Risk of QT Interval Prolongation Associated With Use of Hydroxychloroquine With or Without Concomitant Azithromycin Among Hospitalized Patients Testing Positive for Coronavirus Disease 2019 (COVID-19).
Identifieur interne : 000C10 ( Main/Corpus ); précédent : 000C09; suivant : 000C11Risk of QT Interval Prolongation Associated With Use of Hydroxychloroquine With or Without Concomitant Azithromycin Among Hospitalized Patients Testing Positive for Coronavirus Disease 2019 (COVID-19).
Auteurs : Nicholas J. Mercuro ; Christina F. Yen ; David J. Shim ; Timothy R. Maher ; Christopher M. Mccoy ; Peter J. Zimetbaum ; Howard S. GoldSource :
- JAMA cardiology [ 2380-6591 ] ; 2020.
English descriptors
- KwdEn :
- Aged (MeSH), Anti-Bacterial Agents (therapeutic use), Antimalarials (therapeutic use), Azithromycin (therapeutic use), Betacoronavirus (MeSH), COVID-19 (MeSH), Cohort Studies (MeSH), Coronavirus Infections (drug therapy), Drug Therapy, Combination (MeSH), Female (MeSH), Hospitalization (MeSH), Humans (MeSH), Hydroxychloroquine (therapeutic use), Long QT Syndrome (epidemiology), Male (MeSH), Middle Aged (MeSH), Pandemics (MeSH), Pneumonia, Viral (drug therapy), Risk Assessment (MeSH), SARS-CoV-2 (MeSH).
- MESH :
- chemical , therapeutic use : Anti-Bacterial Agents, Antimalarials, Azithromycin, Hydroxychloroquine.
- drug therapy : Coronavirus Infections, Pneumonia, Viral.
- epidemiology : Long QT Syndrome.
- Aged, Betacoronavirus, COVID-19, Cohort Studies, Drug Therapy, Combination, Female, Hospitalization, Humans, Male, Middle Aged, Pandemics, Risk Assessment, SARS-CoV-2.
Abstract
Importance
Administration of hydroxychloroquine with or without azithromycin for the treatment of coronavirus disease 2019 (COVID-19)-associated pneumonia carries increased risk of corrected QT (QTc) prolongation and cardiac arrhythmias.
Objective
To characterize the risk and degree of QT prolongation in patients with COVID-19 in association with their use of hydroxychloroquine with or without concomitant azithromycin.
Design, Setting, and Participants
This was a cohort study performed at an academic tertiary care center in Boston, Massachusetts, of patients hospitalized with at least 1 positive COVID-19 nasopharyngeal polymerase chain reaction test result and clinical findings consistent with pneumonia who received at least 1 day of hydroxychloroquine from March 1, 2020, through April 7, 2020.
Main Outcomes and Measures
Change in QT interval after receiving hydroxychloroquine with or without azithromycin; occurrence of other potential adverse drug events.
Results
Among 90 patients given hydroxychloroquine, 53 received concomitant azithromycin; 44 (48.9%) were female, and the mean (SD) body mass index was 31.5 (6.6). Hypertension (in 48 patients [53.3%]) and diabetes mellitus (in 26 patients [28.9%]) were the most common comorbid conditions. The overall median (interquartile range) baseline QTc was 455 (430-474) milliseconds (hydroxychloroquine, 473 [454-487] milliseconds vs hydroxychloroquine and azithromycin, 442 [427-461] milliseconds; P < .001). Those receiving concomitant azithromycin had a greater median (interquartile range) change in QT interval (23 [10-40] milliseconds) compared with those receiving hydroxychloroquine alone (5.5 [-15.5 to 34.25] milliseconds; P = .03). Seven patients (19%) who received hydroxychloroquine monotherapy developed prolonged QTc of 500 milliseconds or more, and 3 patients (8%) had a change in QTc of 60 milliseconds or more. Of those who received concomitant azithromycin, 11 of 53 (21%) had prolonged QTc of 500 milliseconds or more and 7 of 53 (13 %) had a change in QTc of 60 milliseconds or more. The likelihood of prolonged QTc was greater in those who received concomitant loop diuretics (adjusted odds ratio, 3.38 [95% CI, 1.03-11.08]) or had a baseline QTc of 450 milliseconds or more (adjusted odds ratio, 7.11 [95% CI, 1.75-28.87]). Ten patients had hydroxychloroquine discontinued early because of potential adverse drug events, including intractable nausea, hypoglycemia, and 1 case of torsades de pointes.
