“It is a first real step towards a different treatment of people affected by Covid”. And again: “Now that the emergency is gradually diminishing, we are moving towards a less hospitalized management of the disease”. Italian doctors thus welcome the update of the guidelines for the “Home management of patients with Sars-CoV-2 infection” just drawn up by the Ministry of Health. New indications – which as established by the Council are “only” advice addressed to health professionals – contained in a circular issued Thursday and made necessary “by the supervening availability of new antiviral drugs and monoclonal antibodies”.
Home care, Pfizer and Merck pills
The reference is above all to the pills of Pfizer and Merck which for some weeks have also been administered in the Peninsula. In a nutshell (and always considering the vaccine the main weapon against the pandemic) doctors are invited to take them into absolute consideration for the home treatment of positives, remembering however in which cases they are really indicated. That is, for subjects who have contracted a mild-moderate infection of recent onset, not hospitalized and not on oxygen therapy, and who have risk factors for the development of severe forms of the disease. “All that remains is to hope that the availability of antivirals will now be increased throughout the territory – explains Fabrizio Pregliasco, virologist and medical director of the Galeazzi hospital in Milan – and above all that it will be possible to speed up the practice, making sure that less time passes possible between the prescription and the actual use of drugs “.
In fact, antivirals must be administered within 5 days of the appearance of the first symptoms. “And it’s not always easy. Because (as the guidelines also clarify), we general practitioners can report the patient, who, however, must then go to the hospital to collect the drug. With the risk of delays or setbacks ». This is explained by Pier Luigi Bartoletti, secretary of the Fimmg of Rome. “The step of updating the indications taken by the Ministry of Health therefore – continues the representative of general practitioners – is an important political signal, but the fact remains that home general medicine is not yet fully granted to us because a patient is not he can come to me and walk away with the pill in his pocket. Yet we manage even more complex drugs. Let’s say therefore that it is a first step towards a different treatment of people affected by Covid, but after two years perhaps something more could be done “. Two critical issues (procurement and prescription) which, not surprisingly, are well photographed by the latest report from the Italian Medicines Agency, Aifa. As of February 10, 5,348 patients were initiated for home treatment with Merck’s Molnupiravir antiviral pill, while 41 were given Pfizer’s Paxlovid pill.
The others
Not just antivirals. According to the recommendations of the ministry – which it is good to remember always leave the last word to the doctor – in addition to proper hydration, nutrition and physical activity (when possible), for mild symptoms we also always recommend paracetamol or NSAIDs (non-steroidal anti-inflammatory drugs). Then, like antivirals, it should also be remembered that for early diagnoses treatments with monoclonals are now available in subjects with immunodeficiency who have a prolonged positive molecular swab. If there is a further need, the empirical use of antibiotics, the use of hydroxychloroquine, the modification of chronic therapies in place for other diseases or the use of benzodiazepines are also discouraged (in consideration of the possible risks of respiratory depression).
While the use of corticosteroids is recommended but only in hospitalized and intubated subjects with severe disease or, at home, only in subjects who have risk factors for disease progression towards severe forms and if immediate hospitalization due to overload is not possible of hospitals. Scenarios that, thanks to the bending of the current curve, will hopefully become increasingly rare.
«These are indications that take stock of the tools available and reaffirm the importance of the new solutions found – explains Pregliasco – especially in a situation like the current one. Now that the emergency is gradually waning and the symptoms seem less severe, we are moving towards a less hospitalized management of the disease and therefore a return to health care as territorial as possible is desirable ”.
© breaking latest news