New Prophylaxis Guidelines Issued in India Rely on Hydroxychloroquine

According to a May 22nd media release, the Joint Monitoring Group under the Chairmanship of DGHS and including representatives from AIIMS, ICMR, NCDC, NDMA, WHO and experts drawn from Central Government

hospitals reviewed the prophylactic use of Hydroxychloroquine (HCQ) in the context of expanding it to healthcare and other front line workers deployed in non-COVID and COVID areas, respectively.

The document covers several points such as in vitro study, safety profile, studies on prophylaxis. 

The prophylactic use of HCQ is recommended in the following categories:

1. All asymptomatic healthcare workers involved in containment and treatment of COVID19 and asymptomatic healthcare workers working in non-COVID hospitals/non-COVID areas of COVID hospitals/blocks

2. Asymptomatic frontline workers, such as surveillance workers deployed in containment zones and paramilitary/police personnel involved in COVID-19 related activities.

3. Asymptomatic household contacts of laboratory confirmed cases.

Exclusions / countraindications are also stipulated.

There are two identified protocols, lasting from 3 to 7 weeks, for the 2 identified groups: 

1) Asymptomatic household contacts of laboratory confirmed cases; and 

2) All asymptomatic healthcare workers involved in containment and treatment of COVID-19 and asymptomatic healthcare workers working in non-COVID hospitals/non-COVID areas of COVID hospitals/blocks; Asymptomatic frontline workers, such as surveillance workers deployed in containment zones and paramilitary/police personnel involved in COVID-19 related activities.

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Its use beyond 8 weeks on weekly dosage is only recommended with strict monitoring of clinical and ECG parameters which would also ensure that the therapy is given under supervision. 

ECG monitoring provisions are included.

The document states: “Based on the available evidence, it has been opined that HCQ is relatively safe, when certain contraindications are avoided, and has some beneficial effect as a prophylactic option.”

Key considerations are being spelled out, including that the drug has to be given under strict medical supervision with an informed consent. 

Source: https://www.icmr.gov.in/pdf/covid/techdoc/V5_Revised_advisory_on_the_use_of_HCQ_SARS_CoV2_infection.pdf

What about Hydroxychloroquine for COVID-19 Patients?

While using hydroxychloroquine for prophylaxis, what is weird in India is that its use at the early stage of the disease, as recommended by Professor Didier Raoult and others, is not foreseen.

The March 31 Revised Guidelines on Clinical Management of COVID – 19, by the Government of India foresee their use “in patients with severe disease and requiring ICU management,” i.e. at a late stage of the disease, while it’s usually considered to be too late for the treatment to be effective.

In other words, India’s guidelines don’t foresee the use of hydroxychloroquine at the stage of the disease when it’s most useful, that is within days of the appearance of the first symptoms.

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Here are excerpts of existing treatment guidelines:

“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:

• Hydroxychloroquine (Dose 400mg BD – for 1 day followed by 200mg BD for 4 days) In combination with

• Azithromycin (500 mg OD for 5 days)

These drugs should be administered under close medical supervision, with monitoring for side effects including QTc interval.”

https://www.mohfw.gov.in/pdf/RevisedNationalClinicalManagementGuidelineforCOVID1931032020.pdf

India is a major producer of hydroxychloroquine, and is even conducting a form of hydroxychloroquine diplomacy in these pandemic times, providing countries with shipments of the drug. Yet, sometimes it’s even shipped to countries such as Canada, that prevent the drug for being used for COVID patients …

See related coverage below.

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