Chloroquine and Hydroxychloroquine for the Prevention or Treatment of COVID-19 in Africa: Caution for Inappropriate Off-label Use in Healthcare Settings.

Abstract

The novel severe acute respiratory syndrome-coronavirus-2 pandemic has spread to Africa, where nearly all countries have reported laboratory-confirmed cases of novel coronavirus disease (COVID-19). Although there are ongoing clinical trials of repurposed and investigational antiviral and immune-based therapies, there are as yet no scientifically proven, clinically effective pharmacological treatments for COVID-19. Among the repurposed drugs, the commonly used antimalarials chloroquine (CQ) and hydroxychloroquine (HCQ) have become the focus of global scientific, media, and political attention despite a lack of randomized clinical trials supporting their efficacy. Chloroquine has been used worldwide for about 75 years and is listed by the WHO as an essential medicine to treat malaria. Hydroxychloroquine is mainly used as a therapy for autoimmune diseases. However, the efficacy and safety of CQ/HCQ for the treatment of COVID-19 remains to be defined. Indiscriminate promotion and widespread use of CQ/HCQ have led to extensive shortages, self-treatment, and fatal overdoses. Shortages and increased market prices leave all countries vulnerable to substandard and falsified medical products, and safety issues are especially concerning for Africa because of its healthcare system limitations. Much needed in Africa is a cross-continental collaborative network for coordinated production, distribution, and post-marketing surveillance aligned to low-cost distribution of any approved COVID-19 drug; this would ideally be piggybacked on existing global aid efforts. Meanwhile, African countries should strongly consider implementing prescription monitoring schemes to ensure that any off-label CQ/HCQ use is appropriate and beneficial during this pandemic.

• Authors: Pascale M Abena, Eric H Decloedt, Emmanuel Bottieau, Fatima Suleman, Prisca Adejumo, Nadia A Sam-Agudu, Jean-Jacques Muyembe TamFum, Moussa Seydi, Serge P Eholie, Edward J Mills, Oscar Kallay, Alimuddin Zumla, Jean B Nachega
• Journal: The American journal of tropical medicine and hygiene (Am J Trop Med Hyg) Vol. 102 Issue 6 Pg. 1184-1188 (06 2020) ISSN: 1476-1645 [Electronic] United States
• PMID: 32323646 (Publication Type: Journal Article)

Chemical References

• Antimalarials
• Antirheumatic Agents
• Antiviral Agents
• Hydroxychloroquine
• Azithromycin
• Chloroquine

Topics

• Antimalarials (therapeutic use)
• Antirheumatic Agents (therapeutic use)
• Antiviral Agents (therapeutic use)
• Azithromycin (therapeutic use)
• Betacoronavirus (drug effects, pathogenicity)
• COVID-19
• COVID-19 Testing
• Chloroquine (therapeutic use)
• Clinical Laboratory Techniques (standards)
• Coronavirus Infections (diagnosis, drug therapy, epidemiology)
• Drug Repositioning
• Humans
• Hydroxychloroquine (therapeutic use)
• Off-Label Use (ethics)
• Pandemics
• Pneumonia, Viral (diagnosis, drug therapy, epidemiology)
• Practice Guidelines as Topic
• Randomized Controlled Trials as Topic (standards)
• SARS-CoV-2
• Sample Size
• Treatment Outcome
• United States (epidemiology)