ICMR issues revised advisory on use of hydroxychloroquine

A revised government advisory on Friday recommended use of hydroxychloroquine as a preventive medication for asymptomatic healthcare workers working in n-COVID-19 hospitals, frontline staff on surveillance duty in containment zones, and paramilitary/police personnel involved in coronavirus infection-related activities.

As was mentioned in earlier advisory, drug against infection is also recommended for all asymptomatic healthcare workers involved in containment and treatment of COVID-19 and household contacts of laboratory-confirmed cases.

revised advisory issued by ICMR, however, cautioned that intake of medicine should t instill a sense of false security.

recommendation was made after Joint Monitoring Group under Chairmanship of Directorate General of Health Services (DGHS) and including representatives from AIIMS, ICMR, National Centre for Disease Control, National Disaster Manment Authority, WHO and experts drawn from central government hospitals reviewed prophylactic use of hydroxychloroquine (HCQ) in context of expanding it to healthcare and or frontline workers deployed in n-COVID-19 and COVID-19 areas.

Three new categories ---all asymptomatic healthcare workers working in n-COVID hospitals/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 ---have w been included.

According to revised advisory, “at NIV, Pune, report of in-vitro testing of HCQ for antiviral efficacy showed a reduction of infectivity and log reduction in viral RNA copy of SARs-CoV2”.

“ drug is contraindicated in persons with kwn case of retipathy, hypersensitivity to HCQ and cardiac rhythm disorders,” it said.

drug is t recommended for prophylaxis in children under 15 years of and in pregnancy and lactation, advisory said.

Rarely drug causes cardiovascular side effects such as cardiomyopathy and rhythm (heart rate) disorders, it said.

"In that situation drug needs to be discontinued. drug can rarely cause visual disturbance including blurring of vision which is usually self-limiting and improves on discontinuation of drug," revised advisory said.

drug has to be given under strict medical supervision with informed consent, it stated.

National Taskforce (NTF) for COVID-19 constituted by ICMR reviewed use of HCQ for prophylaxis of SARS-CoV-2 infection for high risk populations based on emerging evidence on its safety and efficacy.

data on assessment of HCQ prophylaxis among 1,323 healthcare workers indicated mild adverse effects such as nausea (8.9 percent), abdominal pain (7.3 percent), vomiting (1.5 percent), hypoglycemia (1.7 percent) and cardiovascular effects (1.9 percent), advisory said.

However, as per data from Pharma covigilance programme of India, re have been 214 reported instances of adverse drug reactions associated with prophylactic HCQ use, it said.

Of se, seven were serious individual case safety reports with prolongation of QT interval on ECG in three cases, it added.

Highlighting studies on prophylaxis of SARS-CoV-2 infection, advisory stated that a retrospective case-control analysis at ICMR has found that re is a significant dose-response relationship between number of prophylactic doses taken and frequency of occurrence of SARS-CoV-2 infection in symptomatic healthcare workers who were tested for coronavirus infection.

Ar investigation from three central government hospitals in New Delhi indicates that amongst healthcare workers involved in COVID-19 care, those on HCQ prophylaxis were less likely to develop SARS-CoV-2 infection, compared to those who were t on it.

benefit was less prounced in healthcare workers caring for a general patient population.

Besides, an observational prospective study of 334 healthcare workers at AIIMS, out of which 248 took HCQ prophylaxis in New Delhi also showed that those taking HCQ prophylaxis had a lower incidence of SARS-CoV-2 infection than those t taking it.

According to advisory, drug has to be given only on prescription of a registered medical practitioner and it is advised to consult with a physician for any adverse event or potential drug interaction before initiation of medication, it said.

Front line workers should use PPEs in accordance with guidelines issued by health ministry and y should be advised to consult ir physician (within ir hospital/surveillance team/security organisation) for any adverse event or potential drug interaction before initiation of medication, advisory said.

If anyone becomes symptomatic while on prophylaxis, he/she should immediately contact health facility, get tested as per national guidelines and follow standard treatment protocol, it said.

Apart from symptoms of COVID-19 (fever, cough, breathing difficulty), if person on chemoprophylaxis develops any or symptoms, he should immediately seek medical treatment from prescribing medical practitioner, it said.

All asymptomatic contacts of laboratory-confirmed cases should remain in home quarantine as per national guidelines, even if y are on prophylactic rapy, advisory added.