Variation in therapeutic strategies for the management of severe COVID-19 in India: A nationwide cross-sectional survey

Bharat Jagiasi, Prashant Nasa, Gunjan Chanchalani, Ahsan Ahmed, Ajith Kumar Ak, Kanwalpreet Sodhi, Kishore Mangal, Manoj K Singh, Nitesh Gupta, Prasanna U Bidkar, Ranvir S Tyagi, Reshu G Khanikar, Swagata Tripathy, Swapna Khanzode, Kesavarapu Subba Reddy, Saurabh Saigal, Vijay Anand Sivakumar, Yash Javeri, Seema S Tekwani, Bharat Jagiasi, Prashant Nasa, Gunjan Chanchalani, Ahsan Ahmed, Ajith Kumar Ak, Kanwalpreet Sodhi, Kishore Mangal, Manoj K Singh, Nitesh Gupta, Prasanna U Bidkar, Ranvir S Tyagi, Reshu G Khanikar, Swagata Tripathy, Swapna Khanzode, Kesavarapu Subba Reddy, Saurabh Saigal, Vijay Anand Sivakumar, Yash Javeri, Seema S Tekwani

Abstract

Aim: During the pandemic of coronavirus disease 2019 (COVID-19), the physicians are using various off-label therapeutics to manage COVID-19. We undertook a cross-sectional survey to study the current variation in therapeutic strategies for managing severe COVID-19 in India.

Methods: From January 4 to January 18, 2021, an online cross-sectional survey was conducted among physicians involved in the management of severe COVID-19. The survey had three sections: 1. Antiviral agents, 2. Immunomodulators, and 3. Adjuvant therapies.

Results: 1055 respondents (from 24 states and five union territories), of which 64.2% were consultants, 54.3% working in private hospitals, and 39.1% were from critical care medicine completed the survey. Remdesivir (95.2%), antithrombotics (94.2%), corticosteroids (90.3%), vitamins (89.7%) and empirical antibiotics (85.6%) were the commonly used therapeutics. Ivermectin (33%), convalescent plasma (28.6%) and favipiravir (17.6%) were other antiviral agents used. Methylprednisolone (50.2%) and dexamethasone (44.1%) were preferred corticosteroids and at a dose equivalent of 8 mg of dexamethasone phosphate (70.2%). There was significant variation among physicians from different medical specialities in the use of favipiravir, corticosteroids, empirical antibiotics and vitamins.

Conclusion: There is a considerable variation in the physicians' choice of therapeutic strategies for the management of severe COVID-19 in India, as compared with the available evidence.

Conflict of interest statement

All authors declare no conflict of interest related to this article.

© 2021 John Wiley & Sons Ltd.

Figures

FIGURE 1
FIGURE 1
Geographical distribution of the survey respondents. Colour scale represents the number of participants from respective state or union territory
FIGURE 2
FIGURE 2
Percentage of respondents using various therapeutics to manage severe COVID‐19. CP, convalescent plasma
FIGURE 3
FIGURE 3
Percentage distribution of the use of antiviral agents by participating physicians according to the severity level of COVID‐19. A, Based on hospital designation of participants. B, Based on participants' hospital type. C, Based on speciality of participants. Grey bar represents the p‐value using the chi‐square test for variation
FIGURE 4
FIGURE 4
Percentage distribution of the use of immunomodulators by participating physicians according to the severity level of COVID‐19. A, Based on hospital designation of participants. B, Based on participants' hospital type. C, Based on speciality of participants. Grey bar represents the p‐value using the chi‐square test for variation
FIGURE 5
FIGURE 5
Percentage distribution of the use of adjuvant therapies by participating physicians according to the severity level of COVID‐19. A, Based on hospital designation of participants. B, Based on participants' hospital type. C, Based on speciality of participants. Grey bar represents the p‐value using the chi‐square test for variation

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