Enoxaparin most-used drug for Covid-19 in hospitals

Covid-19 patients are now receiving symptomatic treatment with no safe and effective drugs available as yet.

Physicians are commonly prescribing enoxaparin to treat moderate patients who are hospitalised with breathing problems, a number of doctors engaged in Covid-19 treatment said.

However, many patients at home are taking another drug named ivermectin without it being prescribed by a doctor, they said.

Novel coronavirus patients are divided into three categories on the basis of the severity of the illness – mild, moderate and severe. Only moderate patients come to hospitals and they are given supportive treatment.

Oxygen and enoxaparin, an anticoagulant drug that helps prevent blood clots, are given to Covid-19 patients as a supportive treatment at almost all hospitals. Many hospitals use remdesivir to treat patients with severe conditions.

Prof Dr Titu Miah, principal of Mugda Medical College, told The Business Standard, "Most cases are mild and we give them symptomatic treatment with paracetamol and antihistamines. We give oxygen and blood thinners only to those who are admitted to hospital."

"Additionally, we use remdesivir as an antiviral only for severe cases. Otherwise, we do not suggest antivirals because there is no extensive research that antivirals work. We do not give favipiravir to our patients," he added.

Professor Dr ABM Abdullah, noted medicine specialist and member of the national advisory committee on Covid-19 and Prime Minister's personal physician, told the Business Standard that different drugs are used for different people. "Most drugs are administered to remove blood clots. Many patients are given favipiravir and remdesivir. Plasma therapy is also being given," he added.

"The patients with mild symptoms, who receive treatment staying at home, usually take ivermectin. This drug does not work on those who are admitted to hospitals with moderate and severe conditions," said Prof ABM Abdullah.

He advised that individuals not take medicine without a doctor's advice. "The doctor will decide on which medicine needs to be taken and what the dose will be," he said.

The treatment of Covid-19 patients has begun at Shaheed Suhrawardy Medical College and Hospital. The hospital is treating the patients as per the National Guidelines on Clinical Management of Coronavirus Disease-2019.

Dr Tonmoy Mahmud, assistant registrar of the medicine department at Shaheed Suhrawardy Medical College and Hospital, told The Business Standard that patients with mild symptoms who do not have comorbid conditions recover within 10 days. They are given zinc and calcium.

Those who have pneumonia are given favipiravir, an antiviral drug. Patients with moderate symptoms and respiratory distress are given Remdesivir injections, he added.

"We do not have a [novel] coronavirus-dedicated intensive care unit (ICU) here. So, we cannot provide ICU support to the patients who need it," said Dr Tonmoy.

"Remdisivir, insulin, enoxaparin 6, certiaxone, meropenem and all IV fluids are being used for the ICU patients' treatment," said Dr Asadul Mazid Nomaan, a physician at the ICU department of Mugda General Hospital.

He said earlier remdesivir was used more frequently depending on its stock. Dexamethasone steroids are also being given if necessary.

Professor Sayedur Rahman, chairman at Department of Pharmacology of Bangabandhu Sheikh Mujib Medical University (BSMMU), said in addition to the national treatment guidelines, there are some hospitals which are also treating Covid-19 patients in accordance with their own treatment procedures.

"Almost all Covid-19 patients in the hospital are receiving oxygen and taking enoxaparin," he added.

"We are following our own treatment guidelines in our hospital. Neither favipiravir nor ivermectin are given to the patients in the hospital because the drugs are not included in our guidelines. Some 70-80 percent of government hospitals are following the national guidelines for Covid-19 treatment. All hospitals are recommending vitamin E, D, Zinc beyond the guidelines," he said.

Professor Sayedur Rahman said some hospitals, where rich patients go to receive treatment, excessively use expensive drugs. Favipiravir and remdesivir are being used in those hospitals.

The use of favipiravir has increased over the last ten days. Its usage has increased since the publication of research results by the Society of Medicine.

Professor Sayedur Rahman, also chairman of Bangladesh Pharmacological Society, said promoting the name of medicine for personal gain is not ethical. After knowing the name of the medicine, people buy and take it by themselves. The patients at home are taking ivermectin. Millions of people across the country have taken it like puffed rice.