• Tue. Oct 26th, 2021

Covid: fundamental home therapy, no to cortisone and antibiotics


May 5, 2021

Managing the Covid-19 patient at home is central in this pandemic, which is putting a strain on hospitals. But in order to fully exploit the potential of territorial medicine it is necessary to follow standardized, homogeneous and integrated protocols. For this reason, it is essential that the operators responsible for managing the Covid-19 patient in the home keep up with the latest – and constantly updated – strategies for assistance, monitoring and care in the home. This is the objective of the Ecm professional training course of Health In-Training for Consulcesi Club entitled: “The management of the Covid-19 patient in the home context”. “Patient management at home is essential to reduce the pressure on hospitals”, confirms Emanuele Nicastri, director of the highly infectious and highly contagious infectious diseases division of the ‘Lazzaro Spallanzani’ National Institute for Infectious Diseases in Rome and teacher of the Ecm course. “But you have to be careful to do it properly, first of all avoiding the use of drugs that should only be prescribed in hospitals,” he adds. Yet, more than a year after the start of the pandemic, there are still today inappropriate medical prescriptions which, instead of helping patients, risk worsening their situation. “For example, it is necessary to avoid prescribing cortisone, antibiotics and heparin as a treatment for the home management of the Covid-19 patient”, emphasizes Nicastri. “We have evidence – he continues – that the use of cortisone in patients who do not need oxygen is harmful. There is a 19% increase in mortality. Cortisone, in fact, prolongs the viral phase and hides the symptoms. It makes us lose sight of the drop in saturation which is a fundamental parameter for deciding on hospitalization “. Cortisone is in fact part of the treatments that, in the management of the Covid-19 infection, must be provided in the hospital, as well as heparin. The antibiotic should also be avoided. “Why should we imagine bacterial coinfection in a Covid-19 patient?” Says Nicastri. “Only 8% of patients have a bacterial condition and at home this percentage is even lower”, he adds. The management of the Covid-19 patient in the home – reads a note – is largely based on non-pharmacological interventions, as indications on lifestyles, ways of behaving for isolation, for breathing, quarantine, etc. General practitioners and pediatricians of free choice, when they become aware of a case among their patients, must take on different tasks, in the performance of which they have the right to involve the Special Continuity of Care Units (Usca) , whose purpose is to work in collaboration with family doctors and pediatricians in the home management of patients in quarantine or isolation.Daily remote monitoring of the conditions of patients in isolation is essential, since about 10-15% of mild cases degenerate into severe forms of the disease. For his part, the patient must also be instructed, where possible, to self-monitor a very important parameter, namely that of oxygen saturation, a lowering of which indicates an increase in the negative course of the disease and a poor prognosis. Along with saturation, the patient can also check heart rate. Among other home interventions, in addition to drugs used to control symptoms, good hydration and nutrition is recommended, and eventually the patient can be instructed to pronation to promote oxygenation.