Role of Chloroquine and Hydroxychloroquine in the Treatment of COVID-19 Infection- A Systematic Literature Review

Krishan Mohan Kapoor; Aanandita Kapoor

The copyright holder for this preprint (which was not peer-reviewed) is the . https://doi.org/10.1101/2020.03. 24.20042366 doi: medRxiv preprint The suggested regimen by Dutch CDC in adults includes an initial dose of 600 mg of chloroquine base followed by 300 mg after 12 h on the first day, followed by 300 mg twice daily on days second to fifth. This document also emphasizes the need for stopping the treatment at day 5 to reduce the risk of side effects, as CQ has a long half-life of 30 hours. There is also a need to differentiate between treatment based on chloroquine phosphate and chloroquine base since 500 mg of chloroquine phosphate is equivalent to 300 mg of chloroquine base. Another set of guidelines by the Italian Society of Infectious and Tropical disease (Lombardy section) suggests the use of CQ 500 mg twice daily or HCQ 200 mg once daily for ten days with treatment duration varying between 5 to 20 days based on clinical severity. The suggested target group of patients ranged from patients with mild respiratory symptoms having comorbidities to patients with severe respiratory failure. 11 CQ has been recommended for 18-65 years of COVID-19 infected adults at a dose of 500mg twice daily for seven days. For BW ≤ 50 kg patients, the CQ dose should be decreased to 500 once daily during day third to seventh of the treatment cycle ( Table 1 ). There has been no dose recommendation of CQ in COVID-19 infected children so far; hence extreme caution should be followed while prescribing it for children. Acute poisoning of CQ is usually fatal with a dose of 50 mg/kg, and CQ concentration > 25 μ mol/L is a fatal predictor. 12 In Nigerian children with acute uncomplicated malaria, chloroquine absorption appeared reliable as peak chloroquine concentrations were achieved within 0.5 hours, and its concentration decline slowly, with an elimination half-life of 20 to 60 days.