Conclusions and Relevance
In this cohort study, patients who received hydroxychloroquine for the treatment of pneumonia associated with COVID-19 were at high risk of QTc prolongation, and concurrent treatment with azithromycin was associated with greater changes in QTc. Clinicians should carefully weigh risks and benefits if considering hydroxychloroquine and azithromycin, with close monitoring of QTc and concomitant medication usage.
DOI: 10.1001/jamacardio.2020.1834
PubMed: 32936252
PubMed Central: PMC7195692
Links to Exploration step
pubmed:32936252Le document en format XML
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Yen</name><affiliation><nlm:affiliation>Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.</nlm:affiliation></affiliation></author><author><name sortKey="Shim, David J" sort="Shim, David J" uniqKey="Shim D" first="David J" last="Shim">David J. Shim</name><affiliation><nlm:affiliation>Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.</nlm:affiliation></affiliation></author><author><name sortKey="Maher, Timothy R" sort="Maher, Timothy R" uniqKey="Maher T" first="Timothy R" last="Maher">Timothy R. Maher</name><affiliation><nlm:affiliation>Harvard-Thorndike Electrophysiology Institute, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical, Boston, Massachusetts.</nlm:affiliation></affiliation></author><author><name sortKey="Mccoy, Christopher M" sort="Mccoy, Christopher M" uniqKey="Mccoy C" first="Christopher M" last="Mccoy">Christopher M. Mccoy</name><affiliation><nlm:affiliation>Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, Massachusetts.</nlm:affiliation></affiliation></author><author><name sortKey="Zimetbaum, Peter J" sort="Zimetbaum, Peter J" uniqKey="Zimetbaum P" first="Peter J" last="Zimetbaum">Peter J. Zimetbaum</name><affiliation><nlm:affiliation>Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Harvard-Thorndike Electrophysiology Institute, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical, Boston, Massachusetts.</nlm:affiliation></affiliation></author><author><name sortKey="Gold, Howard S" sort="Gold, Howard S" uniqKey="Gold H" first="Howard S" last="Gold">Howard S. Gold</name><affiliation><nlm:affiliation>Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2020">2020</date><idno type="RBID">pubmed:32936252</idno><idno type="pmid">32936252</idno><idno type="doi">10.1001/jamacardio.2020.1834</idno><idno type="pmc">PMC7195692</idno><idno type="wicri:Area/Main/Corpus">000C10</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000C10</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Risk of QT Interval Prolongation Associated With Use of Hydroxychloroquine With or Without Concomitant Azithromycin Among Hospitalized Patients Testing Positive for Coronavirus Disease 2019 (COVID-19).</title><author><name sortKey="Mercuro, Nicholas J" sort="Mercuro, Nicholas J" uniqKey="Mercuro N" first="Nicholas J" last="Mercuro">Nicholas J. Mercuro</name><affiliation><nlm:affiliation>Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, Massachusetts.</nlm:affiliation></affiliation></author><author><name sortKey="Yen, Christina F" sort="Yen, Christina F" uniqKey="Yen C" first="Christina F" last="Yen">Christina F. Yen</name><affiliation><nlm:affiliation>Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.</nlm:affiliation></affiliation></author><author><name sortKey="Shim, David J" sort="Shim, David J" uniqKey="Shim D" first="David J" last="Shim">David J. Shim</name><affiliation><nlm:affiliation>Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.</nlm:affiliation></affiliation></author><author><name sortKey="Maher, Timothy R" sort="Maher, Timothy R" uniqKey="Maher T" first="Timothy R" last="Maher">Timothy R. Maher</name><affiliation><nlm:affiliation>Harvard-Thorndike Electrophysiology Institute, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical, Boston, Massachusetts.</nlm:affiliation></affiliation></author><author><name sortKey="Mccoy, Christopher M" sort="Mccoy, Christopher M" uniqKey="Mccoy C" first="Christopher M" last="Mccoy">Christopher M. Mccoy</name><affiliation><nlm:affiliation>Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, Massachusetts.</nlm:affiliation></affiliation></author><author><name sortKey="Zimetbaum, Peter J" sort="Zimetbaum, Peter J" uniqKey="Zimetbaum P" first="Peter J" last="Zimetbaum">Peter J. Zimetbaum</name><affiliation><nlm:affiliation>Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Harvard-Thorndike Electrophysiology Institute, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical, Boston, Massachusetts.