Evidence of hydroxychloroquine and azithromycin: quick breakdown

Much media buzz about these well known medications as possible COVID-19 treatments, particularly after an announcement by the president to increase availability.

In short, evidence is only preliminary from a study in France:

  • Design: non-randomized; controls were patients from a different center refusing the proposed treatment protocol
  • N = 20 patients with adequate follow-up (treatment group), hospitalized with confirmed COVID-19 by PCR (age > 12yr)
    • Exclusion criteria: retinopathy, G6PD deficiency, QT prolongation, breastfeeding, pregnancy
    • Note: 6 patients lost to follow-up in treatment group (26 originally), reasons included: death, ICU transfer, discontinuation from side effects (nausea)
    • “Control group” (untreated) n = 16
    • Even though some patients were asymptomatic (16%), all patients had pneumonia (on CT)
    • Mean age 45 years
  • End point: viral presence (nasopharyngeal swab) at day 6 of treatment
  • Result: virological “cure” at day 6 (p = 0.001):
    • Hydroxychloroquine group: 70%
    • Control group: 12.5% in the control group
  • Subgroup analysis of the hydroxychloroquine group showed virological “cure” at day 6 (“severe cases” were given azithromycin):
    • Hydroxychloroquine plus azithromycin combination: 100%
      • Notably significant reduction in viral load by day 3
    • Hydroxychloroquine alone: 57.1%
  • Interestingly, two of the hydroxychloroquine failures were seen in a mother and son (suggesting a pattern of resistance in the viral strain or host metabolism)
  • Limitations: non-randomized, open-label, small sample size, limited long-term outcome follow-up, significant dropout, unclear what the criteria was used for addition of azithromycin

Take home: these are promising, hypothesis-driving results. larger studies are being conducted to verify this effect in a rigorous clinical trial. Let’s hope the above hopeful results are validated.

Gautret et al. (2020) Hydroxychloroquine and azithromycin as a treatment of  COVID‐19: results of an open‐label non‐randomized clinical trial. International Journal of  Antimicrobial Agents – In Press 17 March 2020 – DOI : 10.1016/j.ijantimicag.2020.105949 

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5 thoughts on “Evidence of hydroxychloroquine and azithromycin: quick breakdown”

  1. We can use gloves, or sanitize after using ATM. But what about the $$$? How best to avoid what they might be carrying?

    1. Anytime we handle cash we should be washing our hands immediately afterwards. The current outbreak is an important reminder for us to always do so. Paper money certainly represents a vector of transmission for infectious disease!

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