    OD ×7 days
    In ESRD, UH – 5000U SC BD
    can be used
    Steroids To be given if early T. Medrol 16 mg PO/TID for 5 Inj. Dexamethasone 0.2 – 0.4
    pneumonia or days (or) mg /kg ≈ 6 mg to 8 mg IV BD x
    progressing to moderate T. Dexa 8 mg PO/OD for 5 10 Days or
    T. Medrol 16 mg PO/TID days (or) If unresolving inj. Methyl Prednisolone 1.0 -2.0
    for 5 days (or) switch to mg/kg ≈ 80 mg x 10 Days
    T. Dexa 8 mg PO/OD for Inj. Dexamethasone 0.1 –
    5 days 0.2 mg /kg ≈ 6 mg to 8 mg
    IV OD x 5 Days or inj.
    Methyl Prednisolone 0.5 -1
    mg/kg ≈ 60mg x 5 Days
    COVID – 19/SARS-COV2 Treatment Protocol

    Oxygen Support Not Required To be initiated if SPO2 <94% Maintain Target SPo2
    Maintain Target SPo2 of > 90 %
    92 to 96 %
    NRM (10 -15 lit / min)
    Nasal Prongs (4 lit / min) ↓
    ↓ HFNC (10 - 60 lit / min)
    Face Mask (5-10 lit / min) ↓
    ↓ CPAP (TV 6ml/kg; PEEP 5-15 cm
    NRM (10 -15 lit / min) H20; Target PP 30 cm H20)
    ↓ ↓
    HFNC (10 - 40 lit / min) MV (ARDS Protocol)
    ↓
    CPAP (TV 6ml/kg; PEEP 5-15
    cm H20; Target PP 30 cm
    H20)
    Proning Not Indicated Awake Proning (if > 4 L / Prone Ventilation
    min) 16 to 18 hrs / Day
    - 30 to 120 mins prone
    - 30 to 120 mins left lateral
    - 30 to 120 mins right lateral
    - 30 to 120 mins upright –
    Contraindicated in altered
    mental status and
    hemodynamic instability,
    pregnancy
    Cytokine Storm
    Not I Not Indicated Inj. Toculizumab 400 mg Inj. Toculizumab 400 mg (max
    (max 800 mg) slow IV in 100 800 mg) slow IV in 100 ml NS
    ml NS over 1 Hour over 1 Hour
    Repeat Dose after 12 hours if Repeat Dose after 12 hours if
    needed Contra Indications – needed Contra Indications –
    Active Infections, TB, Active Infections, TB, Hepatitis,
    Hepatitis, Platelets < Platelets < 1L/mm3, ANC <
    1L/mm3, ANC < 2000/mm3
    2000/mm3

    COMORBIDITY AND COMPLICATIONS

    Comorbidity Treat Appropriately Treat Appropriately Treat Appropriately


    CAD, HT, DM,
    Hypothyroid,
    Epilepsy
    COVID – 19/SARS-COV2 Treatment Protocol

    Complications Treat Appropriately Treat Appropriately Treat Appropriately


    Septic Shock
    AKI, MODS
    Delirium
    Electrolytes
    ECGabnormalities
    Stress Ulcers
    Liver Dysfunction

    Trial Therapies

    Anti Viral T. Favipiravir T. Favipiravir Not Indicated


    Day 1 – 200 Mg x 9 Tab Day 1 – 200 Mg x 9 Tab
    Twice a day Twice a day
    Day 2 to Day 14 – 200 Day 2 to Day 14 – 200 Mg x 4
    Mg x 4 Tab Twice a day Tab Twice a day

    2 Not Indicated Inj. Remdesivir Inj. Remdesivir


    200mg IV OD on Day 1 and 200mg IV OD on Day 1 and
    100 mg IV OD x 4 Days 100 mg IV OD x 4 Days
    Contraindication – Liver Contraindication – Liver
    Dysfunction/ CKD / Dysfunction/ CKD /
    Pregnancy / Lactation / Pregnancy / Lactation /
    Children Children
    DI – avoid HCQ, Dexa use DI – avoid HCQ, Dexa use
    Methyl Prednisolone Methyl Prednisolone
    MONITORING

    BP / HR Daily 6th Hourly 4th Hourly


    RR/spO2 6th Hourly 2nd Hourly Continuously
    CBC / NLR / RFT / Baseline Every 2 Days Daily
    LFT
    COVID Profile Baseline Once every 4 days Once every 2 days

    D Dimer Repeated 4th day Once every 4 days Once every 2 days
    ECG If Needed Once every 2 days Daily
    ABG - - Daily
    X Ray If Needed If Needed If Needed
    COVID – 19/SARS-COV2 Treatment Protocol

    DISCHARGE CRITERIA

    Afebrile > 3 Days Afebrile > 3 Days without Afebrile > 3 Days without
    without antipyretics antipyretics antipyretics
    + + +
    No Breathlessnes No Breathlessnes No Breathlessnes
    10 Days from Symptom 10 Days from Symptom Clinical Recovery
    Onset Onset
    Repeat RT-PCR if Swab Repeat RT-PCR if Swab Repeat RT-PCR if Swab Negative
    Negative Discharge Negative Discharge Discharge
    If patient is
    Asymptomatic RT-PCR
    may not be needed

    POST Self Monitoring for 7 Self Monitoring for 7 Days Self Monitoring for 7 Days + POST
    DISCHARGE days + POST COVID CARE +POST COVID CARE REHAB COVID CARE REHAB
    ADVICE REHAB

    Note:

    1. This guideline will be updated as more information and research comes


    2. An informed consent is required wherever newer/unlicensed tests and therapies are used

    Compiled by
    Dr. Mahesh Joshi – CEO
    Dr. Sai Kumar – Corporate Lead Physician
    Dr. Sushant Gupta – Sr. Physician, Hyderabad
    Dr. Vishwas Rao – Sr. Physician, Hyderabad
    Dr. Asif – Sr. Physician, Delhi
    Dr. Ranjit – Lead Physician, Chennai
    Dr. Darwin – Sr. Physician, Bangalore
    Dr. Arindam Dubey – Sr. Physician, Kolkata

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