</nlm:affiliation></affiliation></author><author><name sortKey="Gold, Howard S" sort="Gold, Howard S" uniqKey="Gold H" first="Howard S" last="Gold">Howard S. Gold</name><affiliation><nlm:affiliation>Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.</nlm:affiliation></affiliation></author></analytic><series><title level="j">JAMA cardiology</title><idno type="eISSN">2380-6591</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged (MeSH)</term><term>Anti-Bacterial Agents (therapeutic use)</term><term>Antimalarials (therapeutic use)</term><term>Azithromycin (therapeutic use)</term><term>Betacoronavirus (MeSH)</term><term>COVID-19 (MeSH)</term><term>Cohort Studies (MeSH)</term><term>Coronavirus Infections (drug therapy)</term><term>Drug Therapy, Combination (MeSH)</term><term>Female (MeSH)</term><term>Hospitalization (MeSH)</term><term>Humans (MeSH)</term><term>Hydroxychloroquine (therapeutic use)</term><term>Long QT Syndrome (epidemiology)</term><term>Male (MeSH)</term><term>Middle Aged (MeSH)</term><term>Pandemics (MeSH)</term><term>Pneumonia, Viral (drug therapy)</term><term>Risk Assessment (MeSH)</term><term>SARS-CoV-2 (MeSH)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Anti-Bacterial Agents</term><term>Antimalarials</term><term>Azithromycin</term><term>Hydroxychloroquine</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Coronavirus Infections</term><term>Pneumonia, Viral</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Long QT Syndrome</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Aged</term><term>Betacoronavirus</term><term>COVID-19</term><term>Cohort Studies</term><term>Drug Therapy, Combination</term><term>Female</term><term>Hospitalization</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Pandemics</term><term>Risk Assessment</term><term>SARS-CoV-2</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>Importance</b></p><p>Administration of hydroxychloroquine with or without azithromycin for the treatment of coronavirus disease 2019 (COVID-19)-associated pneumonia carries increased risk of corrected QT (QTc) prolongation and cardiac arrhythmias.</p></div><div type="abstract" xml:lang="en"><p><b>Objective</b></p><p>To characterize the risk and degree of QT prolongation in patients with COVID-19 in association with their use of hydroxychloroquine with or without concomitant azithromycin.</p></div><div type="abstract" xml:lang="en"><p><b>Design, Setting, and Participants</b></p><p>This was a cohort study performed at an academic tertiary care center in Boston, Massachusetts, of patients hospitalized with at least 1 positive COVID-19 nasopharyngeal polymerase chain reaction test result and clinical findings consistent with pneumonia who received at least 1 day of hydroxychloroquine from March 1, 2020, through April 7, 2020.</p></div><div type="abstract" xml:lang="en"><p><b>Main Outcomes and Measures</b></p><p>Change in QT interval after receiving hydroxychloroquine with or without azithromycin; occurrence of other potential adverse drug events.</p></div><div type="abstract" xml:lang="en"><p><b>Results</b></p><p>Among 90 patients given hydroxychloroquine, 53 received concomitant azithromycin; 44 (48.9%) were female, and the mean (SD) body mass index was 31.5 (6.6). Hypertension (in 48 patients [53.3%]) and diabetes mellitus (in 26 patients [28.9%]) were the most common comorbid conditions. The overall median (interquartile range) baseline QTc was 455 (430-474) milliseconds (hydroxychloroquine, 473 [454-487] milliseconds vs hydroxychloroquine and azithromycin, 442 [427-461] milliseconds; P < .001). Those receiving concomitant azithromycin had a greater median (interquartile range) change in QT interval (23 [10-40] milliseconds) compared with those receiving hydroxychloroquine alone (5.5 [-15.5 to 34.25] milliseconds; P = .03). Seven patients (19%) who received hydroxychloroquine monotherapy developed prolonged QTc of 500 milliseconds or more, and 3 patients (8%) had a change in QTc of 60 milliseconds or more. Of those who received concomitant azithromycin, 11 of 53 (21%) had prolonged QTc of 500 milliseconds or more and 7 of 53 (13 %) had a change in QTc of 60 milliseconds or more. The likelihood of prolonged QTc was greater in those who received concomitant loop diuretics (adjusted odds ratio, 3.38 [95% CI, 1.03-11.08]) or had a baseline QTc of 450 milliseconds or more (adjusted odds ratio, 7.11 [95% CI, 1.75-28.87]). Ten patients had hydroxychloroquine discontinued early because of potential adverse drug events, including intractable nausea, hypoglycemia, and 1 case of torsades de pointes.