No updated guidelines on COVID treatment in J&K

As COVID19 patients continue to fill up hospitals across Kashmir, the lack of updated treatment guidelines results in ‘abuse of high-end antibiotic and antiviral drugs’, a trend that doctors fear could be catastrophic.

In June 2020, an Apex Level Advisory Committee was constituted in J&K to steer the efforts in COVID19 mitigation, besides formulating guidelines for treatment. These guidelines were shared with the healthcare professionals treating patients across the UT.

In the past one year, a number of drugs and treatments that were part of the guidelines have been obliterated owing to advancements in medical science and understanding the new disease that hit the world as a pandemic in no time. However, in J&K, these guidelines have not been changed yet, resulting in lack of uniformity, consensus and adherence to a treatment protocol.

A senior physician at SKIMS Soura, here, said that doctors are using antibiotics and anti viral drugs “without any limit” to quantity or variety. “We are being forced to use Colistin in a number of our patients because everything else has already been used before they reach us,” the physician said. Colistin is a high-end antibiotic that is usually reserved for use in resistant organisms, the doctor said.

He said the proportion of patients requiring Colistin has nearly doubled in a year which was a clear evidence of the abuse of antibiotics in Kashmir and Jammu divisions both.

Another senior doctor working at GMC Srinagar said that COVID19 care being decentralized and shifted to new hospitals has given rise to a scenario where some doctors are seeing the cases for the first time. “We need to have some kind of training for our doctors. What do we expect them to do in what situation has been left entirely to them,” he said, He said the free availability of antibiotics, antiviral drugs and steroids was being abused. “Many doctors are starting the treatment with drugs like Tazabactum, which we preferably would have reserved if some other drugs did not work,” he said. He said doctors were doing more harm than good to patients with the “cocktail of drugs”.

Many doctors have expressed concern over the “antibiotic resistance catastrophe” that they feared COVID19 was giving rise to. “It is a crisis bigger than the present one,” he said.

Prof Naveed Nazir Shah, head department of Pulmonology at GMC Srinagar said training sessions with “a number of medical officers” had been carried out with National Health Mission facilitation. “The past year saw Plasma Therapy being introduced and then retracted, Remdesivir is still a subject of debate, Toclizumab too,” he said.

He said guidelines were “evolving” and his hospital discussed and deliberated treatment of every patient before he or she was put on it. “I hope it is happening at other hospitals also,” he said.

Chairman of J&K’s Apex Committee Prof Mohammad Sultan Khuroo said the guidelines were being revised but would not be ready till the second week of June. “We have been busy with the third wave deliberations and discussions, as the Government needs to be informed in time if there would be a third wave and what can be done to reduce its impact,” he said.

He said the Committee for ‘Third Wave’ and for Treatment Guidelines was the same and the work overlapped. “Now that we have almost finished this important assignment, we should be able to discuss the Guidelines for Treatment soon,” he said.