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

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

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.