re: Positive News: Another Dr. Touts Success of Hydroxychloroquine

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Barley enough to do anything, though.

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It's "barely".

It's a great excuse for a gin and tonic!

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Is that it has the potential to cause disruption in the electrical rhythm of the heart..

Granted hydroxychloroquine was designed to be MUCH safer in that regard compared to chloroquine

This can theoretically have an additive effect with azithromycin BUT, the whole point of the antibiotic is to prevent the secondary pneumonia so you could hypothetically replace a Z pack with another antibiotic like doxycycline

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The effect (QT prolongation) is truly additive. The more QT prolonging meds you have the higher the chance of a fatal arrhythmia. We don’t have enough data to show safety regarding these two drugs in corona patients, and the French trial that stirred up so much hope about these drugs was very small and poorly controlled/designed.

Like I mentioned earlier in this thread, another hydroxychloroquine trial (slightly larger than the French one) was negative. Anecdotally, docs in New Orleans have not seen improvement in their patients with the hydroxychloroquine, although I found the OP tidbit about it helping zinc enter cells kind of intriguing.

Concomitant bacterial pneumonia is incredibly rare in these patients. The potential benefit of azithromycin lies in its inherent anti inflammatory properties. I doubt changing to doxy would benefit patients.

These patients don’t die from their viral pneumonia, they die from the massive inflammatory response and acute respiratory distress syndrome when their lungs fill with fluid. Stopping the massive cytokine storm/inflammatory cascade that causes this is key I think, and I would guess trials looking at tocilizumab (IL-6 inhibitor) or anakinra (IL-1 inhibitor) will be more promising. Just my 2 cents as an ER doc who follows this stuff super closely, for obvious reasons.

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The head of medicine for Lennox Hill Hospital in Boston completely disagrees with you

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I eagerly look forward to his published, double blind, randomized controlled trial showing this data.

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My biggest question is why isn’t this being used immediately at the onset of symptoms when the data supports it to shorten the duration of the virus

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The French study looked at viral clearance from the nares, an essentially worthless metric. We need mortality data/patient oriented outcomes, as well as proof of safety, to make better clinical decisions.

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Why aren’t our doctors, nurses, & first responders taking this as a prophylactic?

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Because there is only some data showing it does this in a Petri dish and none in humans, but I know of at least one study looking into this. There is no established dosing and there is a low threshold for toxicity.

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Why is the rest of the world’s physician’s and medical personnel taking regimens of this to keep them on the front lines, hell India just made it mandatory that all their front line people start taking it immediately?

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People are desperate to have some big guns to fight this thing. Hydroxychloroquine might be that or it might not. The data isn’t convincing either way. And India also has unlicensed doctors and markets where anyone can buy antibiotics by the bag. Not exactly the pinnacle of medical practice but I get your point.

ETA: the French study that oncologist was touting is a very poor study. Only 26 patients, no real control, not randomized, not blinded. 6 patients lost to follow up, 3 of whom were excluded from the study because they went to the ICU or died. It’s a terrible study design and excluding those patients was super fishy.

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is that around 90-95% of patients who start treatment before they are in the critical stage will see a real improvement

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This is highly, highly unlikely.

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Concomitant bacterial pneumonia is incredibly rare in these patients. The potential benefit of azithromycin lies in its inherent anti inflammatory properties. I doubt changing to doxy would benefit patients. These patients don’t die from their viral pneumonia, they die from the massive inflammatory response and acute respiratory distress syndrome when their lungs fill with fluid. Stopping the massive cytokine storm/inflammatory cascade that causes this is key I think, and I would guess trials looking at tocilizumab (IL-6 inhibitor) or anakinra (IL-1 inhibitor) will be more promising. Just my 2 cents as an ER doc who follows this stuff super closely, for obvious reasons.

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You don’t get the ARDS/ Inflammatory cascade in the first place without the Cov2-SARS virus, so yes patients do die from the viral pneumonia because the ARDS is sequelae of Cov2-SARS induced pneumonia. That’s like saying a patient died from septic shock and not the bacterial pneumonia that caused it. We don’t list cause of death as attributable to septic shock/MODS/MOFS we list it as pneumonia. Not arguing just making a point of distinction.

I think both areas of attack - anti-vitals and inflammatory cascade disrupters are promising - hopefully we can combine them to create a superior treatment regimen and kick this virus’s arse back to China.

Novel antiviral properties of azithromycin in cystic fibrosis airway epithelial cells

Stands to reason these antiviral properties may carry over to lower lung.

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Concomitant bacterial pneumonia is incredibly rare in these patients. The potential benefit of azithromycin lies in its inherent anti inflammatory properties. I doubt changing to doxy would benefit patients.

These patients don’t die from their viral pneumonia, they die from the massive inflammatory response and acute respiratory distress syndrome when their lungs fill with fluid. Stopping the massive cytokine storm/inflammatory cascade that causes this is key I think, and I would guess trials looking at tocilizumab (IL-6 inhibitor) or anakinra (IL-1 inhibitor) will be more promising. Just my 2 cents as an ER doc who follows this stuff super closely, for obvious reasons.

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We do have another doc on here who said they prescribed Hydroxychloroquine only, and saw improvement only to see the patient go critical two days later due to a secondary bacterial pneumonia. It's one data point, but interesting nonetheless.

No, they don't have to test them for the China virus first.

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Why aren’t our doctors, nurses, & first responders taking this as a prophylactic?

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Well, that would be stupid since it’s an immunosuppressive drug and there’s not data to definitively suggest it would work in such a manner.