{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:07:02Z","timestamp":1760148422437,"version":"build-2065373602"},"reference-count":29,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2023,4,29]],"date-time":"2023-04-29T00:00:00Z","timestamp":1682726400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"French government","award":["ANR-15-CE36-0004-01","ANR Investissements d\u2019avenir, Mediterranee infection 10-IAHU-03"],"award-info":[{"award-number":["ANR-15-CE36-0004-01","ANR Investissements d\u2019avenir, Mediterranee infection 10-IAHU-03"]}]},{"name":"Agence Nationale de la Recherche","award":["ANR-15-CE36-0004-01","ANR Investissements d\u2019avenir, Mediterranee infection 10-IAHU-03"],"award-info":[{"award-number":["ANR-15-CE36-0004-01","ANR Investissements d\u2019avenir, Mediterranee infection 10-IAHU-03"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Hydroxychloroquine (HCQ) combined with azithromycin (AZM) has been widely administered to patients with COVID-19 despite scientific controversies. In particular, the potential of prolong cardiac repolarization when using this combination has been discussed. Materials and Methods: We report a pragmatic and simple safety approach which we implemented among the first patients treated for COVID-19 in our center in early 2020. Treatment contraindications were the presence of severe structural or electrical heart disease, baseline corrected QT interval (QTc) &gt; 500 ms, hypokalemia, or other drugs prolonging QTc that could not be interrupted. Electrocardiogram and QTc was evaluated at admission and re-evaluated after 48 h of the initial prescription. Results: Among the 424 consecutive adult patients (mean age 46.3 \u00b1 16.1 years; 216 women), 21.5% patients were followed in conventional wards and 78.5% in a day-care unit. A total of 11 patients (2.6%) had contraindications to the HCQ-AZ combination. In the remaining 413 treated patients, there were no arrhythmic events in any patient during the 10-day treatment regimen. QTc was slightly but statistically significantly prolonged by 3.75 \u00b1 25.4 ms after 2 days of treatment (p = 0.003). QTc prolongation was particularly observed in female outpatients &lt;65 years old without cardiovascular disease. Ten patients (2.4%) developed QTc prolongation &gt; 60 ms, and none had QTc &gt; 500 ms. Conclusions: This report does not aim to contribute to knowledge of the efficacy of treating COVID-19 with HCQ-AZ. However, it shows that a simple initial assessment of patient medical history, electrocardiogram (ECG), and kalemia identifies contraindicated patients and enables the safe treatment of COVID-19 patients with HCQ-AZ. QT-prolonging anti-infective drugs can be used safely in acute life-threatening infections, provided that a strict protocol and close collaboration between infectious disease specialists and rhythmologists are applied.<\/jats:p>","DOI":"10.3390\/medicina59050863","type":"journal-article","created":{"date-parts":[[2023,5,1]],"date-time":"2023-05-01T13:54:46Z","timestamp":1682949286000},"page":"863","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cardiovascular Safety of Hydroxychloroquine\u2013Azithromycin in 424 COVID-19 Patients"],"prefix":"10.3390","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5556-6947","authenticated-orcid":false,"given":"Matthieu","family":"Million","sequence":"first","affiliation":[{"name":"IHU-M\u00e9diterran\u00e9e Infection, 13005 Marseille, France"},{"name":"Unit\u00e9 MEPHI (Microbes, Evolution, Phylog\u00e9nies et Infection), Assistance Publique-H\u00f4pitaux de Marseille, Institut de Recherche pour le D\u00e9veloppement, Facult\u00e9 des Sciences M\u00e9dicales et Param\u00e9dicales, Aix Marseille University, 13005 Marseille, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean-Christophe","family":"Lagier","sequence":"additional","affiliation":[{"name":"IHU-M\u00e9diterran\u00e9e Infection, 13005 Marseille, France"},{"name":"Unit\u00e9 MEPHI (Microbes, Evolution, Phylog\u00e9nies et Infection), Assistance Publique-H\u00f4pitaux de Marseille, Institut de Recherche pour le D\u00e9veloppement, Facult\u00e9 des Sciences M\u00e9dicales et Param\u00e9dicales, Aix Marseille University, 13005 Marseille, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7007-7247","authenticated-orcid":false,"given":"J\u00e9r\u00f4me","family":"Hourdain","sequence":"additional","affiliation":[{"name":"Assistance Publique\u2014H\u00f4pitaux de Marseille, Centre Hospitalier Universitaire La Timone, Service de Cardiologie, 13005 Marseille, France"},{"name":"C2VN, Facult\u00e9 des Sciences M\u00e9dicales et Param\u00e9dicales, Aix Marseille University, 13005 Marseille, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fr\u00e9d\u00e9ric","family":"Franceschi","sequence":"additional","affiliation":[{"name":"Assistance Publique\u2014H\u00f4pitaux de Marseille, Centre Hospitalier Universitaire La Timone, Service de Cardiologie, 13005 Marseille, France"},{"name":"C2VN, Facult\u00e9 des Sciences M\u00e9dicales et Param\u00e9dicales, Aix Marseille University, 13005 Marseille, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean-Claude","family":"Deharo","sequence":"additional","affiliation":[{"name":"Assistance Publique\u2014H\u00f4pitaux de Marseille, Centre Hospitalier Universitaire La Timone, Service de Cardiologie, 13005 Marseille, France"},{"name":"C2VN, Facult\u00e9 des Sciences M\u00e9dicales et Param\u00e9dicales, Aix Marseille University, 13005 Marseille, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philippe","family":"Parola","sequence":"additional","affiliation":[{"name":"IHU-M\u00e9diterran\u00e9e Infection, 13005 Marseille, France"},{"name":"VITROME, AP-HM, SSA, IRD, Facult\u00e9 des Sciences M\u00e9dicales et Param\u00e9dicales, Aix Marseille University, 13005 Marseille, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6125-2805","authenticated-orcid":false,"given":"Philippe","family":"Brouqui","sequence":"additional","affiliation":[{"name":"IHU-M\u00e9diterran\u00e9e Infection, 13005 Marseille, France"},{"name":"Unit\u00e9 MEPHI (Microbes, Evolution, Phylog\u00e9nies et Infection), Assistance Publique-H\u00f4pitaux de Marseille, Institut de Recherche pour le D\u00e9veloppement, Facult\u00e9 des Sciences M\u00e9dicales et Param\u00e9dicales, Aix Marseille University, 13005 Marseille, France"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,4,29]]},"reference":[{"key":"ref_1","unstructured":"Coronavirus Resource Center (2022, March 31). 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