Efficacy and safety of chloroquine, hydroxychloroquine and azithromycin in patients with COVID-19: Summary of evidence
PDF (Español)


COVID-19, hydroxychloroquine, azithromycin, adverse drug event, prophylaxis

How to Cite

Chacón Acevedo K, Pinzón C, Barrera A, Low Padilla E, Yomayusa González N. Efficacy and safety of chloroquine, hydroxychloroquine and azithromycin in patients with COVID-19: Summary of evidence. Rev. Colomb. Nefrol. [Internet]. 2020 Jun. 11 [cited 2024 Jul. 18];7(Supl.2). Available from: https://revistanefrologia.org/index.php/rcn/article/view/469


Introduction: The COVID-19 disease is a health emergency; treatment has not yet been proven.

Objective: To present the available evidence of efficacy and safety of the use of hydroxychloroquine and azithromycin in the prophylaxis and management of patients with COVID-19.

Methods: A rapid literature review was performed; we consulted Medline, scopus and pubmed databases.

Results: Eleven publications were included including rapid literature reviews, observational studies, and clinical trials. No data were found studying prophylaxis with hydroxychloroquine and azithromycin for SARS-CoV-2. Reports of adverse events include episodes of emesis, abdominal pain, nausea, diarrhea, rash, and itching.

Conclusions: The evidence collected suggests that the use of hydroxychloroquine and azithromycin in patients with COVID-19, could abnormal electrocardiogram and increased risk of mortality in-hospital. The effectiveness remains unclear.

PDF (Español)


Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis. 2020;20(5):533-4. http://dx.doi.org/10.1016/S1473-3099(20)30120-1.

Yao X, Ye F, Zhang M, Cui C, Huang B, Niu P, et al. In Vitro Antiviral Activity and Projection of Optimized Dosing Design of Hydroxychloroquine for the Treatment of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Clin Infect Dis. 2020. http://dx.doi.org/10.1093/cid/ciaa237.

Gautret P, Lagier JC, Parola P, Hoang VT, Meddeb L, Mailhe M, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents. 2020;105949. http://dx.doi.org/10.1016/j.ijantimicag.2020.105949.

Sahraei Z, Shabani M, Shokouhi S, Saffaei A. Aminoquinolines against coronavirus disease 2019 (COVID-19): chloroquine or hydroxychloroquine. Int J Antimicrob Agents. 2020;55(4):105945. http://dx.doi.org/10.1016/j.ijantimicag.2020.105945.

Chauhan A, Tikoo A. The enigma of the clandestine association between chloroquine and HIV-1 infection. HIV Med. 2015;16(10):585-90. http://dx.doi.org/10.1111/hiv.12295.

Keyaerts E, Li S, Vijgen L, Rysman E, Verbeeck J, Van Ranst M, et al. Antiviral activity of chloroquine against human coronavirus OC43 infection in newborn mice. Antimicrob. Agents Chemother. 2009;53(8):3416-21. http://dx.doi.org/10.1128/AAC.01509-08.

Vincent MJ, Bergeron E, Benjannet S, Erickson BR, Rollin PE, Ksiazek TG, et al. Chloroquine is a potent inhibitor of SARS coronavirus infection and spread. Virol J. 2005;2:69. http://dx.doi.org/10.1186/1743-422X-2-69.

Touret F, de Lamballerie X. Of chloroquine and COVID-19. Antiviral Res. 2020;177:104762. http://dx.doi.org/10.1016/j.antiviral.2020.104762.

Food and Drog Administration (FDA). EUA Choroquine Phosphate Hea th Care Provider Fact Sheet, version date 4/3/2020. FDA; 2020.

Liu J, Cao R, Xu M, Wang X, Zhang H, Hu H, et al. Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro. Cell Discov. 2020;6:16. http://dx.doi.org/10.1038/s41421-020-0156-0.

Wang M, Cao R, Zhang L, Yang X, Liu J, Xu M, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res. 2020;30(3):269-71. https://doi.org/10.1038/s41422-020-0282-0.

Lane JCE, Weaver J, Kostka K, Duarte-Salles T, Abrahao MTF, Alghoul H, et al. Safety of hydroxychloroquine, alone and in combination with azithromycin, in light of rapid wide-spread use for COVID-19: a multinational, network cohort and self-controlled case series study. medRxiv. 2020. https://doi.org/10.1101/2020.04.08.20054551.

World Health Organization (WHO). The Cardiotoxicity of Antimalarials. World Health Organization.Geneva: WHO; 2017.

Ray WA, Murray KT, Hall K, Arbogast PG, Stein CM. Azithromycin and the Risk of Cardiovascular Death. N Engl J Med. 2012;367(8):772-5. https://doi.org/10.1056/NEJMc1207269.

