Govt reviews use of HCQ and antibiotic combo in treating coronavirus cases

According to the health ministry’s current clinical management protocol for Covid-19, which was revised on March 3, hydroxychloroquine in combination with azithromycin can be used for patients with severe disease and requiring intensive care unit (ICU) management.

The Union health ministry is reviewing use of anti-malarial drug hydroxychloroquine (HCQ), in combination with antibiotic azithromycin, for treating coronavirus disease (Covid-19) on patients in India, and is likely to come up with revised clinical management guidelines for this soon.

According to people familiar with the matter in the health ministry, HCQ is likely to remain as a part of the treatment protocol but azithromycin could be dropped; instead a different combination of medicines that have been allowed for restricted use by the central drugs controller might be tried.

“Health ministry has been reviewing the evidence in favour and against HCQ from all over the world. In the recent group of ministers’ meeting also ICMR presented its views on the medicines currently having shown promise in Covid treatment, including remdesivir and favipiravir. HCQ most likely is going to be continued for use but with probably a different combination. Ministry is looking into it and should soon take a call,” added one ministry official, who asked not to be identified.

According to the health ministry’s current clinical management protocol for Covid, which was revised on March 31, HCQ in combination with azithromycin can be used for patients with severe disease and requiring intensive care unit (ICU) management.

The recommended dosage for HCQ is 400mg twice a day for 1 day, followed by 200mg twice a day for 4 days, and for azithromycin the ministry has recommended 500 mg once a day for 5 days.

The combination, however, is not recommended for children under the age of 12 years, pregnant and lactating women.

“Since there was no other therapeutic option available after combination of antivirals originally in use for HIV/AIDS lopinavir–ritonavir was discontinued for use among Covid patients in March, this combination of HCQ and azithromycin is being given to severely ill patients currently in hospitals across the country on experimental basis. As other medicines have now shown promise against the virus it makes sense to review the evidence and revise the treatment protocol,” added the official.

The jury is still out on HCQ. One international study says it doesn’t serve as a therapeutic or as a prophylactic after exposure to the infection. However, a study by the Indian Council of Medical Research suggests that it works as a prophylaxis pre-exposure.

An expert working with the government says, “In situations like an outbreak, when you don’t have the luxury of conducting randomized clinical trials for paucity of time, you recommend a medicine after looking at whatever data is available globally. However, if a medicine is recommended then as per protocol, you need stronger evidence against it to withdraw its use. As of now the evidence is weak, and HCQ because of its safety and efficacy track record is our best bet that can be easily given even at grassroots level in primary health centres.”

Doctors treating Covid patients afree that more data is required to reach a definite conclusion.

“We need more research on HCQ to be able to tell conclusively whether it is working or not. Its use is not banned as of now,” said Dr Yatin Mehta, chairman, critical care division, Medanta Hospital, Gurugram.