U.S. hospitals differ on best use of hydroxychloroquine for coronavirus

Major hospitals in New York, Louisiana and other areas hit hardest by the coronavirus outbreak are routinely using hydroxychloroquine on patients hospitalized with COVID-19, though robust evidence on whether it works is weeks, if not months, away.Hydroxychloroquine is a treatment for malaria and autoimmune diseases in use since the 1950’s. The related drug chloroquine has been in use even longer, but is considered to be less safe. The drugs can have serious side effects, including vision loss, heart problems or even death, if used incorrectly. Below are examples of how some hospitals are using the therapy:


The 23-hospital healthcare system began in late March to use hydroxychloroquine routinely in patients admitted with the sometimes deadly respiratory illness caused by the virus, according to Dr. Kevin Tracey, chief executive of Northwell’s research arm. This was based on preliminary data that “it may be beneficial,” said Chief Pharmacy Officer Onisis Stefas. Hydroxychloroquine is given to patients who have “really no other options,” and have not qualified for clinical trials of other potential coronavirus treatments, he said. Northwell also allows doctors to prescribe it in conjunction with the antibiotic azithromycin on a case by case basis, but that is not standard of care.


NYU has been giving the drug to patients since early March, according to Dr. Michael Belmont, a rheumatologist. Some doctors at NYU are also prescribing azithromycin in combination with hydroxychloroquine, although Belmont said the medical literature he has seen is “insufficient to draw an inference that the combination is especially effective.”

UNIVERSITY OF CALIFORNIA, LOS ANGELES MEDICAL CENTERUCLA has been advising doctors since mid-March to consider hydroxychloroquine for seriously ill COVID-19 patients. “Our recommendation is based on limiting usage, allowing it as a Hail Mary-type treatment for patients who are very sick,” said Dr. Otto Yang, an infectious disease specialist.


The hospital system advises that severely ill patients should be prescribed hydroxychloroquine if they are not eligible for trials of remdesivir, an experimental antiviral therapy being developed by Gilead Sciences Inc. Gilead earlier this month put compassionate use access to remdesivir on hold due to overwhelming demand. The health system’s treatment guidelines warn that the combination of azithromycin and hydroxychloroquine “has not been rigorously studied; it is unknown if it provides additional benefit. The combination may cause significant cardiac toxicity.”

OCHSNER MEDICAL CENTER, LOUISIANALouisiana’s largest hospital system is prescribing hydroxychloroquine widely, according to its chief medical officer, Dr Robert Hart. “We have been using this from pretty early in the outbreak to see if this helps,” he said.


The hospital system started using hydroxychloroquine around March 27 for inpatient treatment of COVID-19 patients whose oxygen levels drop below a certain level and who have risk factors for severe disease. The system’s protocols take into account patients’ cardiac history and do not advise combining hydroxychloroquine with azithromycin due to the increased risk of heart problems.