Retrospective Drug Utilization Pattern of the Use of Antivirals and Its Outcome in Hospitalized COVID-19 Patients in a Tertiary Care Hospital in Mumbai From July to October 2020

Background The initial recommended treatment at the start of the COVID-19 pandemic in India included isolation, symptomatic treatment, oxygen support, empirical antibiotics, and hydroxychloroquine prophylaxis. However, evolving guidelines and limited evidence on antiviral efficacy highlighted a gap in evidence-based treatment approaches. Recognizing this gap, a study was planned to assess the antiviral impact at our institute. We aimed to study the prescription pattern of antivirals in hospitalized COVID-19 patients over four months and analyse the influence of age, gender, antiviral use, comorbidities, and oxygen requirement on outcomes: clinical improvement and hospital stay duration. Methods This retrospective observational single-centre study included reverse transcription-polymerase chain reaction (RT-PCR)-confirmed COVID-19 patients who were hospitalized and received remdesivir, favipiravir, ivermectin, or oseltamivir. Descriptive statistics were analysed using Microsoft Excel 365 (Microsoft® Corp., Redmond, WA). Multiple linear regression and logistic regression models were used with JASP 0.16.3 software. Results Among 400 patient prescriptions, 5,172 drugs were recorded: 542 repurposed antivirals and 4,630 concomitant drugs. Ivermectin (376, 69.37%) was the most frequently prescribed antiviral, followed by remdesivir (97, 17.9%), favipiravir (59, 10.89%), and oseltamivir (10, 1.85%). Nutritional supplements (1536, 33.1%) were the most common concomitant drug class, with vitamin C being the most prescribed. Logistic regression showed that male gender and oxygen therapy were positively associated with clinical improvement. Linear regression revealed that older age and higher disease severity correlated with longer hospital stays. Antiviral use showed no significant association with either disease improvement or duration of stay. Conclusion Ivermectin and remdesivir were the two most frequently used repurposed antivirals. While male gender and oxygen therapy were linked with clinical improvement, older age and severe disease predicted longer hospitalization. Antivirals themselves did not significantly affect outcomes, underlining the complexity of COVID-19 management.