PMC:7558914 / 16795-19602
Annnotations
{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7558914","sourcedb":"PMC","sourceid":"7558914","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7558914","text":"Several antiviral agents have been proposed for use in combatting COVID-19 based on apparent in vitro activity [3]. One of the most widely used agents has been hydroxychloroquine and chloroquine. Although studies from China [14] and France [15] have reported improved radiologic findings, improved viral clearance, and reduced disease progression with the use of chloroquine and hydroxychloroquine compared to standard supportive care, their efficacy remains inconclusive, and further studies are warranted. In addition, it seems that hydroxychloroquine may act synergistically in combination with azithromycin [3,15]. Recently, in a large observational study from Italy, hydroxychloroquine was associated with a 30% lower risk of death in COVID-19 hospitalized patients [16]. Despite these results, these studies had severe methodological limitations, such as lack of randomization, lack of covariate-adjusted analysis, and potential selection bias. RECOVERY trial—the largest randomized controlled study on hydroxychloroquine—has suggested that hydroxychloroquine might not reduce deaths and might increase length of hospital stay [17]. Chloroquine dosage has been 500 mg orally once or twice daily. However, hydroxychloroquine dosage recommendations have varied from a total daily dose of 400 mg (with a loading dose of 400 mg twice daily for 1 day) to 600 mg orally, based on safety and clinical experience for other diseases [3]. With this limited evidence, international guidelines with consensus statements on the treatment of COVID-19 have not included any recommendation about using hydroxychloroquine/chloroquine as a potential treatment [4,18,19,20], but rather have only suggested its use in the context of a clinical trial [21,22]. In our study, monotherapy with 400 mg hydroxychloroquine twice daily the first day followed by 200 mg twice daily from day 2 to day 5, alone and in combination with azithromycin, were the preferred recommended regimens among protocols in Andalusia for treating mild respiratory illness with clinical risk factors. For mild pneumonia, dual therapies consisting of hydroxychloroquine-azithromycin or hydroxychloroquine-lopinavir/ritonavir were the most frequent treatments recommended, with regimens that included different dosages and durations of treatment. For moderate pneumonia, a shorter regimen of hydroxychloroquine in combination with a longer regimen of lopinavir/ritonavir was the most recommended treatment among all protocols. For the most severe form of pneumonia, the triple therapy with a longer regimen of hydroxychloroquine and lopinavir/ritonavir in combination with azithromycin was the most commonly indicated treatment. Thus, more complex and longer antiviral therapies were recommended according to the severity of COVID-19 in our 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