Hydroxychloroquine and azithromycin use in COVID-19 era and cardiovascular concerns: Current perspective

Abstract

In the present era of coronavirus disease 2019 (COVID-19) pandemic, lack of an established and effective targeted therapy sans a vaccine is proving to be a major hurdle in containing the contagion. Hydroxychloroquine (HCQ), a widely used antimalarial and anti-inflammatory drug, has been proposed for coronavirus infection management by various drug regulatory authorities for emergency use including Indian Council of Medical Research. However, clinical safety concerns primarily regarding cardiovascular issues have been raised against HCQ usage, especially in relatively higher dosage in conjunction with azithromycin (AZM) coprescription. HCQ and to some extent, AZM have proven to be effective against COVID-19. Barring a small at-risk population for cardiovascular adverse effects, their clinical use in the treatment and prevention of COVID-19 was deemed to be beneficial and even recommended by various national and international representative societies including the World Health Organization, especially in high-risk individuals such as health-care workers and exposed contacts of coronavirus positive patients under due medical supervision. Multiple studies evaluating the anticoronaviral efficacy for prevention as well as for treatment prospect were conducted, but none could convincingly demonstrate a beneficial effect of HCQ with or without AZM on alleviating symptoms, shortening hospitalization, improving survival, or preventing disease transmission.