Concerning reactions

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Health professionals should be on the alert for inappropriate prescribing for COVID-19 treatment, researchers warn

The rapidity of change around COVID-19 presents a challenge in keeping up to date with the latest information about treatments, say Australian researchers. 

In an editorial in Australian Prescriber, clinical pharmacologist Darren Roberts, from St Vincent’s Hospital, Sydney and Alexandra Bennett, Conjoint associate professor, St Vincent’s Clinical School, University of New South Wales, Sydney, have called for caution and awareness of the latest information to avoid harmful treatment during the pandemic. 

“COVID‑19 is presenting a number of challenges,” they said. “We should not compound the crisis by inappropriate prescribing based on inadequate evidence, which increases the risk of harm and causes drug shortages”.

Given information about the purported effects of drugs in COVID‑19 is rapidly changing, many health professionals may be struggling to keep up to date, they warn.

“Most reports focus on what is new, rather than summarising what has been learnt to date. It is easy to miss when a treatment claim becomes discredited or raises new safety concerns”.

“Healthcare professionals must constantly analyse the literature and stay up to date using trusted resources. We need to explain clearly the challenge of balancing harm and benefit to our patients, friends and family”.

The situation is compounded by people trying unproven remedies or seeking alternative sources of information.   

“Fear in the community has resulted in people trying unproven remedies. These fads include consuming bleach, and gargling warm salt water or vinegar. Each fad has varying toxicity and none is of likely benefit.

Consuming chloroquine from an aquarium product and drinking methanol have been fatal. High‑dose vitamin C has been discouraged as a treatment for COVID‑19, but reports that it is being prescribed to, and studied in, patients with COVID‑19 could confuse the public about its place in therapy,” they said.

“These examples highlight the need for balanced discussions of the harms and benefits of each proposed treatment”.

They also warned of inappropriate early reporting of ongoing trial results.

Over 300 trials including more than 50 drug or biological treatments for COVID‑19 have been registered, the authors said.

“These will generate both hope and uncertainty. Currently the main approaches include inhibiting viral replication with chloroquine, hydroxychloroquine or antiviral drugs, immune modulation by corticosteroids, tocilizumab or stem cells, and administration of convalescent sera”.

“Some studies that have been popularised by the media have been uploaded to online preprint servers without the rigour of peer review. This may not be apparent from an abstract or media report so a high level of scepticism is required”.


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