Cardiovascular Safety of Hydroxychloroquine-Azithromycin in 424 COVID-19 Patients

被引:2
|
作者
Million, Matthieu [1 ,2 ]
Lagier, Jean-Christophe [1 ,2 ]
Hourdain, Jerome [3 ,4 ]
Franceschi, Frederic [3 ,4 ]
Deharo, Jean-Claude [3 ,4 ]
Parola, Philippe [1 ,5 ]
Brouqui, Philippe [1 ,2 ]
机构
[1] IHU Mediterranee Infect, F-13005 Marseille, France
[2] Aix Marseille Univ, AP HM, Fac Sci Med & Paramed, Inst Rech Dev,Unite MEPHI Microbes Evolut Phylogen, F-13005 Marseille, France
[3] Ctr Hosp Univ Timone, AP HM, Serv Cardiol, F-13005 Marseille, France
[4] Aix Marseille Univ, Fac Sci Med & Paramed, C2VN, F-13005 Marseille, France
[5] Aix Marseille Univ, AP HM, Fac Sci Med & Paramed, VITROME,IRD, F-13005 Marseille, France
来源
MEDICINA-LITHUANIA | 2023年 / 59卷 / 05期
关键词
COVID-19; SARS-CoV-2; hydroxychloroquine; azithromycin; QTc interval; cardiac rhythm; safety; torsades de pointe; COMBINATION; THERAPY;
D O I
10.3390/medicina59050863
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background and Objectives: Hydroxychloroquine (HCQ) combined with azithromycin (AZM) has been widely administered to patients with COVID-19 despite scientific controversies. In particular, the potential of prolong cardiac repolarization when using this combination has been discussed. Materials and Methods: We report a pragmatic and simple safety approach which we implemented among the first patients treated for COVID-19 in our center in early 2020. Treatment contraindications were the presence of severe structural or electrical heart disease, baseline corrected QT interval (QTc) > 500 ms, hypokalemia, or other drugs prolonging QTc that could not be interrupted. Electrocardiogram and QTc was evaluated at admission and re-evaluated after 48 h of the initial prescription. Results: Among the 424 consecutive adult patients (mean age 46.3 +/- 16.1 years; 216 women), 21.5% patients were followed in conventional wards and 78.5% in a day-care unit. A total of 11 patients (2.6%) had contraindications to the HCQ-AZ combination. In the remaining 413 treated patients, there were no arrhythmic events in any patient during the 10-day treatment regimen. QTc was slightly but statistically significantly prolonged by 3.75 +/- 25.4 ms after 2 days of treatment (p = 0.003). QTc prolongation was particularly observed in female outpatients <65 years old without cardiovascular disease. Ten patients (2.4%) developed QTc prolongation > 60 ms, and none had QTc > 500 ms. Conclusions: This report does not aim to contribute to knowledge of the efficacy of treating COVID-19 with HCQ-AZ. However, it shows that a simple initial assessment of patient medical history, electrocardiogram (ECG), and kalemia identifies contraindicated patients and enables the safe treatment of COVID-19 patients with HCQ-AZ. QT-prolonging anti-infective drugs can be used safely in acute life-threatening infections, provided that a strict protocol and close collaboration between infectious disease specialists and rhythmologists are applied.
引用
收藏
页数:12
相关论文
共 50 条
  • [11] Hydroxychloroquine and Azithromycin as Treatments for COVID-19
    Ohe, Masashi
    Furuya, Ken
    Goudarzi, Houman
    GAZI MEDICAL JOURNAL, 2020, 31 (2A): : 337 - 338
  • [12] Electrocardiographic findings and cardiac safety of hydroxychloroquine+azithromycin in hospitalized patients with COVID-19
    Akkus, Oguz
    Bal, Tayibe
    Yagoobi, Hasibullah
    Bekler, Ozkan
    Akkus, Gamze
    Cabalak, Mehmet
    CUKUROVA MEDICAL JOURNAL, 2021, 46 (02): : 691 - 698
  • [13] Clinical efficacy and safety profile of hydroxychloroquine and azithromycin against COVID-19
    Gautret, Philippe
    Lagier, Jean-Christophe
    Honore, Stephane
    Van Thuan Hoang
    Raoult, Didier
    INTERNATIONAL JOURNAL OF ANTIMICROBIAL AGENTS, 2021, 57 (01)
  • [14] Treatment with hydroxychloroquine, azithromycin, and combination in patients hospitalized with COVID-19
    Arshad, Samia
    Kilgore, Paul
    Chaudhry, Zohra S.
    Jacobsen, Gordon
    Wang, Dee Dee
    Huitsing, Kylie
    Brar, Indira
    Alangaden, George J.
    Ramesh, Mayur S.
    McKinnon, John E.
    O'Neill, William
    Zervos, Marcus
    INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES, 2020, 97 : 396 - 403
  • [15] The QT interval in patients with COVID-19 treated with hydroxychloroquine and azithromycin
    Ehud Chorin
    Matthew Dai
    Eric Shulman
    Lalit Wadhwani
    Roi Bar-Cohen
    Chirag Barbhaiya
    Anthony Aizer
    Douglas Holmes
    Scott Bernstein
    Michael Spinelli
    David S. Park
    Larry A. Chinitz
    Lior Jankelson
    Nature Medicine, 2020, 26 : 808 - 809
  • [16] The QT interval in patients with COVID-19 treated with hydroxychloroquine and azithromycin
    Chorin, Ehud
    Dai, Matthew
    Shulman, Eric
    Wadhwani, Lalit
    Bar-Cohen, Roi
    Barbhaiya, Chirag
    Aizer, Anthony
    Holmes, Douglas
    Bernstein, Scott
    Spinelli, Michael
    Park, David S.
    Chinitz, Larry A.
    Jankelson, Lior
    NATURE MEDICINE, 2020, 26 (06) : 808 - 809
  • [17] Dangers of the use of hydroxychloroquine and azithromycin combination in COVID-19 patients
    Alizargar, Javad
    TRAVEL MEDICINE AND INFECTIOUS DISEASE, 2020, 38
  • [18] HYDROXYCHLOROQUINE AND AZITHROMYCIN COMBINATION COULD BE LETHAL TO COVID-19 PATIENTS
    Mohammad, Firdous Sayeed
    Karmakar, Varnita
    Irfan, Zainab
    FARMACIA, 2020, 68 (03) : 384 - 389
  • [19] Hydroxychloroquine with azithromycin in patients hospitalized for mild and moderate COVID-19
    Lamback, Elisa Baranski
    de Oliveira, Monica Amorim
    Haddad, Andrea Ferreira
    Marcondes Vieira, Andre Filipe
    Ferreira Neto, Armando Leao
    Maia, Taciana da Silva
    Chrisman, Juliana de Rezende
    de Mello Spineti, Pedro Pimenta
    de Mattos, Marco Antonio
    Costa, Eduardo
    BRAZILIAN JOURNAL OF INFECTIOUS DISEASES, 2021, 25 (02):
  • [20] Hydroxychloroquine with or without Azithromycin in Covid-19 REPLY
    Cavalcanti, Alexandre B.
    Berwanger, Otavio
    Zampieri, Fernando G.
    NEW ENGLAND JOURNAL OF MEDICINE, 2021, 384 (02): : 191 - 191