In vitro research suggests hydroxychloroquine, alone or in combination with azithromycin, may be an effective treatment for COVID-19. A small study from France involving 26 patients (and other significant study design limitations) has explored this treatment and reported reduced time to resolution of viral shedding of COVID-19. In a vacuum of other leads that are available to manage the infection, much attention has focused upon this small study and the attention has become politicized in some circles. The drugs are being adopted for treatment purposes worldwide, many argue without adequate evaluation rigor.

Regardless of the debate about the efficacy of these drugs, attention is now turning more frequently to the matter of safety. Individual or concurrent use of chloroquine, hydroxychloroquine and azithromycin must be carefully considered as all three medications cause QT prolongation and potentially increase the risk of arrhythmic death. There are complex considerations:

–       Treatment using these medications for acute COVID-19 infection usually has a short duration of 5-10 days
–       The increased risk of arrhythmic death may be smaller than the potential therapeutic benefit for some patients
–       Accelerating viral clearance of COVID-19 may result in significant population-health benefits

Based on this information, an piece published in the American College of Cardiology Magazine suggests chloroquine and hydroxychloroquine use should be limited to clinical trials or registry until adequate evidence is available to use in clinical practice. The article, which can be viewed here, also outlines safety considerations and recommendations for monitoring inpatient and outpatient clinical use, as well as protocol alterations if limited resources or quarantines were to occur. There is a particularly useful table for risk factor stratification and other useful practical guidance for clinicians dealing with this issue.

Contributed by Australian Medication Safety Services Associate – Isabella Singh