COVID-19 research briefs: very small prospective study shows no benefit of hydroxychloroquine plus azithromycin

Daily POEMs

Published: 2020-05-01 © 2020 John Wiley & Sons, Inc.

Clinical question
Can hydroxychloroquine plus azithromycin improve outcomes for patients with COVID-19?

Bottom line
The virologic and clinical outcomes of treatment with hydroxychloroquine plus azithromycin were poor in a prospective study of 11 patients. Larger, well-designed, randomized controlled trials are needed to draw any conclusions. (LOE = 2b)

Reference
Molina JM, Delaugerre C, Goff JL, et al. No evidence of rapid antiviral clearance or clinical benefit with the combination of hydroxychloroquine and azithromycin in patients with severe COVID-19 infection. [published online ahead of print, 2020 Mar 30] Med Mal Infect 2020;S0399-077X(20)30085-8. doi: 10.1016/j.medmal.2020.03.006.

Study design: Cohort (prospective)

Setting: Inpatient (any location)

Synopsis
In a prospective study, French investigators assessed virologic and clinical outcomes of 11 consecutive hospitalized patients (7 men and 4 women with a mean age of 59 years) with COVID-19 who received hydroxychloroquine (HCQ) 600 mg per day for 10 days plus azithromycin 500 mg on day 1 and 250 mg on days 2 to 5. Eight patients had significant comorbidities. At the time of treatment initiation, 10 of the 11 patients had fever and received nasal oxygen therapy. Within 5 days, 1 patient died and 2 were transferred to the intensive care unit. In one patient, treatment with HCQ and azithromycin was discontinued after 4 days because of a prolongation of the QT interval. Repeated nasopharyngeal swabs in 10 patients (not done in the patient who died) using a qualitative PCR assay were still positive for SARS-CoV2 RNA in 8 patients at days 5 or 6 after treatment initiation. These virologic results stand in contrast with those reported by Gautret et al and cast doubts about the strong antiviral efficacy of this combination treatment.

John Hickner, MD, MS
Professor Emeritus
Dept of Family Medicine
Michigan State University
East Lansing, MI

Copyright © 2020 John Wiley & Sons, Inc.