As mentioned in the previous advice, the anti-infection drug is also recommended for all asymptomatic health care workers involved in the containment and treatment of Covid-19 and household contacts in laboratory-confirmed cases.
However, the revised advice issued by the ICMR on Friday warned that taking the medication should not give a sense of false security.
The recommendation was made after the joint monitoring group chaired by the Directorate-General for Health (DGHS) and including representatives from the AIIMS, ICMR, the National Center for Disease Control, the National Disaster Management Authority, WHO and experts drawn from state hospitals reviewed the prophylactic use of hydroxychloroquine (HCQ) in expanding it to healthcare and other frontline workers located in non-Covid-19 and Covid-19 areas.
Three new categories — all asymptomatic health workers working in non-covid hospitals / areas of Covid hospitals / blocks, asymptomatic frontline workers, such as surveillance workers located in containment zones and paramilitary / police personnel involved in Covid-19 related activities — are now included.
According to the revised advice, “at NIV, Pune, the report on in vitro testing of HCQ for antiviral efficacy showed reduction of infectivity and log reduction in viral RNA copy of SARs-CoV2”.
“The drug is contraindicated in people with known cases of retinopathy, hypersensitivity to HCQ and cardiac arrhythmia,” it states.
The drug is not recommended for prophylaxis in children under the age of 15 and during pregnancy and lactation, the adviser says.
Rarely does the drug cause cardiovascular side effects such as cardiomyopathy and rhythm (heartbeat), it says.
“In this situation, the drug must be discontinued. The drug can rarely cause visual disturbances, including visibility, which is usually self-limiting and improves upon discontinuation of the drug,” the audited adviser said.
The drug must be given under strict medical control with an informed consent, it states.
The National Covid-19 Task Force (NTF), composed of the ICMR, reviewed the use of HCQ for the prophylaxis of SARS-CoV-2 infection for high-risk population based on the new evidence for its safety and efficacy.
The data for assessing HCQ prophylaxis among 1,323 healthcare workers indicated mild side effects such as nausea (8.9 per cent), abdominal pain (7.3 per cent), vomiting (1.5 per cent), hypoglycemia (1.7 per cent) and cardiovascular effects (1.9 percent), the adviser said.
However, according to the data from Pharma’s covigilance program in India, there are 214 reported cases of side effects associated with prophylactic HCQ use, it says.
Of these, seven serious individual case safety reports with QT interval prolongation were on ECG in three cases, it added.
By highlighting the studies on prophylaxis of SARS-CoV-2 infection, the advisory stated that a retrospective case-control analysis at ICMR found that there is a significant dose-response relationship between the number of prophylactic doses taken. , and the frequency of occurrence of SARSCoV-2 infection in symptomatic health care workers tested for coronavirus infection.
Another study from three central hospitals in New Delhi indicates that among healthcare workers involved in the care of Covid-19, those who had prophylaxis for HCQ were less likely to develop SARS-CoV-2 infection compared to those; that wasn’t on it.
The benefit was less pronounced in health care workers caring for a general patient population.
In addition, an observational prospective study of 334 healthcare workers at AIIMS, of whom 248 took HCQ prophylaxis in New Delhi, also showed that those who took HCQ prophylaxis had lower incidence of SARS-CoV-2 infection than those who did not take it. .
According to the advisory, the drug should only be given on the prescription of a registered physician, and it is advised to consult a physician for any side effect or potential drug interaction before commencing medication, it says.
Frontline workers should use PPEs in accordance with the guidelines issued by the Department of Health, and they should be advised to consult their physician (within their hospital / monitoring team / safety organization) for any adverse event or potential drug interaction before commencing medication.
If someone becomes symptomatic while on prophylaxis, he / she should immediately contact the health facility, get tested according to national guidelines and follow the standard treatment protocol, it says.
Aside from the symptoms of Covid-19 (fever, cough, respiratory distress), if the person on chemoprophylaxis develops other symptoms, he should seek medical attention immediately from the prescribing physician, it says.
All asymptomatic contacts in laboratory confirmed cases must remain in home quarantine according to national guidelines, even if they are on prophylactic therapy, the adviser added.