Society of General Practitioners does not recommend hydroxochloroquine for covid-19

Covid-19 patients who can be treated by general practitioners do not, according to the Nederlands Huisartsen Genootschap, benefit from the old malaria agent hydroxychloroquine (HDC), even if this is given in combination with the antibiotic azithromycin and the trace element zinc.

This appears from a literature study of the Dutch Society of General Practitioners on (combination) therapy with hydroxychloroquine. The costs of these agents are low and they are also available.

Five bad studies

The NHG found five relevant scientific studies with treatment group and control group, all with many shortcomings. “The quality of evidence from the available studies was low to very low, mainly due to methodological shortcomings and patient failure”, writes the NHG in an accompanying news item.

In an American Canadian study, 491 patients with a recently confirmed infection or high risk of exposure to a covid-19 patient participated. They received 800 milligrams of HDC on day one and 600 milligrams approximately seven hours later and 600 milligrams the next four days.

Both studies showed little or no effect on the number of hospitalizations, the severity of the disease, the length of the recovery period and the chance of death.

Hydroxychloroquine with azithromycin

The first study on the combination hydroxychloroquine and azithromycin (AZT) assessed by the NHG was conducted in Brazil. A total of 636 patients participated. They had been selected by a health insurer. A group of 224 patients who did not want to be treated with HDC and AZT acted as a control group for the remaining 412.

The study was prematurely terminated when the health insurer withdrew. As a result, the results are incomplete and not corrected for factors that may influence the results, such as the fact that the treated group had more disease symptoms. Moreover, not all patients had been tested for covid-19.

In a French study of the same combination therapy 88 doctors and family members were included. Twenty patients received 600 milligrams HDC for seven to ten days and 500 milligrams AZT once and then 250 milligrams AZT for another four days. A control group of 34 patients received no treatment or only paracetamol. The remaining patients were prescribed only the antibiotic AZT.

HDC, AZT and Zinc

Combination therapy HDC, AZT and zinc has been studied in one study with control group. It compared 114 patients who had been treated with this combination with 337 patients who had not received the treatment.

Patients in the treatment group had covid-19 and were 60+ with or without complaints or 60+ with shortness of breath or underlying suffering. The only selection criterion for the control group was that they had to have covid-19. Furthermore, nothing is known about the 337 patients. Therefore it is unclear whether the control group is usable.

The NHG calls the quality of the evidence found very low.

No adjustment

In summary, the NHG researchers conclude that there is no reason to apply any of the three variants of hydroxychloroquine treatments studied.

Players

Arts in favour of early treatment of covid-19 patients with hydroxychloroquine will say that in all studies the applied doses of HDC were too high

Dutch advocates of the drug propagate a dose of 200 milligrams of HDC three times a day for four days, but the NHG has not found a study with control group in which such doses were used.