A number of media reports over the past few days highlighted the death of Dr Utpal Barman, a 44-year-old a senior medical professional at Guwahati-based Pratiksha Hospital. While the cause of death has been attributed to cardiac arrest, co-workers of Barman were quoted by different publications to claim that he was taking the anti-malarial drug hydroxychloroquine, which has been recommended by ICMR as a preventive medication for healthcare workers involved in the care of suspected or confirmed cases of COVID-19, and also asymptomatic household contacts of laboratory confirmed cases. However, the death of the doctor has not yet been officially attributed to the use of the drug. THE WEEK cannot independently vouch for the veracity of the reports.
But, on March 31, the Union Health Ministry had recommended the use of hydroxychloroquine, in combination with azithromycin, on those severely suffering from COVID-19 who require ICU management. In its revised guidelines on the 'Clinical Management of COVID-19, the ministry said the drug is presently not recommended for children aged less than 12 and pregnant and lactating women. "No specific antivirals have been proven to be effective as per currently available data. However, based on the available information [uncontrolled clinical trials], the following drugs may be considered as an off-label indication in patients with severe disease and requiring ICU management," the ministry said, while recommending the drug combination. In its revised guidelines on the 'Clinical Management of COVID-19' issued on Tuesday, the ministry said the drug is presently not recommended for children aged less than 12 and pregnant and lactating women.
The ICMR has also repeatedly stressed and conveyed that the drug is not recommended to be used by everyone. “We have repeatedly said it is not to be used by everyone. It is being given to doctors and contacts of lab confirmed cases. When their data will be complied only then a call can be taken whether it should be recommended to everyone [who is at risk],” said ICMR senior scientist Raman Gangakhedkar.
But, new research has thrown up even more pitfalls regarding the drug usage. Hydroxychloroquine and the antibiotic azithromycin, which are being considered by some for treating COVID-19, may increase the risk for dangerous abnormal heart rhythms, US cardiologists have warned. The researchers from Oregon Health & Science University (OHSU) and Indiana University recommend that clinicians treating COVID-19 patients with the malaria-antibiotic drug combination should consider monitoring those patients for ventricular arrhythmia. The condition leads to the lower heart chambers beating quickly and irregularly, and can lead to cardiac arrest, they said.
In a paper published in the American College of Cardiology's Cardiology Magazine, the researchers noted that there are hundreds of drugs that can increase the risk for cardiac arrest. However, they said, using two together in patients who are already at risk or critically ill could increase that risk further. "While there is yet very little data regarding hydroxychloroquine and azithromycin's effectiveness as a treatment for COVID-19, some clinicians are considering combining them during this global pandemic," said Eric Stecker, the paper's lead author. "If physicians use their best medical judgment and order this drug combination for coronavirus patients, we want them to be aware of potential adverse side effects," said Stecker, an associate professor at the OHSU School of Medicine.
The researchers recommend clinicians who treat COVID-19 patients with the drug combination also monitor patients for dangerous arrhythmias. However, they acknowledged that limited resources could make monitoring a challenge. "Until we have clinical outcome data supporting the benefit or harm of these medications, I would advocate for a cautious approach in using the combination of hydroxychloroquine and azithromycin," Stecker said.
-Inputs from PTI