</p></div><div type="abstract" xml:lang="en"><p><b>Conclusions and Relevance</b></p><p>In this cohort study, patients who received hydroxychloroquine for the treatment of pneumonia associated with COVID-19 were at high risk of QTc prolongation, and concurrent treatment with azithromycin was associated with greater changes in QTc. Clinicians should carefully weigh risks and benefits if considering hydroxychloroquine and azithromycin, with close monitoring of QTc and concomitant medication usage.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">32936252</PMID><DateCompleted><Year>2020</Year><Month>09</Month><Day>30</Day></DateCompleted><DateRevised><Year>2021</Year><Month>03</Month><Day>10</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Electronic">2380-6591</ISSN><JournalIssue CitedMedium="Internet"><Volume>5</Volume><Issue>9</Issue><PubDate><Year>2020</Year><Month>Sep</Month><Day>01</Day></PubDate></JournalIssue><Title>JAMA cardiology</Title><ISOAbbreviation>JAMA Cardiol</ISOAbbreviation></Journal><ArticleTitle>Risk of QT Interval Prolongation Associated With Use of Hydroxychloroquine With or Without Concomitant Azithromycin Among Hospitalized Patients Testing Positive for Coronavirus Disease 2019 (COVID-19).</ArticleTitle><Pagination><MedlinePgn>1036-1041</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1001/jamacardio.2020.1834</ELocationID><Abstract><AbstractText Label="Importance" NlmCategory="UNASSIGNED">Administration of hydroxychloroquine with or without azithromycin for the treatment of coronavirus disease 2019 (COVID-19)-associated pneumonia carries increased risk of corrected QT (QTc) prolongation and cardiac arrhythmias.</AbstractText><AbstractText Label="Objective" NlmCategory="UNASSIGNED">To characterize the risk and degree of QT prolongation in patients with COVID-19 in association with their use of hydroxychloroquine with or without concomitant azithromycin.</AbstractText><AbstractText Label="Design, Setting, and Participants" NlmCategory="UNASSIGNED">This was a cohort study performed at an academic tertiary care center in Boston, Massachusetts, of patients hospitalized with at least 1 positive COVID-19 nasopharyngeal polymerase chain reaction test result and clinical findings consistent with pneumonia who received at least 1 day of hydroxychloroquine from March 1, 2020, through April 7, 2020.</AbstractText><AbstractText Label="Main Outcomes and Measures" NlmCategory="UNASSIGNED">Change in QT interval after receiving hydroxychloroquine with or without azithromycin; occurrence of other potential adverse drug events.</AbstractText><AbstractText Label="Results" NlmCategory="UNASSIGNED">Among 90 patients given hydroxychloroquine, 53 received concomitant azithromycin; 44 (48.9%) were female, and the mean (SD) body mass index was 31.5 (6.6). Hypertension (in 48 patients [53.3%]) and diabetes mellitus (in 26 patients [28.9%]) were the most common comorbid conditions. The overall median (interquartile range) baseline QTc was 455 (430-474) milliseconds (hydroxychloroquine, 473 [454-487] milliseconds vs hydroxychloroquine and azithromycin, 442 [427-461] milliseconds; P < .001). Those receiving concomitant azithromycin had a greater median (interquartile range) change in QT interval (23 [10-40] milliseconds) compared with those receiving hydroxychloroquine alone (5.5 [-15.5 to 34.25] milliseconds; P = .03). Seven patients (19%) who received hydroxychloroquine monotherapy developed prolonged QTc of 500 milliseconds or more, and 3 patients (8%) had a change in QTc of 60 milliseconds or more. Of those who received concomitant azithromycin, 11 of 53 (21%) had prolonged QTc of 500 milliseconds or more and 7 of 53 (13 %) had a change in QTc of 60 milliseconds or more. The likelihood of prolonged QTc was greater in those who received concomitant loop diuretics (adjusted odds ratio, 3.38 [95% CI, 1.03-11.08]) or had a baseline QTc of 450 milliseconds or more (adjusted odds ratio, 7.11 [95% CI, 1.75-28.87]). Ten patients had hydroxychloroquine discontinued early because of potential adverse drug events, including intractable nausea, hypoglycemia, and 1 case of torsades de pointes.</AbstractText><AbstractText Label="Conclusions and Relevance" NlmCategory="UNASSIGNED">In this cohort study, patients who received hydroxychloroquine for the treatment of pneumonia associated with COVID-19 were at high risk of QTc prolongation, and concurrent treatment with azithromycin was associated with greater changes in QTc. Clinicians should carefully weigh risks and benefits if considering hydroxychloroquine and azithromycin, with close monitoring of QTc and concomitant medication usage.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Mercuro</LastName><ForeName>Nicholas J</ForeName><Initials>NJ</Initials><AffiliationInfo><Affiliation>Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, Massachusetts.