Physicians must use best practices

Dear Dr. Roach: Is there a difference between COVID-19 treatment in academia vs. the real world? I had a telemedicine appointmentthe other day to seemy internist, and he said to call right away if I developed symptoms consistent with COVID. He would order tests for me and start me right away on hydroxychloroquine, doxycycline and zinc. Your thoughts, please.— B.R.

All physicians are obligated to stay abreastof current standards of care for the practice of medicine. With COVID-19, it can be hard to keep abreast of all the changes and the sometimesdata.

Hydroxychloroquine appeared to showbenefit in some early, uncontrolled studies, but the vast majority of the evidence has shown no benefit and significant potential for harmfor hydroxychloroquine.

Doxycycline is an antibacterial agent, and is used in people with COVID-19 and concurrent bacterial infections. It has been studied in early trials, it is anti-inflammatory as well and may have some antiviral effects. It may have a role in treatment, but it is not recommended for use until there are clear results.

Similarly, there are theoretical reasons why zinc might be effective, and people with zinc deficiency have suppression of the immune system. However, there are no data showing benefit of zinc treatment in people withCOVID-19.

Hydroxychloroquine has clear potential for harm, and some studies have shown worse outcomes in people with COVID-19 taking it. Zinc and doxycycline are both safe but unproven. At the beginning of the pandemic, I sawmany doctors, frustrated at the lack of treatment options, choose to try unproven medications out of a feeling they need to be doing something.

I would not follow the recommendation who recommends hydroxychloroquine.