Since there is no approved vaccine or treatment for the novel Coronavirus, many doctors have been using a combination of hydroxychloroquine and azithromycin to treat COVID-19 patients. But a panel of experts convened by the National Institute of Allergy and Infectious Diseases recommends against the use of the cocktail of these two drugs due to potential toxicities.
The panel stated that the combination of hydroxychloroquine and azithromycin was associated with QTc prolongation, which increases the risk of sudden cardiac death, in Coronavirus patients.
The use of hydroxychloroquine and azithromycin combination
The recommendation against the use of the cocktail of these two drugs came after US President Donald Trump suggested that the combination might be helpful and repeatedly touted the use of the drugs during televised coronavirus task force briefings from White House.
On March 21, he tweeted that "HYDROXYCHLOROQUINE & AZITHROMYCIN, taken together, have a real chance to be one of the biggest game changers in the history of medicine. The FDA has moved mountains - Thank You! Hopefully they will BOTH (H works better with A, International Journal of Antimicrobial Agents)."
On March 31, he said that "I think it's not a bad idea to do it, but that's up to the doctors," and later on April 3 without having any evidence to back his own comments, Trump said:
What do you have to lose? And a lot of people are saying that when — and are taking it — if you're a doctor, a nurse, a first responder, a medical person going into hospitals, they say taking it before the fact is good. But what do you have to lose? They say, 'Take it.' I'm not looking at it one way or the other, but we want to get out of this.
If it does work, it would be a shame if we didn't do it early. But we have some very good signs. So that's hydroxychloroquine and azithromycin.
On the other hand, the panel of experts said that there was "insufficient clinical data to recommend either for or against" the use of hydroxychloroquine or chloroquine alone. The panel has produced a set of guidelines for doctors to use in treating Coronavirus patients. The guidelines are agnostic about the use of experimental drugs while pointing out that there is a lack of strong scientific evidence to make a conclusion one way or the other.
The panel, which convened by the NIH Institute that Dr Anthony Fauci directs, recommended against using Lopinavir/ritonavir or other HIV protease inhibitors after the clinical trials showed negative results. It also advised not to use interferon because it seemed to make patients with SARS and MERS worse.
The NIH panel recommendation against drug cocktail
The experts in the NIH panel said that there are very less information and evidence to recommend any kind of treatment to prevent the novel Coronavirus infection or to minimize the symptoms in those who are already infectious. However, the recommendation could change based on clinical trials currently underway.
It should be mentioned that both hydroxychloroquine and convalescent serum are being studied for the possible use for prophylaxis. But the result of the trials is not available.
Based on the available research results the guidelines will be changed or updated. Dr Susan Swindells, a professor in the department of internal medicine at the University of Nebraska College of Medicine said there could be an update about the recommendations regarding promising anti-viral drug, remdesivir, developed by Gilead Sciences- in the coming week or so.