In the midst of the rebound in infections facing our country, the Ministry of Health (SSa) has published the new Clinical Guide for the Treatment of Covid-19 in Mexico. As mentioned in the document, it represents the perspective of representatives of all public institutions in the health sector, which was reached after a careful evaluation of the available scientific evidence.
It is aimed at all health workers and its objective is to support the needs, capacities, preferences and values that they require with their patients. Although a very important point that is mentioned is that the guide does not supplant the responsibility of making decisions appropriate to the circumstances of each individual, focusing on people and considering the will of their families, caregivers or guardians.
Options that can be used
For its part, the work takes into account the most recent scientific evidence. One of the most important sections is that of medicines recommended for the care of Covid-19 patients. As of current knowledge, there are only five that medical personnel should employ.
- Unfractionated Heparin / Enoxaparin.
- Dexamethasone or other corticosteroids with equivalent doses.
- Remdesivir.
- Oxygen.
- Tocilizumab – Il-6 inhibitors.
While the same guide indicates that from the evolution of Covid-19 certain drugs must be used. As described, the ideal is to act as follows:
Mild sickness
features
No evidence of pneumonia or hypoxia, SpO2 ≥ 94% in room air.
Medications and patient eligibility criteria
Symptomatic treatment.
Moderate illness
features
Clinical signs of pneumonia (fever, cough, dyspnea, rapid breathing) without signs of severe pneumonia, including SpO2 ≥ 90% in room air.
Medications and patient eligibility criteria
Unfractionated heparin / enoxaparin (AIII): Assess risk of thrombosis to indicate drug as thromboprophylaxis. Dexamethasone or other dose-equivalent corticosteroids (AI): Administer exclusively in patients who require supplemental oxygen to maintain SpO SpO2 ≥ 94%. Mortality increases 20% in those with SpO2 ≥ 94%, who do not require oxygen.
Remdesivir (BIIa): In hospitalized patients older than 12 years and weighing more than 40 kilos, with a requirement of less than 15 liters per minute of oxygen. Not on mechanical ventilation. Less than 8 days from the onset of symptoms.
Tocilizumab (BIIa): In patients with current or previous steroid use, who have not received another IL-6 inhibitor during current hospitalization, and when there is no evidence of another bacterial or viral infection (other than SARS-CoV -2), with a need for supplemental oxygen and a C-reactive protein level greater than 75 mg / liter; or started less than 48 hours ago with high-flow nasal oxygen, continuous positive airway pressure, non-invasive ventilation, or invasive mechanical ventilation.
Serious illness
features
Clinical signs of pneumonia (fever, cough, dyspnea, rapid breathing) plus 1 of the following:
– Respiratory rate greater than 30 breaths per minute.
– Severe shortness of breath.
– SpO2 <90% to ambient air
Medications and patient eligibility criteria
Unfractionated heparin / enoxaparin (AIII): Assess risk of thrombosis to indicate drug as thromboprophylaxis. Dexamethasone or other dose-equivalent corticosteroids (AI): Administer exclusively in patients who require supplemental oxygen. Mortality increases in those who do not require oxygen.
Tocilizumab (BIIa): In patients with current or previous 10-day steroid use, who have not received another IL6 inhibitor during current hospitalization, and when there is no evidence of another bacterial or viral infection (other than SARS- CoV-2), with a need for supplemental oxygen and a C-reactive protein level greater than 75 mg / liter; or started less than 48 hours ago with high-flow nasal oxygen, continuous positive airway pressure, non-invasive ventilation, or invasive mechanical ventilation.