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   Table of Contents     
EDITORIAL  
Year : 2021  |  Volume : 13  |  Issue : 2  |  Page : 65-66
State of the globe: The frenzy of self-medication, cocktail regimens and everchanging guidelines on SARS-CoV-2


1 Department of Medicine, IGMC, Shimla, Himachal Pradesh, India
2 Department of, Microbiology, IGMC, Shimla, Himachal Pradesh, India

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Date of Submission13-May-2021
Date of Acceptance14-May-2021
Date of Web Publication31-May-2021
 

How to cite this article:
Chauhan V, Thakur S. State of the globe: The frenzy of self-medication, cocktail regimens and everchanging guidelines on SARS-CoV-2. J Global Infect Dis 2021;13:65-6

How to cite this URL:
Chauhan V, Thakur S. State of the globe: The frenzy of self-medication, cocktail regimens and everchanging guidelines on SARS-CoV-2. J Global Infect Dis [serial online] 2021 [cited 2021 Dec 4];13:65-6. Available from: https://www.jgid.org/text.asp?2021/13/2/65/317375




We are in the 2nd year of the SARS-CoV-2 Pandemic and still, we do not have safe and effective evidence-based drugs active against this virus. Moore JL et al. in the current issue studied the side effects of tocilizumab and found that its use in SARS-CoV-2 patients was not associated with any increase in the rate of secondary infections among the patients.[1] Tocilizumab was once perceived as a wonder drug against SARS-CoV-2 induced cytokine storm but by the time the research is being published, now it is considered only as an add-on agent on select group of patients already receiving dexamethasone.[2] Among the changing treatment guidelines and the rush of SARS-CoV-2-infected patients, the physicians tend to forget that some of the manifestations in their patients may not be virus related but due to the adverse effects of the drugs taken as self-medication as well as the cocktail regimens being tried on them in the hospitals. This problem is potentiated when we use drugs and therapies approved under emergency use authorization (EUA) without proper evidence.

Remdesivir is the only United States Food and Drug Administration (US FDA)-approved treatment for SARS-CoV-2 infection.[2] At the same time, World Health Organization (WHO) advises against its use for SARS-CoV-2, in their recommendation in November 2020.[3] This drug is still being used in many countries including India. It acts as an antiviral agent and is and thought to be effective during the early viraemic phase.[2] It becomes less effective for patients needing mechanical ventilation in the later stages of infection where the recommended drugs is dexamethasone[2] Dexamethasone improves survival in hospitalized patients requiring oxygen with a maximum benefit seen in mechanically ventilated patients.[1] It is being seen as a panacea by many patients across India and they are self-medicating with dexamethasone for even mild symptoms. Top doctor from India expressed his fear that early self-medication with dexamethasone may be the reason for triggering viral replication and drop in oxygen levels.[4]

Steroid-induced hyperglycemia, immunosuppression, and prolonged use of masks in the hospital make diabetic patients susceptible to the fatal rhinocerebral mucormycosis. Case reports of rhinocerebral mucormycosis in patients treated for SARS-CoV-2 have increased over the past 6 months. Indian hospitals are seeing an unprecedented rise in mucormycosis cases and one Ahmedabad hospital in Gujarat has created a separate ward for mucormycosis where they have admitted 298 patients of mucormycosis.[5]

We witnessed similar frenzy for self-medication and conflicting guidance on use of hydroxychloroquine during the first wave of SARS-CoV-2 in 2020. The Indian guidelines recommended hydroxychloroquine during the first wave of SARS-CoV-2 for both prophylaxis and treatment despite the US FDA declaring its use unsafe outside of a hospital.[6]

Self-medication with hydroxychloroquine was quite common practice as a preventive and treatment agent against SARS-CoV-2 without any strong evidence for its use.[7]

In absence of proven treatments against SARS-CoV-2, people also tend to self-medicate with any new drug that hits the news without realizing the fact that many of the articles related to SARS-CoV-2 go into publication without any peer review. The increasing influence of social media amplifies the effects seen in such studies.[8] Self-medication is quite common with drugs such as hydroxychloroquine, ivermectin, favipiravir, melatonin, dexamethasone, antibiotics, Vitamin C, zinc, and Vitamin D for both prevention and treatment of mild viral symptoms.[8]

The guidance on convalescent plasma therapy has been dropped by the Indian Government just recently.[9] Use of convalescent plasma is feared to be the cause of emergence of double mutant strains of SARS-CoV-2.[10] This is another example of how EUA of therapies can actually do more harm to the world.

