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Empirical treatment with hydroxychloroquine and azithromycin for suspected cases of COVID-19 followed-up by telemedicine

Esper et al., Prevent Senior Institute, São Paulo, Brazil
Apr 2020  
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Hospitalization 64% Improvement Relative Risk HCQ for COVID-19  Esper et al.  EARLY TREATMENT Is early treatment with HCQ + AZ beneficial for COVID-19? Prospective study of 636 patients in Brazil Lower hospitalization with HCQ + AZ (p=0.024) Esper et al., Prevent Senior Institute.., Apr 2020 FavorsHCQ Favorscontrol 0 0.5 1 1.5 2+
HCQ for COVID-19
1st treatment shown to reduce risk in March 2020
*, now with p < 0.00000000001 from 411 studies, recognized in 46 countries.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,300+ studies for 75 treatments.
636 patients. HCQ+AZ reduced hospitalization 79% when used within 7 days (65% overall). Non-randomized.
risk of hospitalization, 64.0% lower, RR 0.36, p = 0.02, treatment 8 of 412 (1.9%), control 12 of 224 (5.4%), NNT 29.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
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.
This PaperHCQAll
Empirical treatment with hydroxychloroquine and azithromycin for suspected cases of COVID-19 followed-up by telemedicine
M.D Rodrigo Barbosa Esper, Ph.D Rafael Souza Da Silva, M.D Fernando Teiichi Costa Oikawa, Ph.D Marcelo Machado Castro, M.D Alvaro Razuk-Filho, Ph.D Pedro Benedito Batista, M.D Sergio Wilhelm Lotze, M.D Cleber Nunes Da Rocha, Roberto De Sá, M.D Cunha Filho, Saulo Emanuel Barbosa De Oliveira, Philipe Leitão Ribeiro, M.D Valéria Cristina, M.D Vigar Martins, Fernando Silva, M.D Braga Bueno, Priscila Ligeiro, M.D Gonçalves Esper, Eduardo Fagundes, Avenida Lourenço Marques, São Paulo -Brazil, Clinicaltrials Gov Identifier
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 evaluated suspected COVID-19 outpatients with flu-like symptoms, if no contraindications were detected, treatment with hydroxychloroquine and 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. Conclusion: Empirical treatment with hydroxychloroquine associated with azithromycin for suspected cases of COVID-19 infection reduces the need for hospitalization (p< 0.001).
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