The Indian Council of Medical Research’s (ICMR) revised advisory on the use of hydroxychloriquine (HCQ) as prophylaxis for COVID-19, extending its use to asymptomatic health-care workers in non-COVID hospitals and those on the front lines, will be implemented by the State only after more evidence collection and detailed discussions.

“The protocol regarding HCQ followed by Kerala is very different from ICMR’s suggestion. During an online meeting held with the Centre on Saturday, since all States were at variance with each other, it was decided to meet again with more clinical details and evidence on the use of HCQ for COVID-19 patients. Till then, there will be no change in our HCQ protocol,” a senior Health official told The Hindu.

In Kerala, HCQ is being administered only for confirmed COVID-19 patients who have definite symptoms and as prophylaxis for those health-care staff who are working in COVID wards.

The ICMR’s advisory issued in March had said that HCQ could be administered as chemoprophylaxis for asymptomatic health-care workers involved in the care of suspected or confirmed COVID-19 cases and for asymptomatic household contacts of lab-confirmed cases.

On May 22, the ICMR sought to revise this advisory and extended it to health-care workers working in non-COVID hospitals and caring for general patients in COVID hospitals. It said that front line workers such as the police, who are deployed in containment zones could be administered the drug as prophylaxis.

The revised advisory was issued after it reviewed data on in-vitro testing of HCQ for antiviral efficacy against SARS-CoV-2, the safety profile of the drug as reported to the pharmacovigilance programme of India and the data on the use of HCQ as prophylaxis among health-care workers from All India Institute of Medical Sciences(AIIMS) and other hospitals.

The revised advisory comes a day after The Lancet reported the findings of a large longitudinal study on the use of HCQ in 96,000 patients in 671 hospitals. It reported an increased risk of mortality by 33-45% and increased risk of ventricular arrhythmia by almost five-fold in COVID-19 patients who were administered the drug.

The study concluded that not only was HCQ of no benefit to COVID-19 patients, but it also brought more harm. However, the critical care physicians in Kerala who are involved in the care of COVID-19 patients choose to differ.

“We have to go by a risk vs benefit aspect in choosing HCQ as a potential treatment, till a definitive treatment for COVID-19 emerges. HCQ is an affordable drug. We have decades of experience using it and its safety profile is also well-established. Its ability as an antiviral against SARS-CoV-2 is quite promising and we have observed that early administration of HCQ prevents the patient from developing respiratory distress. In The Lancet study, HCQ administration seems to have been in patients who had already developed significant illness,” a senior clinician said.

“We have a better recovery rate because we pick up and treat our patients early, before complications set in. As soon as they exhibit any symptoms, we start administering them HCQ. However, we are not quite confident about extending its use to the asymptomatic population as prophylaxis, other than for our nurses directly engaged in COVID wards,” a senior Health official said.

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