PUNE: Methylene blue, a century-old blood-pressure booster and a precursor to anti-malarial drug hydroxychloroquine, and anti-leprosy cure
Mycobacterium w have emerged as potential supportive (adjuvants) treatment for
patients with Covid-19, say several doctors from across the country.
While methelyne blue promotes oxygen saturation in the blood, mycobacterium w is being found effective in suppressing the release of inflammatory blood markers (particularly interleukin-6 or IL-6) and preventing multi-organ damage.
Doctors said the drugs, used as intravenous injections, have helped reduce hospitalization periods and significantly improved recovery rates.
Encouraged by the outcome, doctors have started using these drugs as potential therapeutics to counter hypoxia (oxygen deficiency in blood) and cytokine storm (abnormal immune response) — two main complications that Sars-CoV-2 has been causing in the human body.
Mumbai-based critical care expert Ujwala Mhatre of Nanavati hospital said, “We have used methylene blue in intravenous and nebulized form as a rescue measure in patients with persistent low oxygen saturation. Also, it is easily available and cost-effective.”
The drug helps prevent the effects of bradykinin and improves oxygen saturation. “Bradykinin is a
peptide that promotes inflammation in the blood,” she added.
Rajesh Mishra, Ahmedabad-based intensivist and president (elect) of the Indian Society of Critical Care Medicine, said, “Methylene blue as nebulizer has the potential to reduce lung fibrosis and improve outcome. Mycobacterium w is useful in managing early mild to moderate cases of Covid-19 infection by activating T helper cell. It should be used early.”
In the fight against Covid-19, doctors have been using an algorithmic approach to employ antivirals, immunomodulatory agents and anti-coagulation to counter the triple menace of rapid viral replication, organ dysfunction and thrombosis (blood clotting) seen in the infected patients.
“Our therapy is guided by the clinical, biochemical and radiological evolution of the disease process,” said Mumbai-based critical care expert Abdul Ansari, who is associated with Nanavati hospital.
Both drugs are being mainly used in patients with persistently low levels of white blood cells (lymphopenia or lymphocytopenia), rising inflammatory levels of interleukin 6 (IL-6), poor immune response, multiple co-morbidities and needed for life support.
“Mycobacterium w is like a TB vaccine that modulates the body’s own immunity to overcome the bad life-threatening effect of the infection like sepsis. I have been using it with quite impressive results in patients with Covid-19,” said Gurgaon-based intensivist Yatin Mehta, chairman of Medanta Institute of Critical Care and Anesthesiology
Mycobacterium w has been used successfully in moderate to severe patients with Covid-19 in Karnataka. The drug has been included as part of the state’s Covid management protocol in patients falling in the severe category.
“The outcome in patients for whom the drug has been administered is being collated to publish our data in a scientific journal,” said Bengaluru-based critical care expert Pradeep Rangappa, who is part of the Karnataka government’s task force on Covid-19.
Ruby Hall Clinic’s chief intensivist Kapil Zirpe said, “Early use of mycobacterium w can be considered as an add-on therapy in hypoxic Covid patients. Key to success is the timing of initiating the drug.”
The timing is crucial along with the selection of patients. “We found benefits of using methylene blue in nebulized patients, especially in those needing non-invasive ventilation. As adjuvants, they do the trick when used in combination with the standard antiviral and steroid medications,” said Sanjeevan hospital’s chief intensivist Subhal Dixit.
“The early use of mycobacterium w has been found beneficial in reducing hospital stay, secondary infection rate, and days on vasopressors (drugs meant for raising blood pressure),” said Dixit.