The expert collegium for PHI University Clinic for Pulmonology and Allergology and the covid-centers in the internist block, prepared an opinion on the use of the drug ivermectin in patients infected with covid-19. The protocol was sent to the family doctors through the Medical Chamber. The Ministry of Health appeals that its application should be exclusively under medical supervision, whether it is home treatment or hospitalization. Doctor Lilija Cholakova Dervishova for "Free Press" states that the family doctors asked the Ministry of Health to submit protocols for three situations during the issuance and treatment with ivermectin, because the demand for this drug began immediately.

Dr. Cholakova Dervishova, a protocol has already been sent to the family doctors for treatment with ivermectin. What does the protocol cover? In what dose and how should ivermectin be used, ie how much should be taken by the one who had contact with the patient, and how much infected with covid-19?

- A new drug ivermectin was introduced in our country - a drug that has shown efficiency in the world in destroying the coronavirus. However, the family doctors did not have protocols for this, so we asked the Ministry of Health to immediately submit protocols for three situations, because the patients immediately started asking us to prescribe it to them with a pink prescription.
We needed to have a protocol on how to give it, in what dose and for how many days in patients who are chronically ill and at the slightest contact with a patient with covid-19 - how to react, second moment - how to act at the beginning of the disease and third case - how to act if it appears in our country, and there are already complications with bronchopneumonia.

Last week we received an email from the Medical Chamber protocols prepared by the Clinic for Pulmonology and Allergology. The protocol clearly states that in patients who have been in contact with a coronavirus patient, it is necessary to take 12 milligrams of ivermectin in a single dose.

The protocol states that 12 milligrams per week should be taken preventively, ie 4 tablets if someone has been in contact with a patient, but still has no symptoms.

In patients who already have symptoms, this drug is dosed 0,2 mg per kilogram of body weight. And in patients who are sick, it is necessary to give this dose with a repetition after 24 hours.

What is the primary use and effect of ivermectin, and what is the effect of the new coronavirus?

- Ivermectin is an antiparasitic drug and it is its primary use, but in numerous studies around the world it has been shown to affect the destruction of the virus and stop its multiplication in the body. Ivermectin has been shown to be highly effective in combination with vibramycin.

To which patients can GP prescribe ivermectin for use? Is there a risk group among patients with covid-19, who, however, should not take the drug ivermectin?

- The family doctor can prescribe the medicine on a private prescription. So far, no specific contraindications have been recorded. No studies have been performed in young children and pregnant women, but like any medicine, ivermectin should not be given to pregnant women up to the third month of pregnancy.

Has interest in this drug grown? Do ivermectin prescriptions require people who have not been infected with covid-19 at all?

- These days there is a demand for this drug, but not to a large extent. We clearly explain to the patients that we will prescribe the medicine where it is needed and that this medicine is not for everyday use. Drugs are not candy, every drug cures one health condition, but it can also have side effects on another system in the body.

During the Covid-19 pandemic, what are the biggest obstacles for GPs to communicate, treat and dispense prescriptions and refer patients?

- For the entire period with the coronary crisis or during this pandemic, the family doctors took on a great responsibility, and most of the patients who were positive for covid-19 were treated through us. PCR testing appointments also go through the primary care physician, infectious disease ward appointments, ambulance calls, saturation measurements - all accommodation management for critically ill patients goes through the family doctor. Surveying patients who were numerous and receiving treatment at home also took two hours each day to be on the phone. We asked the HIF to make a co-referral so that coronavirus patients could be examined in one place. To check blood count, X-ray, CRP, D-dimers, LDH. We got that recently as an option. There was a great need for patients who were positive for covid-19, and who are at home, to have occasional tests. Only in that way, the family doctor would be able to guide them properly and react in a timely manner.

All health must return to normal function, because it is not just a corona as a diagnosis, there are other pathologies, such as hypertension, cerebral ischemia, heart attacks, malignancies, autoimmune diseases… The number of specialist terms should be increased and we must work as a state of rapid diagnosis of diseases. Get to the diagnosis in 24 hours. By not having appointments through My appointment, precious time is lost for many diagnoses.

We must all together as a medical profession, HIF, MOH and the Medical Chamber make changes in the regime of prescribing drugs, to introduce new drugs on prescription and at the expense of the HIF, the people who regularly pay for health insurance, to have better treatment. Do not buy a large number of drugs in private, as is now the case - there is no klexan and you have to buy xarelto in private. To work on the introduction of telemedicine, primary health care to have more time to learn new methods of treatment and more time for the patient. To make complete e-health, without paper, simply to move forward, to have satisfied patients and satisfied doctors.

The protocol states that 12 milligrams per week should be taken preventively, ie 4 tablets if someone has been in contact with a patient, but still has no symptoms. In patients who already have symptoms, this drug is dosed 0,2 mg per kilogram of body weight. And in patients who are sick it is necessary to give this dose with a repetition after 24 hours.

"We clearly explain to the patients that we will prescribe the medicine where it is needed and that this medicine is not for everyday use. Drugs are not candy, every drug cures one health condition, but it can also have side effects on another system in the body.", Says the doctor Lilija Cholakova Dervishova.