Negative Nasopharyngeal SARS-CoV-2 PCR Conversion in Response to Different Therapeutic Interventions
Hassan Alwafi, Mohammed H Shabrawishi, Abdallah Y Naser, Ahmad M Aldobyany, Sultan A Qanash, Abdelfattah A Touman
Cureus, doi:10.7759/cureus.21442
Background The current management practices for patients with COVID-19 consist of infection prevention and supportive care. We aimed to explore the association between negative nasopharyngeal SARS-CoV-2 polymerase chain reaction (PCR) clearance and different therapeutic interventions.
Methods This study is a retrospective cohort study of 93 patients who were admitted to a tertiary hospital in Saudi Arabia with a PCR confirmed diagnosis of COVID-19. There were three intervention subgroups (group A) (n = 45), which included those who received chloroquine or hydroxychloroquine (HCQ) only (A1), those who received chloroquine or HCQ in combination with azithromycin (A2), and those who received chloroquine or HCQ in combination with antiviral drugs with or without azithromycin (A3), as well as one supportive care group (group B) (n = 48). The primary and secondary endpoints were achieving negative SARS-CoV-2 nasopharyngeal PCR samples within five and 12 days from the start of the intervention, respectively.
Results A median time of three days (interquartile range (IQR): 2.00-6.50) is needed from the time of starting the intervention/supportive care to the first negative PCR sample. There was no statistically significant difference neither between the percentage of patients in the intervention group and the supportive care group who achieved the primary or secondary endpoint nor in the median time needed to achieve the first negative PCR sample (p > 0.05).
Conclusion Prescribing antimalarial medications was not shown to shorten the disease course nor to accelerate the negative PCR conversion rate.
Additional Information Disclosures Human subjects: Consent was obtained or waived by all participants in this study. The institutional ethics board of the Ministry of Health of Saudi Arabia issued approval H-02-K-076-0420-286. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.
References
For, Control, Information for clinicians on investigational therapeutics for patients with COVID-19
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"key": "ref1",
"unstructured": "World Health Organization. Coronavirus disease (COVID-19) weekly epidemiological update and weekly operational update. (2022). Accessed: May 4, 2020: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports."
},
{
"DOI": "10.1016/S0140-6736(20)30211-7",
"article-title": "Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study",
"author": "Chen N",
"doi-asserted-by": "publisher",
"journal-title": "Lancet",
"key": "ref2",
"unstructured": "Chen N, Zhou M, Dong X, et al.. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020, 395:507-13. 10.1016/S0140-6736(20)30211-7",
"volume": "395",
"year": "2020"
},
{
"DOI": "10.1056/NEJMc2001468",
"article-title": "Transmission of 2019-nCoV infection from an asymptomatic contact in Germany",
"author": "Rothe C",
"doi-asserted-by": "publisher",
"journal-title": "N Engl J Med",
"key": "ref3",
"unstructured": "Rothe C, Schunk M, Sothmann P, et al.. Transmission of 2019-nCoV infection from an asymptomatic contact in Germany. N Engl J Med. 2020, 382:970-1. 10.1056/NEJMc2001468",
"volume": "382",
"year": "2020"
},
{
"DOI": "10.1001/jama.2020.2565",
"article-title": "Presumed asymptomatic carrier transmission of COVID-19",
"author": "Bai Y",
"doi-asserted-by": "publisher",
"journal-title": "JAMA",
"key": "ref4",
"unstructured": "Bai Y, Yao L, Wei T, Tian F, Jin DY, Chen L, Wang M. Presumed asymptomatic carrier transmission of COVID-19. JAMA. 2020, 323:1406-7. 10.1001/jama.2020.2565",
"volume": "323",
"year": "2020"
},
{
"DOI": "10.1097/CM9.0000000000000819",
"article-title": "Diagnosis and treatment protocol for novel coronavirus pneumonia (trial version 7)",
"doi-asserted-by": "publisher",
"journal-title": "Chin Med J (Engl)",
"key": "ref5",
"unstructured": "Diagnosis and treatment protocol for novel coronavirus pneumonia (trial version 7). Chin Med J (Engl). 2020, 133.1087-95. 10.1097/CM9.0000000000000819",
"volume": "133",
"year": "2020"
},
{
"key": "ref6",
"unstructured": "Saudi center for disease prevention and control. Quick interim guide to COVID-19 surveillance case definition and disposition. (2020). https.//covid19.cdc.gov.sa/."