Chen CY, Wang FL, Lin CC. Chronic hydroxychloroquine use associated with QT prolongation and refractory ventricular arrhythmia. Clin Toxicol (Phila). 2006;44(2):173-5. http://dx.doi.org/10.1080/15563650500514558.

Yang Z, Prinsen JK, Bersell KR, Shen W, Yermalitskaya L, Sidorova T, et al. Azithromycin Causes a Novel Proarrhythmic Syndrome. Circ Arrhythm Electrophysiol. 2017;10(4):e003560. http://dx.doi.org/10.1161/CIRCEP.115.003560.

Ventricular Arrhythmia Risk Due to Hydroxychloroquine-Azithromycin Treatment For COVID-19. Marzo 29 de 2020. Cardiology Magazine. 2020 [citado Jul 2 2020]. Disponible en: https://www.acc.org/latest-in-cardiology/articles/2020/03/27/14/00/ventricular- arrhythmia-risk-due-to-hydroxychloroquine-azithromycin-treatment-for-covid-19.

Chang R, Sun W. Repositioning Chloroquine as Ideal Antiviral Prophylactic against COVID-19 - Time is Now. Preprints. 2020. http://dx.doi.org/10.20944/preprints202003.0279.v1.

Gao J, Tian Z, Yang X. Breakthrough: Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. Biosci Trends. 2020;14(1):72-3. http://dx.doi.org/10.5582/bst.2020.01047.

. Huang M, Tang T, Pang P, Li M, Ma R, Lu J, et al. Treating COVID-19 with Chloroquine. J Mol Cell Biol. 2020;12(4):322-5. https://doi.org/10.1093/jmcb/mjaa014.

1 . Borba MGS, Val F de A, Sampaio VS, Alexandre MAA, Melo GC, Brito M, et al. Chloroquine diphosphate in two different dosages as adjunctive therapy of hospitalized patients with severe respiratory syndrome in the context of coronavirus (SARS-CoV-2) infection: Preliminary safety results of a randomized, double-blinded, phase IIb clinical trial (CloroCovid-19 Study). medRxiv. 2020. https://doi.org/10.1101/2020.04.07.20056424.

Magagnoli J, Narendran S, Pereira F, Cummings T, Hardin JW, Sutton SS, et al. Outcomes of hydroxychloroquine usage in United States veterans hospitalized with Covid-19. medRxiv. 2020 https://doi.org/10.1101/2020.04.16.20065920.

Molina JM, Delaugerre C, Le Goff J, Mela-Lima B, Ponscarme D, Goldwirt L, et al. No evidence of rapid antiviral clearance or clinical benefit with the combination of hydroxychloroquine and azithromycin in patients with severe COVID-19 infection. Med Mal Infect. 2020;50(4):384. http://dx.doi.org/10.1016/j.medmal.2020.03.006.

Mercuro NJ, Yen CF, Shim DJ, Maher TR, McCoy CM, Zimetbaum PJ, et al. Risk of QT Interval Prolongation Associated With Use of Hydroxychloroquine With or Without Concomitant Azithromycin Among Hospitalized Patients Testing Positive for Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. 2020;e201834. http://dx.doi.org/10.1001/jamacardio.2020.1834.

Bessière F, Roccia H, Delinière A, Charrière R, Chevalier P, Argaud L, et al. Assessment of QT Intervals in a Case Series of Patients With Coronavirus Disease 2019 (COVID-19) Infection Treated With Hydroxychloroquine Alone or in Combination With Azithromycin in an Intensive Care Unit. JAMA Cardiol. 2020;e201787. https://doi.org/10.1001/jamacardio.2020.1787.

Rosenberg ES, Dufort EM, Udo T, Wilberschied LA, Kumar J, Tesoriero J, et al. Association of Treatment With Hydroxychloroquine or Azithromycin With In-Hospital Mortality in Patients With COVID-19 in New York State. JAMA. 2020;323(24):2493-2502. https://doi.org/10.1001/jama.2020.8630.

Chowdhury MS, Rathod J, Gernsheimer J. A Rapid Systematic Review of Clinical Trials Utilizing Chloroquine and Hydroxychloroquine as a Treatment for COVID-19. Acad Emerg Med. 2020;27(6):493-504. https://doi.org/10.1111/acem.14005.

Mehra MR, Desai SS, Ruschitzka F, Patel AN. Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19?: a multinational registry analysis. Lancet. 2020;6736(20):1-10. http://dx.doi.org/10.1016/S0140-6736(20)31180-6.

No national or foreign publication may partially or totally reproduce or translate Revista Colombiana de Nefrología articles or abstracts without prior written permission from the journal’s Editorial Board.




Download data is not yet available.