Based on the best available evidence reviewed through April 17, 2020, the American College of Physicians (ACP) does not recommend the use of chloroquine or hydroxychloroquine, with or without azithromycin, as prophylaxis against or as treatment for coronavirus disease (COVID-19). The new practice points, published in the Annals of Internal Medicine,1 will be maintained as a living document and updated by the Scientific Medical Policy Committee of the ACP as new evidence becomes available.
This first version of the ACP practice points provides rapid clinical advice based on a concise summary of the best available evidence on the benefits and harms of the use of chloroquine or hydroxychloroquine alone or in combination with azithromycin for prophylaxis or treatment of COVID-19. These practice points are based on a systematic evidence review conducted by the University of Connecticut Health Outcomes, Policy, and Evidence Synthesis Group.
Although the ACP recommends against the use of these medications to either prevent COVID-19 or to treat patients with COVID-19, the practice points note that clinicians may treat hospitalized patients with COVID-19 with these medications in the context of a clinical trial using shared and informed decision-making with patients and their families.
“With the rapid emergence of COVID-19, physicians and clinicians have found themselves managing the frontlines of the pandemic with a paucity of evidence available to inform treatment decisions,” said Jacqueline W. Fincher, MD, MACP, president of the ACP, in a news release.2 “ACP rapidly developed its Practice Points as concise, synthesized summaries of the current state of evidence in order to address urgent questions related to the transmission, diagnosis, and treatment of COVID-19. As such, these Practice Points give frontline physicians guidance to provide patients with the care based on the best available evidence,” Dr Fincher added.
1. Qaseem A, Yost J, Etxeandia-Ikobaltzeta I, et al; for the Scientific Medical Policy Committee of the American College of Physicians. Should clinicians use chloroquine or hydroxychloroquine alone or in combination with azithromycin for the prophylaxis or treatment of COVID-19? Living practice points from the American College of Physicians (version 1) [published online May 13, 2020]. Ann Intern Med. doi:10.7326/M20-1998
2. ACP: evidence does not support chloroquine or HCQ use alone or in combination with azithromycin as prophylaxis for COVID-19 [news release]. Philadelphia, PA: American College of Physicians (ACP). Published May 13, 2020. Accessed June 28, 2020.