Pharmacists have asked doctors to stop prescribing dexamethasone for Covid-19 patients undergoing home-based care, saying the medicine lowers immunity and increases the risk of developing severe disease.
The pharmacists also asked doctors to stop prescribing azithromycin, another drug recommended by the Ministry of Health for home-based care, saying it would worsen issues of antimicrobial resistance that the country is grappling with.
Dr Samuel Opio, the secretary of Pharmaceutical Society of Uganda (PSU), yesterday said dexamethasone should only be used on critically-ill Covid-19 patients.
“Dexamethasone is a steroid which has two effects. Its anti-inflammatory effect is useful in stopping symptoms such as flu by reducing mucus production. But its other effect is that it lowers immunity and yet for someone with mild disease, they have to boost their immunity,” Dr Opio said.
There are mild, moderate, severe and critical categories of Covid-19 disease. The patients with mild disease are the only ones recommended to undergo home-based care, according to the Health ministry.
Dr Stella Nanyonga, another pharmacist at PSU, said: “People are self-medicating with dexamethasone as prophylaxis for Covid-19. This is so wrong. Sadly, they buy this from authorised pharmacies and clinics...” she said in a tweet.
Dr Richard Idro, the president of Uganda Medical Association, is in support of limiting dexamethasone.
“Dexamethasone is a steroid and it lowers your immunity. So if you are incubating diseases such as tuberculosis, it will blow up,” he said.
When contacted, Dr Charles Olaro, the director of clinical services at the Ministry of Health, said they had not recommended dexamethasone for Covid-19 treatment at home, but declined to comment on how they are regulating the use.
In a statement sent by National Drug Authority (NDA) to Daily Monitor earlier, the authority warned that dexamethasone must only be prescribed by a doctor. Both Dr Opio and Dr Kyoyetera Kabbale from the PSU, said azithromycin, which is being recommended by the Ministry of Health for home care is a drug for treating bacterial infections and not viral diseases such as Covid-19.
Dr Kyoyetera wrote in a piece sent to this newspaper: “It is unethical to sell these antibiotics [Azithromycin] to asymptomatic [Covid-19] patients as a treatment for Covid-19 because it is doesn’t treat Covid-19 infection...”
“Also, Azithromycin is not recommended for prophylaxis in asymptomatic Covid-19 patients. It is argued that azithromycin maybe prescribed for prevention of bacterial infections,” he added.
Reacting to the argument of the pharmacists, Dr Jackson Amone, the commissioner of clinical services at the Health ministry, said the drug was recommended after a thorough assessment by a team of experts .
About 22,217 Covid-19 patients with mild disease are being treated from home due to the limited capacity of hospitals with only 1,099 patients admitted in hospitals, according to statistics from the Ministry of Health released on Tuesday.
Yesterday, the ministry reported 859 new cases, pushing the cumulative total to 74,260 and deaths to 752. A total of 50,085 people have recovered from the virus.