Severe pill esophagitis with oral doxycycline, and hypercalcemia from hypervitaminosis D are some common problems of self-medication during this Pandemic. Ivermectin is being used extensively for SARS-CoV-2 infection and physicians need to be aware that it can cause confusion, seizure, tremors, vomiting as its adverse effects.[11]

The management of SARS-CoV-2 is chaotic amidst the scores of patients presenting into the hospitals, everchanging treatment guidance, glorification of drugs by social media and EUA based on poor evidence. People are resorting to self-medication without being aware of the dangers of such practices. Physicians have to be extra careful to differentiate the adverse effects of drugs from the effects of SARS-CoV-2 in their patients.



 
   References Top

1.
Moore JL, Stroever SJ, Rondain PE, Scatena RN. Incidence of secondary bacterial infections following utilization of tocilizumab for the treatment of COVID-19 – A matched retrospective cohort study. J Global Infect Dis 2021;13:67-71.  Back to cited text no. 1
  [Full text]  
2.
Therapeutic Management of Adults with COVID-19: NIH; 2021. Available from: https://www.covid19treatmentguidelines.nih.gov/therapeutic-management/. [Last accessed on 2021 Apr 21; Last updated on 2021 Apr 21].  Back to cited text no. 2
    
3.
WHO recommends against the use of remdesivir in COVID-19 patients: World Health Organization; 2020 [updated 20/11/2020]. Available from: https://www.who.int/news-room/feature-stories/detail/who-recomm ends-against-the-use-of-remdesivir-in-covid-19-patients. [Last accessed on 2021 May 20].  Back to cited text no. 3
    
4.
Steroid use too early may be causing drop in oxygen: AIIMS chief Randeep Guleria: The Indian Express; 2021 [updated 5/5/2021. Available from: https://indianexpress.com/article/india/steroid-use-too-early-may-be-causing-drop-in-oxygen-aiims-chief- randeep-guleria-7300712/. [Last accessed on 2021 May 20].  Back to cited text no. 4
    
5.
P S. Mucormycosis: Patients make beeline for Civil Hospital: The Times of India; 2021 [updated 15/05/2021. Available from: https://timesofindia.indiatimes.com/city/ahmedabad/mucormycosis-patients -make-beeline-for-civil-hospital/articleshow/82642801.cms. [Last accessed on 2021 May 20].  Back to cited text no. 5
    
6.
US Food and Drug Administration. FDA Cautions Against use of Hydroxychloroquine or Chloroquine for COVID-19 Outside of the Hospital Setting or a Clinical Trial Due to Risk of Heart Rhythm Problems; July 1, 2020. Available from: https://www.fda.gov/drugs/drug-safety -and-availability/fda-cautions-against-use-hydroxychloroquine -or-chloroquine-covid-19-outside-hospital-setting-or. [Last accessed on 2021 May 12].   Back to cited text no. 6
    
7.
Chauhan V, Galwankar S, Raina S, Krishnan V. Proctoring Hydroxychloroquine Consumption for Health-care Workers in India As Per The revised national guidelines. J Emerg Trauma Shock 2020;13:172-3.  Back to cited text no. 7
  [Full text]  
8.
Malik M, Tahir MJ, Jabbar R, Ahmed A, Hussain R. Self-medication during Covid-19 pandemic: Challenges and opportunities. Drugs Ther Perspect 2020:1-3. [Epub ahead of print].  Back to cited text no. 8
    
9.
Sharma M MS. Govt removes plasma therapy as treatment for Covid-19 among adults: India Today; 2021 [updated 18/05/2021. Available from: https://www.indiatoday.in/coronavirus-outbreak /story/icmr-removes-plasma-therapy-as-treatment-for-covid19 -among-adults-1803708-2021-05-17. [Last accessed on 2021 May 20].  Back to cited text no. 9
    
10.
Kemp SA, Collier DA, Datir RP, Ferreira IATM, Gayed S, Jahun A, et al. SARS-CoV-2 evolution during treatment of chronic infection. Nature. 2021;592 (7853):277-82.  Back to cited text no. 10
    
11.
Molento MB. COVID-19 and the rush for self-medication and self-dosing with ivermectin: A word of caution. One Health 2020;10:100148.  Back to cited text no. 11
    

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Correspondence Address:
Dr. Vivek Chauhan
Department of Medicine, IGMC, Shimla - 171 006, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jgid.jgid_114_21

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2008 Journal of Global Infectious Diseases | Published by Wolters Kluwer - Medknow
Online since 10th December, 2008