In open letter, 30 doctors issue appeal against use of ‘unwarranted medications, diagnostics’

The doctors, including Dr Anant Bhan, Dr Rajani Bhat, Dr Anjali Chhabria, Dr Sonia Dalal, Dr Bharat Gopal, Dr Richa Gupta, Dr Raghuraj Hegde, Dr Tushar Shah, Dr Zarir Udwadia, Dr Satchit Balsari, Dr Manoj Jain and Dr Madhukar Pai, have raised three critical issues, including “unwarranted medications”.

The vast majority of patients with Covid-19, with asymptomatic and mild symptoms, will require little to no medication. Most prescriptions we have reviewed in the past two weeks include several Covid-19 “kits” and cocktails, they said.

Prescribing vitamin combinations, azithromycin, doxycycline, hydroxychloroquine, favipiravir, and ivermectin for treating Covid-19 is irrational practice, they said. Such wanton use of drugs is not without harm as the Delta wave has shown, the letter has said.

Outbreaks of opportunistic fungal infections like mucormycosis in India, and aspergillosis in Brazil were attributed to the widespread abuse of inappropriate medications, they said.

The doctors also raised the issue of “unwarranted tests”.

The vast majority of Covid-19 patients will need no additional diagnostics after the initial positive rapid antigen or RT-PCR test, except for home monitoring of their oxygen level in some cases, they said. There is also growing evidence that while Omicron may cause many breakthrough cases among previously infected or previously vaccinated populations, the morbidity and mortality associated with the disease among them will be lower, they added. Yet, CT scans and a battery of laboratory tests like D-dimer and IL-6 are routinely being prescribed by practitioners in asymptomatic and mild cases, placing undue financial burden on families, the doctors have said in the letter.

The doctors have also raised the issue of “unwarranted hospitalizations”.

“Unnecessary hospitalisations besides further adding to the financial load, risk the lives of hundreds of thousands of other, non-Covid patients who cannot find a hospital bed for more emergent conditions,” they said.

Health care workers in India rely heavily on government guidelines which had “unfortunately promoted expensive diagnostics and medications with limited evidence”, they said. “We believe it is incumbent on state agencies and on professional medical societies to put an end to this travesty, in the best interest of the nation,” they added.

Doctors have urged central and state governments to update the evidence-based June 2021 DGHS guidelines. They have, in particular, asked to be provided specific guidance on the use of monoclonal antibodies, given their “limited efficacy” for the Omicron variant, and their continued widespread use.