Donald Trump is touting a particular cocktail of drugs for COVID-19. Here is why you should listen to the experts, not to him

Abantika Ghosh
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US President Donald Trump (Photo: AP)

US President Donald Trump had donned a scientist’s hat and talked about the hydroxychloroquine-azithromycin combination as a promising one against the novel coronavirus disease (COVID-19), even before his own drug regulatory agency has approved its use.

So should you rush out to buy the drugs?

The short answer: No.

If you have any suspicions of having contracted the infection, please visit a doctor or a hospital. Do not even attempt to self medicate. That includes use of painkillers too, because some studies seem to suggest use of Ibuprofen in COVID-19 can be dangerous.

But, here’s why chloroquine has suddenly become hot and people are queueing up to buy Lariago (one of the commonest brands).

On Saturday, following his press conference in which he endorsed the drug combination, Trump tweeted: “HYDROXYCHLOROQUINE & AZITHROMYCIN, taken together, have a real chance to be one of the biggest game changers in the history of medicine. The FDA has moved mountains — Thank You! Hopefully they will BOTH (H works better with A, International Journal of Antimicrobial Agents).....be put in use IMMEDIATELY. PEOPLE ARE DYING, MOVE FAST, and GOD BLESS EVERYONE!”

So, what is the evidence regarding these drugs?

Azithromycin is a commonly used antibiotic, while hydroxychloroquine (not to be confused with anti-malaria drug chloroquine) is used in the treatment of autoimmune diseases such as rheumatoid arthritis.

The roles of both chloroquine and hydroxychloroquine in management of COVID-19 are still an open question for the scientific community, though there are some small studies on both that seem to suggest they are efficacious.

The azithromycin-hydroxychloroquine combination in fact is part of an upcoming multi-country trial anchored by the World Health Organisation to examine the efficacy of various drug combinations against COVID-19.

What do the experts say as of now?

According to the US Centres for Disease Control and Prevention (CDC): “Hydroxychloroquine and chloroquine are oral prescription drugs that have been used for treatment of malaria and certain inflammatory conditions. Chloroquine has been used for malaria treatment and chemoprophylaxis, and hydroxychloroquine is used for treatment of rheumatoid arthritis, systemic lupus erythematosus and porphyria cutanea tarda. Both drugs have in-vitro activity against SARS-CoV, SARS-CoV-2, and other coronaviruses, with hydroxychloroquine having relatively higher potency against SARS-CoV-2.

“A study in China reported that chloroquine treatment of COVID-19 patients had clinical and virologic benefit versus a comparison group, and chloroquine was added as a recommended antiviral for treatment of COVID-19 in China. Based upon limited in-vitro and anecdotal data, chloroquine or hydroxychloroquine are currently recommended for treatment of hospitalized COVID-19 patients in several countries.”

The novel coronavirus has been named SARS-CoV-2.

Has the azithromycin-hydroxychloroquine combo been tested on a COVID-19 patient yet?

The azithromycin-hydroxychloroquine combination has sometimes been administered to COVID patients in the US, CDC says.

In a small study published in the International Journal of Antimicrobial Agents, published on March 17, French scientists reported: “Twenty cases were treated in this study and showed a significant reduction of the viral carriage at D6-post inclusion compared to controls, and much lower average carrying duration than reported of untreated patients in the literature. Azithromycin added to hydroxychloroquine was significantly more efficient for virus elimination.”

In other words, the combination did reduce the viral load but the size of the study is too small for the conclusion to be treated as definitive.

What is the situation in India with regard to the use of this combination of drugs?

Neither chloroquine nor hydroxycholoquine are at present a part of the management guidelines for COVID-19 patients issued by the Ministry of Health; these guidelines are being revised very often though.

Dr S Chatterjee, Consultant, Medicine at Indraprastha Apollo Hospitals, said India is yet to take a call on this.

“I had a word with my microbiologist but we are right now not in a position to authenticate or support this entire thought process of using hydroxychloroquine and azithromycin on COVID-19 patients. There are some studies here and there, but let more evidence emerge on its efficacy before we take a call one way or the other,” Dr Chatterjee said.