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Antimicrobial Alert 

For more information, contact 

SAAGAR executive 

Communicable Disease Control Branch 

SA Health 
HealthAntibio@sa.gov.au Public   I2   A1   

Potential shortage of 
This alert provides information regarding the potential national shortage of 

hydroxychloroquine, and provides guidance from the SA expert Advisory Group on 

Antimicrobial Resistance (SAAGAR) on the appropriate place of 

hydroxychloroquine in clinical practice.  

Hydroxychloroquine is a disease-modifying anti-rheumatic drug (DMARD) used for the treatment of 

rheumatoid arthritis and other inflammatory conditions such as systemic lupus erythematosus (SLE).

Historically it was used to treat malaria, however its use has declined since the emergence of 

Plasmodium resistance to chloroquine and hydroxychloroquine.

Summary of issues 

? There is potentially a critical global shortage of hydroxychloroquine imminent due to recent media 

attention on its possible role in the treatment of SARS-CoV-2 infection (COVID-19). Inappropriate 

use of hydroxychloroquine is increasing the risk that it will be unavailable to treat patients with 

a proven need for the drug.  

? The currently available evidence for hydroxychloroquine in COVID-19 is limited to in vitro data 

suggesting antiviral activity against SARS-CoV-2.
 in addition to a small single arm open label 

 A small prospective randomised study found no benefit with hydroxychloroquine compared to 

standard supportive care.

? There are currently no adequately powered, published randomised trials to determine the efficacy 

and safety of hydroxychloroquine for the treatment of COVID-19. There is no evidence that 

prophylaxis with hydroxychloroquine reduces the risk of infection with SARS-CoV-2. 

Risk of toxicity with hydroxychloroquine 

? Gastrointestinal adverse effects are common with hydroxychloroquine. In addition, 

hydroxychloroquine may cause ocular toxicity, including blurred vision, keratopathy and retinopathy. 

Rarely, it is associated with cardiomyopathy, resulting in heart failure.  Hydroxychloroquine may 

prolong the QT interval, and cause arrhythmias including torsade de pointes, particularly if given with 

other medications that also prolong the QT interval, such as azithromycin.

The role of hydroxychloroquine in the treatment of COVID-19 

? Hydroxychloroquine should only be prescribed for treatment of COVID-19 as part of a clinical trial 

with or without concomitant antiviral drugs.  

? For prophylaxis or treatment of mild COVID-19, there is no evidence that the possible benefits 

outweigh the risk of serious adverse effects to hydroxychloroquine.  


1. Suarez-Almazor ME, et al (2000). Antimalarials for treating rheumatoid arthritis. Cochrane Systematic Reviews, doi:10.1002/14651858.CD000959 
2. Plantone D, Koudriavtseva T. Current and future use of chloroquine and hydroxychloroquine in infectious, immune, neoplastic and neurological diseases: a mini-

review. Clin Drug Invest 38:653-71 
3. Yao X, et al (2020). In vitro antiviral activity and projection of optimized dosing design of hydroxychloroquine for the treatment of Severe Acute Respiratory 

Syndrome Coronavirus 2 (SARS-CoV-2). Clin Infect Dis, doi:10.1093/cid/ciaa237. 
4. Gautret P, et al (2020). Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomised clinical trial. 

5. Chen J, et al (2020). A pilot study of hydroxychloroquine in treatment of patients with common coronavirus disease-19 (COVID-19). J Zhejiang Uni, doi:10.3785/j.issn 
6. Hancox JC, et al (2013). Azithromycin, cardiovascular risks, QT interval prolongation, torsade de pointes, and regulatory issues. Ther Adv Infect Dis 1(5):155-65.