},
{
"key": "ref7",
"unstructured": "Centre for Disease Control and Prevention. Information for clinicians on investigational therapeutics for patients with COVID-19. (2020). Accessed: May 4, 2020: https://www.cdc.gov/coronavirus/2019-ncov/hcp/therapeutic-options.html."
},
{
"DOI": "10.1016/j.ijantimicag.2020.105949",
"article-title": "Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial",
"author": "Gautret P",
"doi-asserted-by": "publisher",
"journal-title": "Int J Antimicrob Agents",
"key": "ref8",
"unstructured": "Gautret P, Lagier JC, Parola P, et al.. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents. 2020, 56:105949. 10.1016/j.ijantimicag.2020.105949",
"volume": "56",
"year": "2020"
},
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"DOI": "10.1016/j.ijantimicag.2020.105932",
"article-title": "Chloroquine and hydroxychloroquine as available weapons to fight COVID-19",
"author": "Colson P",
"doi-asserted-by": "publisher",
"journal-title": "Int J Antimicrob Agents",
"key": "ref9",
"unstructured": "Colson P, Rolain JM, Lagier JC, Brouqui P, Raoult D. Chloroquine and hydroxychloroquine as available weapons to fight COVID-19. Int J Antimicrob Agents. 2020, 55:105932. 10.1016/j.ijantimicag.2020.105932",
"volume": "55",
"year": "2020"
},
{
"DOI": "10.1038/s41421-020-0156-0",
"article-title": "Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro",
"author": "Liu J",
"doi-asserted-by": "publisher",
"journal-title": "Cell Discov",
"key": "ref10",
"unstructured": "Liu J, Cao R, Xu M, et al.. Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro. Cell Discov. 2020, 6:16. 10.1038/s41421-020-0156-0",
"volume": "6",
"year": "2020"
},
{
"DOI": "10.1093/cid/ciaa237",
"article-title": "In vitro antiviral activity and projection of optimized dosing design of hydroxychloroquine for the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)",
"author": "Yao X",
"doi-asserted-by": "publisher",
"journal-title": "Clin Infect Dis",
"key": "ref11",
"unstructured": "Yao X, Ye F, Zhang M, et al.. In vitro antiviral activity and projection of optimized dosing design of hydroxychloroquine for the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Clin Infect Dis. 2020, 71:732-9. 10.1093/cid/ciaa237",
"volume": "71",
"year": "2020"
},
{
"DOI": "10.1038/s41422-020-0282-0",
"article-title": "Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro",
"author": "Wang M",
"doi-asserted-by": "publisher",
"journal-title": "Cell Res",
"key": "ref12",
"unstructured": "Wang M, Cao R, Zhang L, et al.. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res. 2020, 30:269-71. 10.1038/s41422-020-0282-0",
"volume": "30",
"year": "2020"
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"DOI": "10.3785/j.issn.1008-9292.2020.03.03",
"article-title": "[A pilot study of hydroxychloroquine in treatment of patients with moderate COVID-19]",
"author": "Chen J",
"doi-asserted-by": "publisher",
"journal-title": "Zhejiang Da Xue Xue Bao Yi Xue Ban",
"key": "ref13",
"unstructured": "Chen J, Liu D, Liu L, et al.. [A pilot study of hydroxychloroquine in treatment of patients with moderate COVID-19]. Zhejiang Da Xue Xue Bao Yi Xue Ban. 2020, 49:215-9. 10.3785/j.issn.1008-9292.2020.03.03",
"volume": "49",
"year": "2020"
},
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"DOI": "10.1136/bmj.m1432",
"article-title": "Chloroquine and hydroxychloroquine in covid-19",
"author": "Ferner RE",
"doi-asserted-by": "publisher",
"journal-title": "BMJ",
"key": "ref14",
"unstructured": "Ferner RE, Aronson JK. Chloroquine and hydroxychloroquine in covid-19. BMJ. 2020, 369:m1432. 10.1136/bmj.m1432",
"volume": "369",
"year": "2020"
},
{
"DOI": "10.1177/0310057X0903700112",
"article-title": "Survival after massive hydroxychloroquine overdose",
"author": "Gunja N",
"doi-asserted-by": "publisher",
"journal-title": "Anaesth Intensive Care",
"key": "ref15",
"unstructured": "Gunja N, Roberts D, McCoubrie D, et al.. Survival after massive hydroxychloroquine overdose. Anaesth Intensive Care. 2009, 37:130-3. 10.1177/0310057X0903700112",
"volume": "37",
"year": "2009"
},
{
"DOI": "10.1038/s41591-020-0888-2",
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"doi-asserted-by": "publisher",
"journal-title": "Nat Med",
"key": "ref16",
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"volume": "26",
"year": "2020"
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"journal-title": "Gut",
"key": "ref17",
"unstructured": "Makin AJ, Wendon J, Fitt S, Portmann BC, Williams R. Fulminant hepatic failure secondary to hydroxychloroquine. Gut. 1994, 35:569-70. 10.1136/gut.35.4.569",
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"year": "1994"
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{
"DOI": "10.1046/j.1365-2230.2001.00857-3.x",
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"author": "Murphy M",
"doi-asserted-by": "publisher",
"journal-title": "Clin Exp Dermatol",
"key": "ref18",
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"volume": "26",
"year": "2001"
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"DOI": "10.1016/S0140-6736(20)30566-3",
"article-title": "Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study",
"author": "Zhou F",
"doi-asserted-by": "publisher",
"journal-title": "Lancet",
"key": "ref19",
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"volume": "395",
"year": "2020"
},
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"DOI": "10.1101/2020.04.16.20065920",
"article-title": "Outcomes of hydroxychloroquine usage in United States veterans hospitalized with Covid-19",
"author": "Magagnoli J",
"doi-asserted-by": "publisher",
"journal-title": "medRxiv",
"key": "ref20",
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"year": "2020"
},
{
"DOI": "10.1002/brb3.1730",
"article-title": "Mental health status of the general population, healthcare professionals, and university students during 2019 coronavirus disease outbreak in Jordan: a cross-sectional study",
"author": "Naser AY",
"doi-asserted-by": "publisher",
"journal-title": "Brain Behav",
"key": "ref21",
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"volume": "10",
"year": "2020"
},
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"DOI": "10.3389/fpubh.2020.00506",
"article-title": "Epidemiology of COVID-19 in the Kingdom of Saudi Arabia: an ecological study",
"author": "Alyami MH",
"doi-asserted-by": "publisher",
"journal-title": "Front Public Health",
"key": "ref22",
"unstructured": "Alyami MH, Naser AY, Orabi MA, Alwafi H, Alyami HS. Epidemiology of COVID-19 in the Kingdom of Saudi Arabia: an ecological study. Front Public Health. 2020, 8:506. 10.3389/fpubh.2020.00506",
"volume": "8",
"year": "2020"
},
{
"DOI": "10.1371/journal.pone.0237130",
"article-title": "Clinical, radiological and therapeutic characteristics of patients with COVID-19 in Saudi Arabia",
"author": "Shabrawishi M",
"doi-asserted-by": "publisher",
"journal-title": "PLoS One",
"key": "ref23",
"unstructured": "Shabrawishi M, Al-Gethamy MM, Naser AY, et al.. Clinical, radiological and therapeutic characteristics of patients with COVID-19 in Saudi Arabia. PLoS One. 2020, 15:e0237130. 10.1371/journal.pone.0237130",
