**16. Drugs used in COVID-19 and cause of MODS**

Various drugs are used in COVID-19 which can alter immunity, can cause organ damage like acute liver and kidney injury, may lead to electrophysiological disturbances in heart and can contribute to pre-existing MODS or may become the risk factor [9]. Tocilizumab (TCZ), a monoclonal antibody which inhibits the interleukin-6 receptor may predispose COVID-19 patients to secondary infections [123]. Tocilizumab (TCZ) can cause liver dysfunction, lead to induction and reduction of cytochrome P450 enzyme and can cause allergic reaction apart from secondary infection [124, 125]. Use of HCQ and Azithromycin may be responsible for QT prolongation, which can in turn lead to torsades' de pointes [126]*.* Use of

corticosteroids in COVID-19 patients can also induce secondary bacterial and fungal infections and such patients may need more antibiotic coverage [127]. It is imperative to see the drug contribution in MODS of COVID-19 infections.
