hydroxychloroquine in symptomatic COVID-19 patients

Q: What is the recommended dose and treatment course of hydroxychloroquine in symptomatic COVID-19 patients?


Answer: 200 mg three times per day for 10 days

Both chloroquine and hydroxychloroquine inhibits SARS-CoV-2 at least in vitro. Hydroxychloroquine appears to have more potent antiviral activity than Chloroquine. In COVID-19, some data from China has shown reduced progression of disease and decreased duration of symptoms. The dose is 200 mg three times per day for 10 days. 

Some reports suggest that it is associated with a higher rate of undetectable SARS-CoV-2 RNA on nasopharyngeal specimens by day 6 compared with no specific treatment (70 % vs 12.5%). Also, addition of azithromycin in combination with hydroxychloroquine appeared to have additional benefit, although the basis for this benefit is not clear.

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References:

1. Yao X, Ye F, Zhang M, et al. In Vitro Antiviral Activity and Projection of Optimized Dosing Design of Hydroxychloroquine for the Treatment of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Clin Infect Dis 2020. 

 2. Gao J, Tian Z, Yang X. Breakthrough: Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. Biosci Trends 2020; 14:72. 

 3. Colson P, Rolain JM, Lagier JC, et al. Chloroquine and hydroxychloroquine as available weapons to fight COVID-19. Int J Antimicrob Agents 2020; :105932. 

 4. Cortegiani A, Ingoglia G, Ippolito M, et al. A systematic review on the efficacy and safety of chloroquine for the treatment of COVID-19. J Crit Care 2020. 

 5. Gautret et al. (2020) Hydroxychloroquine and azithromycin as a treatment of COVID‐19: results of an open‐label non‐randomized clinical trial. International Journal of Antimicrobial Agents – 
DOI:10.1016/j.ijantimicag.2020.105949.