Experts believe that the alleged mismanagement of steroid therapies had triggered a sort of ‘mini pandemic’ in the form of fungal infections like mucormycosis which claimed lives and caused serious side-effects like loss of eyesight etc.
Endogenous endophthalmitis too had come to fore as a possible side-effect of steroid after a Covid-recovered cop ended life due to the ailment.
Professor and head of the department of medicine, AIIMS, Nagpur, Dr Prashant Joshi said that steroids save lives when Covid-19 patient is hypoxic. “If someone is maintaining SPO2 of 94% and above on room air, then there is no need of steroids. It is only to be given when SPO2 is 93% or less,” said Dr Joshi.
Dr Joshi further said that in diabetic patients, steroids can shoot up blood sugar level which is the chief cause of mucormycosis. “Proper blood sugar control is crucial,” said Dr Joshi who is also an expert on epidemiology. “Clinical trials show that steroids are not required for more than 10 days,” he said.
Dr Kamal Bhutada, director of ICU at a private hospital and chairman of Indian Society for Critical Care Medicine, Nagpur chapter, said that he had used Dexamethasone in the second wave while it was Methylprednisolone in the first wave. “There are studies supporting the use and administration of Dexamethasone whose dose as per the guidelines is 6 mg per day for 10 days,” he said adding that steroid overuse can trigger fungal infections like mucormycosis and candida, also secondary drug-resistant bacterial infection, fluid retention in the body, muscle and bone weaknesses too.
He said that patients requiring hospitalization with SPO2 saturation falling below 94% need steroids.
Professor and head of medicine, Government Medical College and Hospital, Dr Prashant Patil said that state and health department guidelines must be followed but we need tailored and customized treatment for each patient. “In any case administration of steroids is not advisable for more than five to 10 days,” he said.
Physician Dr Rajesh Atal said that giving steroids within seven days of infection when the viral load is high in the phase of viremia can lead to disaster. “Steroids must be introduced when the immuno-response is exaggerated. It is an immunosuppressant and hence should be used in moderation and short duration just to tide over the crisis,” he said.
Internal medicine specialist Dr Nitin Wadaskar, associated with Alexis Multispecialty Hospital, said that misuse or overuse of steroids led to opportunist pathogens to strike and secondary infections were on rise during the second wave. “If the C-Reactive protein (CRP) is found raised and CT score too is on the higher side, only then steroids can be introduced moderately,” said Dr Wadaskar adding that many patients had grown steroid dependent even after discharge.