ICMR national protocol says no evidence of benefit of injectable steroids in patients not requiring oxygen

The revised clinical guidance for treatment of adult COVID patients by the Indian Council of Medical Research (ICMR) and (All Indian Institute of Medical Sciences (AIIMS) states that there is no evidence of benefit for injectable steroids in those not requiring oxygen.

The revised guidance updated on January 14 also warns of potential risk of fungal infections such as invasive mucormycosis, if anti-inflammatory or immunomodulatory therapies such as steroids when used too early, at higher dose or for longer than required.

The treatment protocol recommends use of steroids such as injectable methylprednisolone or dexamethasone two doses daily usually for a duration 5 to 10 days for both the moderate and severe hospitalised COVID patients. Indiscriminate use of steroids on COVID patients, in the second wave has been cited as one of the prominent reasons that led to thousands of life-threatening fungal infection called mucormycosis.


The revised protocol didn't include anticoagulation therapy for people with severe disease.

A patient is said to be having severe disease if his or her respiratory rate is greater than 30 per minute, having breathlessness and oxygen saturation levels of less than 90% on room air.

The last guidance issued on September 23, has recommended conventional dose low molecular weight heparin for severe cases, on condition that there should be no contraindication or high risk of bleeding. However heparin treatment has been retained for patients having moderate disease.

No new drugs were added to the revised protocol. Antiviral drug remdesivir and immunosuppressant tocilizumab were recommended for "off-label based on limited available evidence and only in specific circumstances".

Tocilizumab usage recommendation was slightly modified, allowing the drug to be preferably given with steroids. The drug has to be given preferably within 24-48 hours of onset of severe disease or ICU admission with significantly raised inflammatory markers CRP and/or IL-6.

The drug shouldn't be given to those having active tuberculosis, fungal, and systemic bacterial infection. The protocol also recommended longterm follow up for secondary infections such as reactivation of TB, flaring of herpes, among others.

As indicated by the COVID-19 National Task Force earlier, molnupiravir wasn't included in the protocol.