Drug used to manage hospital Covid-19 withheld from nursing homes

A drug being used to successfully manage Covid-19 patients in hospitals is being withheld from patients in the community, including in nursing homes.

A HSE circular to pharmacists, dated April 17th, seen by The Irish Times, refers to the “appropriate prescribing of azithromycin in the community”, and notes: “Letters have issued to GPs requesting that prescriptions for azithromycin should not be offered in the community for the management of Covid-19 in the home.Your co-operation and ongoing support is appreciated.”

There is a global shortage of the antibiotic azithromycin, which is also used to treat some sexually transmitted diseases, according to the Irish Pharmacy Union.

The circular refers to a memo from Prof Michael Barry, HSE national clinical lead of the medicines management programme, dated April 10th. He says "prescribing of anti-virals for the management of patients with confirmed Covid-19 disease should be restricted to hospitals only".

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He adds that “careful” consideration of whether to prescribe azithromycin in the community “will support the safe use of this agent, and ensure continuity of supply”.

One nursing home operator who runs three facilities in the east and west with over 200 beds told The Irish Times that the fatality rate from Covid-19 had “declined dramatically” when the homes’ GP started prescribing azithromycin to coronavirus patients.

He would not provide his name for fear of being ordered to stop using the drug. He has raised his concerns with Hiqa, who told The Irish Times: “We have referred these issues to the clinical lead in the HSE.”

The home operator said: “If it works in hospitals why can it not be allowed in care homes? This is lunacy.”

Tadhg Daly, chief executive of Nursing Homes Ireland, said he was "absolutely very concerned".

“We are being told there is no discrimination between hospital patients and nursing home residents in their treatment, but this looks discriminatory.”

Respiratory failure

Azithromycin has produced positive outcomes in some cases of Covid-19, particularly where there has been pneumonia and respiratory failure. In other cases results have been inconclusive, according to a HSE bulletin on its use, dated April 2nd.

Prepared by the Covid-19 rapid evidence review group, the bulletin reports on two studies on the use of azithromycin with hydrochloraquin.

It states: “There are inconsistencies in the study findings, with one study in 80 patients reporting broadly positive outcomes from the combination therapy, including negative viral load in 83 per cent of the cohort on day seven, while another study in 11 patients concluded there is no evidence of rapid anti-viral clearance or clinical benefit.”

The Irish College of General Practitioners was not concerned at the ban on azithromycin for Covid-19 patients outside hospital.

“There is currently no evidence to support using any antibiotic to treat viral Covid-19 in patients in the community who are otherwise healthy...We do not need access to azithromycin for treatment of viral Covid-19 in the community.”

A HSE spokeswoman said guidelines on the use of several drugs, including azithromycin, in treating Covid-19 had been published. “Pharmacies are working centrally to maintain stocks for clinically indicated patients as per the national guidance.”