Wednesday 25 March 2020

Hydroxychloroquine / Azithromycin

Are hydroxychloroquine and azithromycin an effective treatment for COVID-19?

The evidence is pretty poor at the moment, alas.
Aside from not adhering to an intent-to-treat design, here’s where the study is truly revealed to be crap.....

 But like Chicken Soup, it can't hurt, right? Welll..not usually... but sometimes it does hurt.

Hydroxychloroquine (trade name Plaquenil) is a derivative of chloroquine (trade name Aralen), a common antimalarial drug. Indeed, some of you reading this might well have taken chloroquine as prophylaxis to prevent malaria while traveling to tropical regions where the disease is endemic. It is also used to treat amoebic liver abscesses when other drugs used for such infections are not working. These drugs also mildly suppress the immune system, which is why they are used as part of the treatment of some autoimmune disorders, such as lupus erythematosis or rheumatoid arthritis.

One thing that should be understood is that these are not entirely benign drugs. They have a number of side effects and adverse reactions. In addition to more mild side effects, such as nausea, headache, loss of appetite, and diarrhea, there are two more severe potential side effects. One is that long term use of these drugs can damage the retina and lead to macular degeneration, which is why patients taking these drugs long term need regular ophthalmological examinations. They can also affect the heart by prolonging the QT interval and also lead to drug-induced torsade de pointes, a potentially lethal ventricular tachycardia.

The other drug in the combination, azithromycin (trade names Zithromax, Azithrocin, and others), is a common antibiotic, used to treat a number of infections, ranging from ear infections, to strep throat, pneumonia, and a number of sexually transmitted infections, including chlamydia and gonorrhea. It’s commonly prescribed as a “Z-Pak,” to be taken for five days, and it’s widely prescribed. It can also be used to treat malaria. It has few adverse side effects, but it shares one with hydroxychloroquine: QT-segment prolongation. Indeed, the FDA issued a warning in 2013 that azithromycine “can cause abnormal changes in the electrical activity of the heart that may lead to a potentially fatal irregular heart rhythm.” The warning further cautioned that people with certain pre-existing conditions are at particular risk, such as those with QT interval prolongation, low potassium or magnesium levels, a slower than normal heart rate, or those who use certain drugs to treat abnormal heart rhythms.
A number of doctors on Twitter were alarmed at the suggestion that two drugs that can affect heart rhythm be taken together without much stronger evidence that they were effective....

No comments: