Esper et al., 15 Apr 2020, prospective, Brazil, preprint, 15 authors, average treatment delay 5.2 days, dosage 800mg day 1, 400mg days 2-7, this trial uses multiple treatments in the treatment arm (combined with AZ) - results of individual treatments may vary.
Abstract: Empirical treatment with hydroxychloroquine and azithromycin for suspected
cases of COVID-19 followed-up by telemedicine
Rodrigo Barbosa Esper M.D., Ph.D., Rafael Souza da Silva M.D., Fernando Teiichi
Costa Oikawa M.D., Ph.D., Marcelo Machado Castro M.D., Alvaro Razuk-Filho M.D.,
Ph.D., Pedro Benedito Batista Junior M.D., Sergio Wilhelm Lotze M.D., Cleber
Nunes da Rocha M.D., Roberto de Sá Cunha Filho M.D., Saulo Emanuel Barbosa
de Oliveira M.D, Philipe Leitão Ribeiro, M.D., Valéria Cristina Vigar Martins M.D.,
Fernando Silva Braga Bueno M.D., Priscila Ligeiro Gonçalves Esper M.D., Eduardo
Fagundes Parrillo M.D.
Affiliation/institution: Prevent Senior Institute, São Paulo, Brazil
Rodrigo Barbosa Esper M.D., Ph.D.
Avenida Lourenço Marques, n 158, São Paulo – Brazil
ZIP CODE: 04547-100
Phone: +55 11 999869306
Word Count: 4803
The Ethics Committee approved study number - CONEP/Plataforma Brasil CAAE:
30586520.9.0000.0008 (Número Parecer:3.968.699)
ClinicalTrials.gov Identifier: NCT04348474
Background: Telemedicine can facilitate patient’s assessment with initial flu-like
symptoms in the COVID-19 pandemic, moreover it promotes social isolation.
Hydroxychloroquine and azithromycin are associated with reduction in COVID-19
patients' viral load. This study aims to assess whether empirical prescription of
hydroxychloroquine and azithromycin for patients with suspected COVID-19 is
associated with less need for hospitalization Methods: A telemedicine team
azithromycin was prescribed after consent from subjects. Patients were monitored
daily by telemedicine appointments. Results: Of the 636 symptomatic outpatients,
412 started treatment with hydroxychloroquine and azithromycin and 224 refused
medications (control group). Need for hospitalization was 1.9% in the treatment
group and 5.4% in the control group (2.8 times greater) and number needed to treat
was 28 (NNT = 28). In those who started treatment before versus after the seventh
day of symptoms, the need for hospitalization was 1.17% and 3.2%, respectively.
azithromycin for suspected cases of COVID-19 infection reduces the need for
hospitalization (p< 0.001).
Funding: this study does not have any type of funding
In the past two decades, severe acute respiratory syndromes have been one of
the most critical threats to global health. Coronaviruses (Mers-CoV, SARS-Cov) are
virus that may affect humans and cause severe infections and deaths worldwide (1).
In December 2019, a new Beta-coronavirus, named SARS-CoV-2, was
associated with a set of respiratory tract infections in Wuhan, Hubei province in
China, and spread rapidly across continents (2). According to the World Health
Organization (WHO), the outbreak was declared a public health emergency of
international interest on January 30, 2020 and on March 11, WHO announced
COVID-19 outbreak a pandemic (3).
Patient’s clinical characteristics from China revealed that comorbities such as
diabetes, hypertension and others cardiovascular diseases were related to poor
outcomes and high death rates, with three to four times more chances..
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