"volume": "15",
"year": "2020"
},
{
"DOI": "10.3390/ijerph18147645",
"article-title": "Incidence and outcomes of pulmonary embolism among hospitalized COVID-19 patients",
"author": "Badr OI",
"doi-asserted-by": "publisher",
"journal-title": "Int J Environ Res Public Health",
"key": "ref24",
"unstructured": "Badr OI, Alwafi H, Elrefaey WA, Naser AY, Shabrawishi M, Alsairafi Z, Alsaleh FM. Incidence and outcomes of pulmonary embolism among hospitalized COVID-19 patients. Int J Environ Res Public Health. 2021, 18:10.3390/ijerph18147645",
"volume": "18",
"year": "2021"
},
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"DOI": "10.1111/ijcp.14244",
"article-title": "Depression and anxiety during the COVID-19 pandemic in Saudi Arabia: a cross-sectional study",
"author": "Alyami HS",
"doi-asserted-by": "publisher",
"journal-title": "Int J Clin Pract",
"key": "ref25",
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"volume": "75",
"year": "2021"
},
{
"DOI": "10.1177/0020764020966631",
"article-title": "The effect of the 2019 coronavirus disease outbreak on social relationships: a cross-sectional study in Jordan",
"author": "Naser AY",
"doi-asserted-by": "publisher",
"journal-title": "Int J Soc Psychiatry",
"key": "ref26",
"unstructured": "Naser AY, Al-Hadithi HT, Dahmash EZ, Alwafi H, Alwan SS, Abdullah ZA. The effect of the 2019 coronavirus disease outbreak on social relationships: a cross-sectional study in Jordan. Int J Soc Psychiatry. 2020, 20764020966631. 10.1177/0020764020966631",
"year": "2020"
},
{
"DOI": "10.2147/JMDH.S304788",
"article-title": "Predictors of length of hospital stay, mortality, and outcomes among hospitalised COVID-19 patients in Saudi Arabia: a cross-sectional study",
"author": "Alwafi H",
"doi-asserted-by": "publisher",
"journal-title": "J Multidiscip Healthc",
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"unstructured": "Alwafi H, Naser AY, Qanash S, et al.. Predictors of length of hospital stay, mortality, and outcomes among hospitalised COVID-19 patients in Saudi Arabia: a cross-sectional study. J Multidiscip Healthc. 2021, 14:839-52. 10.2147/JMDH.S304788",
"volume": "14",
"year": "2021"
},
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"DOI": "10.1016/j.tmaid.2020.101663",
"article-title": "Clinical and microbiological effect of a combination of hydroxychloroquine and azithromycin in 80 COVID-19 patients with at least a six-day follow up: a pilot observational study",
"author": "Gautret P",
"doi-asserted-by": "publisher",
"journal-title": "Travel Med Infect Dis",
"key": "ref28",
"unstructured": "Gautret P, Lagier JC, Parola P, et al.. Clinical and microbiological effect of a combination of hydroxychloroquine and azithromycin in 80 COVID-19 patients with at least a six-day follow up: a pilot observational study. Travel Med Infect Dis. 2020, 34:101663. 10.1016/j.tmaid.2020.101663",
"volume": "34",
"year": "2020"
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"key": "ref29",
"unstructured": "Ministry of Health - Kingdom of Saudi Arabia. COVID-19 guidelines. (2020). https://www.moh.gov.sa/en/Ministry/MediaCenter/Publications/Pages/covid19.aspx."
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"key": "ref30",
"unstructured": "National Institutes of Health. COVID-19 vaccines. (2021). Accessed: January 17, 2021: https://covid19.nih.gov/treatments-and-vaccines/covid-19-vaccines."
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