Western Cape begins treating COVID-19 patients with “breakthrough” drug

The Western Cape provincial health department has officially advised hospitals in the province to treat patients suffering from COVID-19 with dexamethasone.

Dexamethasone is a steroid which was labelled as the “breakthrough” drug for the treatment of seriously ill COVID-19 patients who are in ICU and on oxygen or ventilators.

A circular sent out by the provincial health department outlined its official position on the use of dexamethasone and other steroids in the management of COVID-19 patients.

“We recommend steroids in all patients with COVID-19 who are admitted to hospital and who need supplemental oxygen,” the department said.

“Steroids should only be used for adult patients with confirmed or high clinical likelihood of COVID-19 who are admitted to hospital and require supplemental oxygen, in the absence of existing risk factors for adverse events.”

It noted that this position is subject to further changes as data becomes available from the University of Oxford’s Recovery Trial.

The department provided the following guidelines to hospitals for treating COVID-19 patients with steroids in South Africa:

  • Steroids should not be started in the outpatient environment: they are only for admitted patients on oxygen.
  • Steroids should not be started in the Emergency Centre unless discussed with a senior clinician or inpatient team.
  • Always seek senior clinical input in patient care decisions, through your usual supervisory pathways.
  • Follow usual clinical pathways regarding steroids in COVID-19 patients with chronic lung disease.
  • There are risks associated with short-term use of high dose steroids, including hyperglycaemia, electrolyte abnormalities, neuropsychiatric reactions, hypertension, fluid retention and susceptibility to co-infections. Monitor glucose, electrolytes and fluid status. Always aim to balance potential benefit and potential harm in clinical judgement.

Steroid treatment

The department said that treatment with steroids (either Dexamethasone IV or Prednisone) can be commenced upon the admission of a qualifying patient.

The recommended dosage for 10 days of treatment is 8mg of Dexamethasone IV once per day for ICU patients only.

Alternatively, the following may be prescribed:

  • 40mg Prednisone orally once daily
  • 80mg Hydrocortisone intravenous twice daily
  • 6mg Betamethasone intravenous once daily
  • 32mg Methylprednisolone oral or intravenous once daily
  • 6mg of Dexamethasone orally once daily

“The use of steroids has been approved for use on our clinical platform in line with international recommendations and the MAC recommendations,” the Western Cape health department confirmed to MyBroadband.

“This will have a positive impact on the clinical outcomes of patients infected with COVID-19.”

“These steroids will be used for ventilated patients and those on high flow nasal oxygen,” he said.

“Breakthrough” drug

Dexamethasone is a steroid that has been used since the 1960s to reduce inflammation in a range of conditions, including inflammatory disorders and certain cancers.

It has been listed on the WHO Model List of Essential Medicines since 1977 in multiple formulations and is currently off-patent and affordably available in most countries.

For patients on ventilators, the treatment was shown to reduce mortality by about one third, and for patients requiring only oxygen, mortality was cut by about one fifth.

“This is the first treatment to be shown to reduce mortality in patients with COVID-19 requiring oxygen or ventilator support,” said Dr Tedros Adhanom Ghebreyesus, WHO director-general.

“This is great news and I congratulate the Government of the UK, the University of Oxford, and the many hospitals and patients in the UK who have contributed to this lifesaving scientific breakthrough.”

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Western Cape begins treating COVID-19 patients with “breakthrough” drug