Challenge to implement steroid mandate: Doctors | Bengaluru News – Times of India


BENGALURU: Recent guidelines issued by the Union ministry of health and family welfare have restricted use of steroids only to hospitalised Covid-19 patients with moderate to severe disease.
The change comes in the backdrop of many patients, who recovered in home isolation since they could not find beds in hospitals during the second wave, being prescribed steroids without checking their sugar levels. Over the past couple of months, some of them have contracted mucormycosis, the fungal infection, due to irrational use of steroids.
Guidelines issued by the Directorate General of Health Services, Union ministry of health and family welfare, state steroids are not necessary and are even harmful in asymptomatic and mild cases of Covid-19.
Incidentally, steroids like dexamethasone were a part of the medical kit given by the state government, but the issue was debated, and the drugs were later withdrawn.
Dr KS Satish, a Bengalurubased pulmonologist and member of Covid-19 clinical expert committee, said steroids cannot be administered to a patient without checking his or her glycosylated haemoglobin (HbA1c) level — which indicates the amount of blood sugar (glucose) in the haemoglobin. A HbA1c test shows the average sugar level in an individual for the past three months.
“Blood sugar level must be tested before administering steroids,” said Dr Satish. “But, while guidelines are formed after multiple experts discuss medical issues of Covid-19 patients, the major question is who is going to monitor implementation of the guidelines.”
Dr Satish, however, said current mucormycosis cases cannot be blamed only on steroid use and could be due to currently circulating Covid variants.
Agreeing with him, Dr Ravindra Mehta, pulmonologist said many patients who should have ideally been treated in hospital were treated at home because they could not find beds in hospitals. He says many of these patients were incorrectly administered steroids.
Dr Mehta said that in many cases during the peak of the second wave, several patients were contacting doctors through video consultations due to lack of beds.
“Steroids should not be given in the first seven days,” said Dr Mehta. “Steroids are only for those with moderate to severe disease. But in many cases, steroids were given irrespective of the state of the disease. There was no monitoring of steroid-related sugar effects,” he said, adding that the guidelines must be effectively implemented.
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Sagar Biswas

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