ABSTRACT
Objective: Though systemic corticosteroid is used for treatment of COVID 19, questions regarding the appropriate dose, duration and type of corticosteroid use still remain unanswered. This study aimed to address, whether choice of systemic corticosteroid significantly influences the clinical outcome of COVID 19 patients. Materials and Methods: Studies reporting the comparison between clinical outcome of dexamethasone and methylprednisolone in treatment of COVID 19 were searched from inception till April, 2021. Random-effect model was used. Odd’s ratio (OR) and 95% confidence interval was expressed. I 2 statistics used for test of heterogeneity. Result: Three studies with 373 patients (160 in dexamethasone group and 213 in methyl prednisolone group) were included. Though, statistically significant reduction in all-cause mortality with methyl prednisolone group in comparison to dexamethasone group (OR=1.80, 95%CI: 1.08 to 3.01, P=0.02) estimated, sub group analysis of observational studies did not support the finding (OR=1.60, 95% CI: 0.88 to 2.92, P=0.12). No significant difference in terms of need for invasive ventilator or intensive care unit (ICU) between the 2 groups. The grade of evidence was very low for both the outcomes. Conclusion and Relevance: In the present context, both dexamethasone and methyl prednisolone are equally effective in the management of COVID 19.
ABSTRACT
The concept of essential medicines was introduced in 1977 with the publication of the World Health Organization's (WHO) Model List of Essential Medicines. These medicines are intended to satisfy the priority health care needs of the population. They are selected with regard to public health relevance, evidence of efficacy and safety, and comparative cost-effectiveness. Essential medicines are intended to be available within the context of functioning health systems at all times in adequate amounts, in the appropriate dosage forms, with assured quality and at a price the individual and the community can afford. The WHO advises countries to adapt the essential medicines list according to their priority health care needs. The model list of WHO serves as a guide for the development of a national list of essential medicines (NLEM). An essential medicines list can serve as a model for procurement, local licensing and manufacturing, and the rational use of good-quality medicines, especially within the public sector. It also helps in allocating limited resources effectively and in a cost-effective manner.