Hydroxychloroquine and Azithromycin in Severe COVID-19 Infection

For those of you new to the page/blog, I am a Critical Care physician. My team and I are usually the last line of care patients receive. Many of you are part of my extended team working in ICU's throughout the world. I would honestly love for this combination of HCQ and azithro to work. This study makes us further curb our enthusiasm.

A bit of background:
The two French studies that "showed a benefit" as well as the Chinese study I posted that "showed a benefit" were conducted in patients who were NOT critically ill. This paper was published on March 30th. I'm late to the party, I know. But it correlates with the anecdotal experience I've noted from various facilities who are taking care of critically ill patients.

We get another small study here. n=11. They weren't critically ill when they started the data collection but within 5 days, 1 died and 2 were transferred to the ICU.

Regimen: HCQ 600mg daily x 10 days + Azithromycin 500mg on day 1, 250mg on days 2-5.

Results: 8 patients still had positive RNA at days 5 to 6 after treatment initiation.

Bottom line: in this subset of patients, there was no rapid clearance of COVID-19 by giving this combination. It wasn't as 100% as the Gautret/Raoult studies that I have taken apart in the past. This study is also fraught with flaws. No control group, small, no baseline characteristics. They do not define what made these patients "severe" as opposed to mild or moderate. They could have also waited the full 10 days of therapy. I guess they were in a rush to pump out data or they're going to publish the full data in a couple days and have two publications for their CV instead of just one. Sigh.

I am personally not excited about the HCQ/Azithro combo in my critically ill patients.

Molina JM, Delaugerre C, Goff JL, Mela-Lima B, Ponscarme D, Goldwirt L, de Castro N, No Evidence of Rapid Antiviral Clearance or Clinical Benefit with the Combination of Hydroxychloroquine and Azithromycin in Patients with Severe COVID-19 Infection, Me ́decine et Maladies Infectieuses (2020), doi: https://doi.org/10.1016/j.medmal.2020.03.006

Link to Abstract

Link to FULL FREE PDF


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