#256 Hydroxychloroquine with or without azithromycin for COVID-19
CLINICAL QUESTION
Is hydroxychloroquine (with or without azithromycin) effective in treating COVID-19?
BOTTOM LINE
One nonrandomized study found that more hydroxychloroquine/azithromycin patients tested negative for virus at days 3 and 6 but clinical outcomes were not reported. One unblinded randomized trial showed no effect from hydroxychloroquine on viral or clinical outcomes. Without further evidence, hydroxychloroquine is not appropriate for patients with COVID-19 in primary care.
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EVIDENCE
One non-blinded randomized study in China (30 in-patients, mean age 48).1
- Hydroxychloroquine 400 mg daily for 5 days was given to one group and both groups received conventional treatments.
- Number with negative PCR nasopharyngeal swab:
| Day 7 | Adverse effects (examples diarrhea and elevated aspartate aminotransferase) | |
| Control | 14/15 (93%) | 3/15 |
| Hydroxychloroquine | 13/15 (87%) | 4/15 |
-
- Median time to temperature normalization was 1 day in each group.
- All patients survived.
- Limitations: not blinded. Much of the text was in Chinese.
- Number with negative PCR nasopharyngeal swab:
| Day 3 | Day 6 | |
| Control | 1/16 (6%) | 2/16 (13%) |
| Hydroxychloroquine | 5/14 (36%) | 8/14 (57%) |
| Hydroxychloroquine + Azithromycin | 5/6 (83%) | 6/6 (100%) |
- There are no studies evaluating the use of hydroxychloroquine to prevent COVID-19 infection.
- At least 23 other clinical trials currently in progress.3
- Both azithromycin and hydroxychloroquine are associated with an increased risk of sudden cardiac death from QT prolongation.4
- Applying early data, when we really need treatments and hope, is challenging. However, interventions that have not been verified to provide clinical/symptomatic benefits for hospitalized patients with COVID-19 are unlikely to benefit patients in primary care.
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