Treating Covid at home not only with paracetamol (tachiprin) and anti-inflammatories but also with other drugs that are proving to be increasingly effective: from monoclonals to the newest oral antivirals, the first “pills” authorized to defeat the virus. With a new circular, the Ministry of Health has just updated the indications for the home management of patients, taking into account the “emerging scientific knowledge in particular in the pharmacological field”. It is a pity that the availability of new therapies risks being an obstacle course against time: the family doctor must in fact quickly select suitable patients to send them to hospital centers that dispense treatments not yet available in pharmacies.
From family doctor to specialized centers
As regards both the treatment with monoclonal antibodies and with antivirals, this is intended for subjects with mild-moderate disease who are not hospitalized and not on oxygen therapy who have risk factors – from oncological diseases to diabetes up to obesity – for the development of Covid. -19 severe. As mentioned, the selection of the patient to be treated with these drugs is entrusted to family doctors, pediatricians of free choice and also to doctors of the Usca. With the time factor, however, it is crucial: patients must in fact “be referred quickly to the centers authorized to prescribe, administer and dispense these drugs identified by the Regions”. Both monoclonal antibodies and antivirals for the treatment of Covid are in fact subject to the control of the Aifa monitoring registers and are normally prescribed and dispensed by hospital pharmacies and specialized hospitals.
The time factor is crucial
In Italy, three different monoclonal antibody-based treatments are currently available and should be administered within 7 days of the onset of symptoms (but preferably within 72 hours). Monoclonals must be dispensed in hospitals since their administration takes place by infusions. In the updated indications, however, the ministry specifies that, compared to the others, “a preferential use of the monoclonal antibody sotrovimab is recommended, given its neutralizing capacity compared to the circulating variants of SarsCoV2”, including Omicron. Three antivirals have recently become available: remdesivir which is always administered intravenously. Then there is Pfizer’s brand new oral antiviral Paxlovid which promises to prevent hospitalization in 90% of cases and should be administered no later than 5 days after the onset of symptoms (treatment
consists of taking three tablets, twice a day, for 5 days). Same goes for Merck’s oral antiviral Molnupiravir.
Home treatments: from paracetamol to Fans
Among the patient’s home monitoring tools, it is confirmed that in the circular, the doctor will have to use a specific table for the determination of risk (Mews) which includes various parameters: from pressure to respiratory rate, and with specific indications for pregnant women. The monitoring of oxygen saturation at home through the pulse oximeter is also fundamental: the patient must promptly contact their doctor if the oxygen saturation values are less than 92%. With respect to the drugs to be used, the possibility of symptomatic treatments is confirmed for asymptomatic or paucisymptomatic patients: for example paracetamol or non-steroidal anti-inflammatory drugs -Fans- in case of fever or joint or muscle pain, unless there is a clear contraindication to ‘use. The circular also reminds that corticosteroids (cortisone), heparin and antibiotics should not be used routinely, but only in specific cases. However, hydroxychloroquine, whose efficacy has not been confirmed, should not be used.
Signs for children
In the new circular, precise indications also apply to children: in asymptomatic children no medication is required, while in those who suffer from flu-like symptoms it is advisable, in case of need (fever> 38.5 ° C, sore throat, headache , joint pain, etc.), on the recommendation of the pediatrician, administer symptomatic therapy with Paracetamol or Ibuprofen. “In subjects in developmental age, about 1,000 cases have required intensive care in Italy since the beginning of the pandemic and have increased in recent weeks – specifies the circular – until the introduction of vaccination from 12 years of age. in intensive care they were diagnosed with Mis-C (Multisystem Inflammatory Syndrome in Children); in almost all the cases of Mis-C there was the complete resolution of the picture and recovery, and only in a minority of cases there were results ».