Tendencias en el uso de fármacos para la COVID-19 durante la primera ola de la pandemia en un hospital de Lima, Perú

Abstract

Con el objetivo de evaluar las tendencias en el uso de fármacos en pacientes con la COVID-19 en un hospital del Perú durante la primera ola de la pandemia se realizó un estudio retrospectivo entre abril y septiembre del 2020. Se revisaron las historias clínicas de pacientes hospitalizados por neumonía por COVID-19 en el Hospital Nacional Dos de Mayo (Lima, Perú). De un total de 3103 pacientes, se incluyeron aleatoriamente 381 historias clínicas (77,4% de sexo masculino y una mediana de edad de 44 años). Se observó un incremento del uso de cuatro fármacos (azitromicina, ivermectina, corticoides y ceftriaxona) antes de la hospitalización, así como una disminución del uso de seis fármacos (ceftriaxona, azitromicina, hidroxicloroquina, ivermectina, pulso de corticoides y anticoagulación profiláctica) y un aumento en el uso de anticoagulación plena, durante la hospitalización. Estos hallazgos sugieren que el manejo de la COVID-19 varió durante la primera ola de la pandemia, aumentando el uso de fármacos prehospitalarios y disminuyendo el uso de fármacos intrahospitalarios.

Association between prehospital medication and fatal outcomes in a cohort of hospitalized patients due to coronavirus disease-2019 in a referral hospital in Peru

“…A study done in Lima between April and September 2020 revealed that before hospital admission, 44% of patients used some drug, 32% azithromycin, 28.9% ivermectin, and 20.7% corticosteroids. However, the frequency of some used drugs increased over the months [ 20 ]. In addition to the variation in official recommendations, the authors also suggested that drug infodemia could explain this increase [ 20 ].…”

“…However, the frequency of some used drugs increased over the months [ 20 ]. In addition to the variation in official recommendations, the authors also suggested that drug infodemia could explain this increase [ 20 ].…”

“…Like NSAIDs, other self-medicated drugs were antibiotics; however, unlike studies during the first wave [ 31 , 32 ] where azithromycin was the most commonly used antibiotic, our study revealed macrolides and ceftriaxone in addition to ivermectin. A study at the Hospital Nacional 2 de Mayo in Lima also revealed an increased frequency of ceftriaxone before hospital admission during the first wave of the pandemic [ 20 ]. As noted by the authors, infodemia through social networks, conferences, chats, or daily conversations, sharing supposedly successful experiences of COVID-19 treatment, could explain the increased antibiotic usage before hospitalization, despite the known infrequent bacterial coinfections [ 20 ].…”

“…A study at the Hospital Nacional 2 de Mayo in Lima also revealed an increased frequency of ceftriaxone before hospital admission during the first wave of the pandemic [ 20 ]. As noted by the authors, infodemia through social networks, conferences, chats, or daily conversations, sharing supposedly successful experiences of COVID-19 treatment, could explain the increased antibiotic usage before hospitalization, despite the known infrequent bacterial coinfections [ 20 ]. This is congruent with the persistence, almost 2 years after the beginning of the pandemic, in the discarded use of drugs by regulatory institutions, such as ivermectin or chlorine dioxide [ [37] , [38] , [39] ].…”

“…This led to the use of Hydroxychloroquine, Ivermectin and Azithromycin as the standard regimen for the management of COVID-19, even in Peruvian Social Security institutions, which improved with the subsequent incorporation of evidence-based national recommendations during May 2021 [ 18 , 19 ]. This meant a variation in the use of prescribed medication by physicians in outpatients and hospitalized patients [ 20 ]; however, the use of drugs without evidence and with potential harm, both by prescription and self-medication, persists [ 20 , 21 ].…”