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Yen</LastName><ForeName>Christina F</ForeName><Initials>CF</Initials><AffiliationInfo><Affiliation>Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Shim</LastName><ForeName>David J</ForeName><Initials>DJ</Initials><AffiliationInfo><Affiliation>Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Maher</LastName><ForeName>Timothy R</ForeName><Initials>TR</Initials><AffiliationInfo><Affiliation>Harvard-Thorndike Electrophysiology Institute, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical, Boston, Massachusetts.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>McCoy</LastName><ForeName>Christopher M</ForeName><Initials>CM</Initials><AffiliationInfo><Affiliation>Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, Massachusetts.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Zimetbaum</LastName><ForeName>Peter J</ForeName><Initials>PJ</Initials><AffiliationInfo><Affiliation>Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Harvard-Thorndike Electrophysiology Institute, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical, Boston, Massachusetts.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Gold</LastName><ForeName>Howard S</ForeName><Initials>HS</Initials><AffiliationInfo><Affiliation>Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>JAMA Cardiol</MedlineTA><NlmUniqueID>101676033</NlmUniqueID></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D000900">Anti-Bacterial Agents</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D000962">Antimalarials</NameOfSubstance></Chemical><Chemical><RegistryNumber>4QWG6N8QKH</RegistryNumber><NameOfSubstance UI="D006886">Hydroxychloroquine</NameOfSubstance></Chemical><Chemical><RegistryNumber>83905-01-5</RegistryNumber><NameOfSubstance UI="D017963">Azithromycin</NameOfSubstance></Chemical></ChemicalList><SupplMeshList><SupplMeshName Type="Protocol" UI="C000705127">COVID-19 drug treatment</SupplMeshName></SupplMeshList><CitationSubset>IM</CitationSubset><CommentsCorrectionsList><CommentsCorrections RefType="ErratumIn"><RefSource>JAMA Cardiol. 2020 Sep 1;5(9):1071</RefSource><PMID Version="1">32936256</PMID></CommentsCorrections><CommentsCorrections RefType="CommentIn"><RefSource>JAMA Cardiol. 2021 Mar 1;6(3):357-358</RefSource><PMID Version="1">33084841</PMID></CommentsCorrections><CommentsCorrections RefType="CommentIn"><RefSource>JAMA Cardiol. 2021 Mar 1;6(3):357</RefSource><PMID Version="1">33084843</PMID></CommentsCorrections></CommentsCorrectionsList><MeshHeadingList><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000900" MajorTopicYN="N">Anti-Bacterial Agents</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000962" MajorTopicYN="N">Antimalarials</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D017963" MajorTopicYN="N">Azithromycin</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="Y">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000073640" MajorTopicYN="Y">Betacoronavirus</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000086382" MajorTopicYN="N">COVID-19</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D015331" MajorTopicYN="N">Cohort Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D018352" MajorTopicYN="N">Coronavirus Infections</DescriptorName><QualifierName UI="Q000188" MajorTopicYN="Y">drug therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D004359" MajorTopicYN="N">Drug Therapy, Combination</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006760" MajorTopicYN="N">Hospitalization</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006886" MajorTopicYN="N">Hydroxychloroquine</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="Y">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008133" MajorTopicYN="N">Long QT Syndrome</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="Y">epidemiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D058873" MajorTopicYN="N">Pandemics</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011024" MajorTopicYN="N">Pneumonia, Viral</DescriptorName><QualifierName UI="Q000188" MajorTopicYN="Y">drug therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D018570" MajorTopicYN="N">Risk Assessment</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000086402" MajorTopicYN="N">SARS-CoV-2</DescriptorName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2020</Year><Month>9</Month><Day>16</Day><Hour>12</Hour><Minute>15</Minute></PubMedPubDate><PubMedPubDate 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| HfdSelect -Kh $EXPLOR_AREA/Data/Main/Corpus/biblio.hfd \
| NlmPubMed2Wicri -a CovidChloroV1
| This area was generated with Dilib version V0.6.38. |  |