Brazil’s Health Ministry Recommends Wide Use of Hydroxychloroquine, Chloroquine

May 20, 2020 Updated: May 21, 2020

Brazil’s Health Ministry on Wednesday recommended using hydroxychloroquine and the closely related chloroquine in hospitalized patients, from the mild cases to the most serious ones.

Doctors should consider prescribing the increasingly popular three-drug combination of hydroxychloroquine or chloroquine with azithromycin, an antibiotic, and zinc, the new guidelines (pdf) state.

Brazil’s federal guidelines previously said hydroxychloroquine and chloroquine should only be used in patients suffering from severe cases of COVID-19. The new guidance says the anti-malarials should be used with azithromycin at the first sign of symptoms.

Patients will have to sign a waiver recognizing potential side effects caused by the medicines.

Because of the heightened toxicity of chloroquine, children should receive hydroxychloroquine, health officials said.

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A photograph of a laptop shows hydroxychloroquine for sale on a Brazilian website in Rio de Janeiro, Brazil, on May 20, 2020. (Mauro Pimentel/AFP via Getty Images)

Chloroquine should be used with caution in patients with heart disease, liver disease, kidney disease, and mental illness.

The guidance came after the national medicine council authorized the prescription of hydroxychloroquine and chloroquine against COVID-19, a new disease that’s caused by the CCP (Chinese Communist Party) virus.

Brazil’s Health Ministry said patients with mild or moderate cases should receive two doses of 450 milligrams of chloroquine on day one and a single dose of the same amount on days two through five, along with 500 milligrams of azithromycin per day through day five. The same regimen is recommended for hydroxychloroquine at the slightly lowered dosing of 400 milligrams.

Patients with severe illness shouldn’t be given the chloroquine regimen, health officials said.

The ministry issued the guidelines in consideration of “the existence of several studies and the wide experience in the use of chloroquine and hydroxychloroquine in the treatment of other infectious diseases and chronic diseases in the scope of the” healthcare system.

It said no other effective treatments for COVID-19 exist to date.

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Brazilian Executive Secretary of the Ministry Health Eduardo Pazuello during a press conference to give updates on the COVID-19 pandemic at the Planalto Palace in Brasilia on April, 27, 2020. (Andressa Anholete/Getty Images)

Interim Health Minister Eduardo Pazuello, an active duty army general, authorized the new guidelines after two trained doctors left the ministry’s top job. Nelson Teich, an oncologist and health care consultant, resigned on Friday after taking the position in mid-April.

“Life is made up of choices and today I decided to leave,” Teich told reporters in Brasilia.

Hydroxychloroquine and chloroquine have long been used around the world to prevent and treat malaria and other ailments and their use against COVID-19 has gained steam in a number of nations, including the United States, India, and Turkey.

The guidelines cited 76 documents, including some completed and ongoing studies, about the drugs, including studies in the early 2000s about the effectiveness of zinc, chloroquine, and hydroxychloroquine.

More recent studies included a March 22 study in France that found hydroxychloroquine was associated with a reduction in viral load; an April 10 study in China finding the use of the drug could “significantly shorten” time to clinical recovery; and a May 1 study from Chinese researchers that found hydroxychloroquine associated with a decreased mortality rate in critically ill COVID-19 patients.

Medical experts said studies have not confirmed the effectiveness of the drugs in treating the CCP virus, including Marcos Espinal, director for communicable diseases at the Pan American Health Organization.

“Our recommendations are crystal clear that they should not be used yet and in fact studies are suggesting a higher rate of secondary effects and cardiological problems in people who use it,” Espinal told journalists in a Tuesday briefing.

The Associated Press and Reuters contributed to this report. 

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