A Look at Brazil’s Early Treatment Guidelines

Brazil’s Ministry of Health published on May 20 new guidelines for the early treatment of COVID-19. The guidelines aim to expand the access of patients with COVID-19 to early treatment, that is, in the first days of symptoms, within the scope of Brazil’s Unified Health System.

The guidelines provide a classification of the signs and symptoms of the disease, which can vary from mild to severe; and guidance for prescribing adult patients with two drugs associated with azithromycin: chloroquine and hydroxychloroquine sulfate.

https://www.saude.gov.br/images/pdf/2020/May/20/orientacoes-manuseio-medicamentoso-covid19.pdf

What is extremely important to stress here is that the therapy is recommended at an early stage, like for example recommended by France’s Professor Didier Raoult. 

It’s important to note that both chloroquine and hydroxychloroquine are part of the protocol, even if chloroquine is usually not recommended, as less safe than hydroxychloroquine. 

Note also that the dosages that are recommended in these guidelines differ significantly from those used by Professor Raoult, including in the context of his landmark study over 1061 patients. 

The Brazilian guidelines foresee treatments of 5 days, whereas the standard treatment at IHU Marseille is 10 days.

Access to these drugs is only possible through a medical prescription. That is, it is the physician’s competence, in agreement declared in writing by the patient, to use the drug treatment. The ministry also drew up a consent form. 

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https://saude.gov.br/images/pdf/2020/May/20/Termo-de-Cie–ncia-e-Consentimento-Hidroxicloroquina-Cloroquina-COVID-19.pdf

The purpose of the formulation of the guidelines, by the Ministry of Health, is to guide and standardize the information for health professionals who serve in the public health network. The document also warns of the risk of self-prescription by the population. 

There is guidance regarding symptoms and how to treat, according to the severity of the diagnostic. Refer to the guidelines, in Portuguese, for details.

Surprisingly, Zinc is not part of the standard protocol, even if it is now widely seen as a key for effectiveness.

Zinc is only mentioned in Note #16, which translates likes this: 

“16. Zinc – For adult patients, consider the administration of zinc sulfate concomitant with treatment with chloroquine / hydroxychloroquine + azithromycin.”

Domestic production of chloroquine will be increased and international contacts are made to bring to Brazil the active ingredients of hydroxychloroquine, currently in short supply worldwide, according to the ministerial media release.

Source: https://www.saude.gov.br/

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