Remdesivir not effective in patients requiring ventilation: PGI doctor

Remdesivir an antiviral drug does not have any effect in reducing mortality and it is not effective for patients requiring high oxygen support or ventilation, a senior doctor with the Postgraduate Institute of Medical Education and Research (PGIMER) said here on Thursday.

G.D. Puri, HoD of Anaesthesia and Intensive Care, PGIMER, said that if the drug has to be rationally used, it should be used within the first seven to eight days in COVID-19 patients developing room air hypoxia, meaning oxygen saturation less than 94 per cent.

Remdesivir was the first drug to be approved by the US FDA for the treatment of COVID-19 patients.

"It is not likely to be beneficial after 10 days in patients who are already on ventilator support. It has a potential to worsen renal functions and may cause arrhythmia, so it needs to be used with caution and under strict monitoring. There are very limited indications of using Remdesivir and a very narrow therapeutic window, so it should be used judiciously," he said.

The only medicine with definite effect on reducing mortality in critically ill patients is steroids (dexamethasone), which is beneficial only when Covid positive patients develop hypoxia at room air, Puri said.

Use of steroids in patients not having room air hypoxia is associated with the increased risk of mortality. So steroids have to be used judiciously under medical supervision, the doctor warned.

On the use of Tocilizumab, he said it is a strong immune system suppressant and is indicated to control "cytokine storms" rapidly. Its use has to be guided by the clinical condition of the patient, Puri said.

Since it can increase the incidence of secondary bacterial infections in the patients, it should be used only after ruling out significant bacterial or fungal infections, he added.

In case it is not available, good supportive care, steroids and ventilation may be tried, the doctor added.