Centre reviews use of HCQ and antibiotic combo in Covid cases

The Union health ministry is reviewing the use of antimalarial drug hydroxychloroquine (HCQ), in combination with antibiotic azithromycin, for treating Covid-19 patients and is likely to come up with revised clinical management guidelines.

According to people familiar with the matter in the health ministry, HCQ is likely to remain as part of the treatment but azithromycin could be dropped; instead a different combination of medicines might be tried.

“Health ministry has been reviewing the evidence in favour and against HCQ. 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 but with a different combination,” said one ministry official.

According to the health ministry’s current protocol for Covid, HCQ in combination with azithromycin can be used for patients requiring intensive care. The recommended dosage for HCQ is 400mg twice a day for a 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 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, this combination is being given on experimental basis. As other medicines have now shown promise it makes sense to review it,” 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. However, an ICMR study suggests that it works as a prophylaxis pre-exposure.

An expert with the government said, “When you don’t have the luxury of conducting randomised clinical trials, 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 it. HCQ, because of its safety and efficacy track record, is our best bet.”

Doctors patients say they need more data.“we need more research on HCQ to be able to tell whether it is working or not. Its use is not banned as of now,” said Dr Yatin Mehta, chair, critical care division, Medanta Hospital.