Brazil includes chloroquine in treatment of mild cases of COVID-19

It is up to the doctor to prescribe the drug and the patient to agree

Published in 20/05/2020 - 15:33 By Andreia Verdélio - Brasília

The Brazilian Health Ministry today (May 20) included chloroquine and its derivative hydroxychloroquine in the treatment protocol for patients with mild symptoms of COVID-19. According to the ministry, it will be up to the doctor to decide to prescribe the drug, and patients to agree to sign a document stating they have been informed and agree with the terms.

The government cautions that, even though these are medications used in a number of protocols, with in vitro activitity demonstrated against the new coronavirus, there are still no results from clinical trials proving the benefit in the treatment against COVID-19.

Nonetheless, in bringing the guidelines on the use of the drugs up to date, the Health Ministry considered the existence of a number of studies and the wide experience stemming from the use of chloroquine and hydroxychloroquine in the treatment of other infectious and chronic diseases in Brazilian public hospitals. The drug is originally recommended in the treatment of illnesses like malaria, lupus, and arthritis.

Late in March, the Health Ministry included in its protocols the suggested use of chloroquine on hospitalized patients with medium to high severity. The ministry also distributed at least 3.4 million doses of the drug to state health care netoworks.

Brazil’s Federal Council of Medicine (CFM) does not recommend the use of the drug, but authorized prescriptions in specific situations, including mild cases, at the discretion of the doctor and following a joint decision with patients.

President Jair Bolsonaro argues for the possibility of treating COVID-19 with hydroxychloroquine from the early stages of the disease, he says, after he heard doctors, researchers, and heads of state. The Executive abolished the tax on imports of the drug. As former health ministers Luiz Henrique Mandetta and Nelson Teich did not agree with this protocol, they ended up leaving the government.

New guidelines

The guidelines issued today for the early treatment of patients diagnosed with the novel coronavirus include the use of chloroquine or the hydroxychloroquine sulfate associated with azithromycin for 14 days in the stage of mild or moderate symptoms. After the 14th day, medicines must be prescribed according to the symptoms presented.

Mild cases are those where patients do not need to be hospitalized and show symptoms like a running nose, fever, loss of senses of taste and smell, muscle and abdominal pain, cough, fatigue, and headache.

Persistent cough and fever, with the aggravation of other symptoms and the presence of other risk factors are moderate signs of COVID-19. For moderate cases, the medical team must assess the need for hospitalization and the presence of bacterial infection in order to consider the use of anticoagulants and corticosteroids.

Severe cases are those with shortage of breath and low arterial pressure. For these patients, the Health Ministry advises the administration of hydroxychloroquine sulfate and azithromycin, for no specified duration. The doctor must also consider the use of human immunoglobulin, anticoagulants, and pulse corticosteroid therapy.

Contraindications

In the document, the ministry also lists contraindications in the use of hydroxychloroquine during pregnancy and in cases of diagnosed retinopathy/maculopathy secondary to the use of the drug, hypersensitivity to the drug, and myasthenia gravis.

In children, priority must be given to the use of hydroxychloroquine for the toxicity risk of chloroquine. Chloroquine must be used with caution in patients with heart, liver, and kidney disease, hematoporphyria, and mental disorders.

Translation: Fabrício Ferreira -  Edition: Maria Cláudia

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