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LETTER TO THE EDITOR
Year : 2020  |  Volume : 18  |  Issue : 3  |  Page : 266-267

Hydroxychloroquine as a prophylactic agent for Covid-19


1 Department of Medicine, GMC, Srinagar, Jammu and Kashmir, India
2 Department of Pharmacology, GMC, Srinagar, Jammu and Kashmir, India

Date of Submission19-Apr-2020
Date of Decision04-May-2020
Date of Acceptance23-May-2020
Date of Web Publication10-Jul-2020

Correspondence Address:
Dr. Irfan Yousuf Wani
Department of Medicine, GMC, Srinagar, Jammu and Kashmir
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cmi.cmi_57_20

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How to cite this article:
Wani IY, Mehraj I. Hydroxychloroquine as a prophylactic agent for Covid-19. Curr Med Issues 2020;18:266-7

How to cite this URL:
Wani IY, Mehraj I. Hydroxychloroquine as a prophylactic agent for Covid-19. Curr Med Issues [serial online] 2020 [cited 2020 Aug 12];18:266-7. Available from: http://www.cmijournal.org/text.asp?2020/18/3/266/289421



Till date, there is lack of evidence for approving a drug as a prophylactic agent for COVID-19. However, on March 22, 2020, the National Task Force for COVID-19 constituted by the Indian Council of Medical Research recommended the use of hydroxychloroquine (HCQ) for prophylaxis of SARS-CoV-2 infection for high-risk population, which included asymptomatic healthcare workers involved in the care of suspected or confirmed cases of COVID-19.[1] The dose recommended was 400 mg twice a day on 1st day, followed by 400 mg weekly for 7 weeks. This advisory was based on somein vitro studies which had shown HCQ to be effective against coronavirus.[2],[3] The same was shown in one small nonrandomized clinical study also.[4] However, some other trials have shown no benefits with this drug.[5],[6]

After 3 weeks of the recommendation, we did an online survey in our region, i.e., Union Territory of Jammu and Kashmir, after taking approval from our institutional ethical clearance committee, to see how many doctors have accepted this recommendation and whether those who had taken HCQ had any side effects. One hundred doctors accepted and gave informed consent to take part in this online survey. Of 100 doctors, only 37 had started taking HCQ. Of 63 doctors who did not take HCQ, 24 said that there was lack of evidence in favor of HCQ, 17 said that they did not take as they were afraid in view of the side effect profile, especially QT prolongation, 16 were not involved in the management of COVID 19 patients, whereas rest said that they did not take HCQ as it was not recommended by the USFDA. Thirty out of 37 doctors who had started HCQ took the medication only after discussing with their colleagues, whereas the rest of seven said that they took it believing that something was better than nothing. Side effects were reported by eight doctors, which included loose motions in three, itching in three, gastritis in one, and myalgia in one. Because of these side effects, five doctors modified the dose on their own by either decreasing the second dose by half or increasing the duration between the first two doses. After doing this survey, we came to the conclusion that recommendations even if given by national healthcare bodies will be accepted by majority of the doctors only if backed by evidence even if such recommendations come when nothing else is available. Second, that gastrointestinal symptoms are the main side effects of HCQ. Till date, none of these doctors have tested positive for COVID-19. Now, whether HCQ does help anyone among the group of doctors who have taken HCQ or not only time will tell.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
2.
Liu J, Cao R, Xu M, Wang X, Zhang H, Hu H, et al. Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro. Cell Discov 2020;6:16.  Back to cited text no. 2
    
3.
Yao X, Ye F, Zhang M, Cui C, Huang B, Niu P, et al.In vitro antiviral activity and projection of optimized dosing design of hydroxychloroquine for the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Clin Infect Dis 2020. pii: ciaa237.  Back to cited text no. 3
    
4.
Gautret P, Lagier JC, Parola P, Hoang VT, Meddeb L, Mailhe M, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: Results of an open-label non-randomized clinical trial. Int J Antimicrob Agents 2020:105949.  Back to cited text no. 4
    
5.
Paton NI, Lee L, Xu Y, Ooi EE, Cheung YB, Archuleta S, et al. Chloroquine for influenza prevention: A randomised, double-blind, placebo controlled trial. Lancet Infect Dis 2011;11:677-83.  Back to cited text no. 5
    
6.
Ooi EE, Chew JS, Loh JP, Chua RC.In vitro inhibition of human influenza A virus replication by chloroquine. Virol J 2006;3:39.  Back to cited text no. 6
    




 

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