Antimalarials and macrolides

a review of off-label pharmacotherapies during the first wave of the SARS-CoV-2 pandemic


  • Paulo Michel Pinheiro Ferreira Department of Biophysics and Physiology
  • Rayran Walter Ramos de Sousa Department of Biophysics and Physiology, Federal University of Piauí, Teresina, Brazil,
  • Dalton Dittz Department of Biochemistry and Pharmacology, Federal University of Piauí, Teresina, Brazil,
  • João Marcelo de Castro e Sousa Department of Biochemistry and Pharmacology, Federal University of Piauí, Teresina, Brazil,
  • Francisco Leonardo Torres-Leal Department of Biophysics and Physiology, Federal University of Piauí, Teresina, Brazil,
  • Daniel Pereira Bezerra Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil



Aminoquinolines, Coronavirus, Comorbidity, Adverse effect, Hospitalization


We critically analyzed clinical trials performed with chloroquine (CQ) and hydroxychloroquine (HCQ) with or without macrolides during the first wave of COVID-19 and discussed the design and limitations of peer-reviewed studies from January to July 2020. Seventeen studies were eligible for the discussion. CQ and HCQ did not demonstrate clinical advantages that justified their inclusion in therapeutic regimens of free prescription for treatment or prophylactic purposes, as suggested by health authorities, including in Brazil, during the first wave. Around August 2020, robust data had already indicated that pharmacological effects of CQ, HCQ and macrolides as anti-SARS-CoV-2 molecules were limited to in vitro conditions and largely based on retrospective trials with low quality and weak internal validity, which made evidence superficial for decision-making. Up to that point, most randomized and nonrandomized clinical trials did not reveal beneficial effects of CQ or HCQ with or without macrolides to reduce lethality, rate of intubation, days of hospitalization, respiratory support/mechanical ventilation requirements, duration, type and number of symptoms, and death and were unsuccessful in increasing virus elimination and/or days alive in hospitalized or ambulatory patients with COVID-19. In addition, many studies have demonstrated that side effects are more common in CQ-or HCQ-treated patients.


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Al-Kofahi M, Jacobson P, Boulware DR, Matas A, Kandaswamy R, Jaber MM, et al. Finding the dose for hydroxychloroquine prophylaxis for COVID-19: the desperate search for effectiveness. Clin Pharmacol Ther. 2020;108(4):766-9.

Aquino EML, Silveira IH, Pescarini JM, Aquino R, Souza-Filho JA, Rocha AS, et al. Medidas de distanciamento social no controle da pandemia de COVID-19: potenciais impactos e desafios no Brasil. Cienc Saúde Coletiva. 2020;25(1):2423-46.

Arshad S, Kilgore P, Chaudhry ZS, Jacobsen G, Wang DD, Huitsing K, et al. Treatment with hydroxychloroquine, azithromycin, and combination in patients hospitalized with COVID-19. Int J Infec Dis. 2020;97:396-403.

Atkinson JG. Problems with the analysis in “Treatment with hydroxychloroquine, azithromycin, and combination in patients hospitalized with COVID-19”. Int J Infec Dis . 2020;99:37.

Axfors C, Schmitt AM, Janiaud P, Hooft J, Abd-Elsalam S, Abdo EF, et al. Mortality outcomes with hydroxychloroquine and chloroquine in COVID-19 from an international collaborative meta-analysis of randomized trials. Nat Commun. 2021;12(1):2349.

Banjanac M, Munić Kos V, Nujić K, Vrančić M, Belamarić D, Crnković S, et al. Anti-inflammatory mechanism of action of azithromycin in LPS-stimulated J774A.1 cells. Pharmacol Res. 2012;66(4):357-62.

Balevic SJ, Hornik CP, Green TP, Clowse MEB, Gonzalez D, Maharaj AR, et al. Hydroxychloroquine in patients with rheumatic disease complicated by COVID-19: clarifying target exposures and the need for clinical trials. J Rheumatol. 2020;47(9):1424-30.

Ben-Zvi I, Kivity S, Langevitz P, Shoenfeld Y. Hydroxychloroquine: from malaria to autoimmunity. Clin Rev Allerg Immunol. 2012;42(2):145-53.

Bergamo M. Supply of medicines used to intubate COVID-19 patient will last 20 days; 2021 [cited 2021 April 11]. Available from: Available from:


Bessière F, Roccia H, Delinière A, Charrière R, Chevalier P, Argaud L, et al. Assessment of QT Intervals in a case series of patients with coronavirus disease 2019 (COVID-19) infection treated with hydroxychloroquine alone or in combination with azithromycin in an intensive care unit. JAMA Cardiol. 2020;5(9):1067-69.

Borba MGS, Val FFA, Sampaio VS, Alexandre MAA, Melo GC, Brito M, et al. 2020. Effect of high vs low doses of chloroquine diphosphate as adjunctive therapy for patients hospitalized with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection a randomized clinical trial. JAMA Network Open. 2020;3(4):e208857.

Bosnar M, Bosnjak B, Cuzic S, Hrvacic B, Marjanovic N, Glojnaric I, et al. Azithromycin and clarithromycin inhibit lipopolysaccharide-induced murine pulmonary neutrophilia mainly through effects on macrophage-derived granulocyte-macrophage colony-stimulating factor and interleukin-1beta. J Pharmacol Exp Therap. 2009;331(1):104-13.

Boulware DR, Pullen MF, Bangdiwala AS, Pastick KA, Lofgren SM, Okafor EC, et al. A randomized trial of hydroxychloroquine as post exposure prophylaxis for Covid-19. N Engl J Med. 2020;383(6):517-25.

Braga IA, Valle D. Aedes aegypti: insecticides, mechanisms of action and resistance. Epidemiol Serv Saúde. 2007;4:179-293.

Brasil. Ministério da Saúde. Secretaria de Ciência, Tecnologia, Inovação e Insumos Estratégicos em Saúde. Diretrizes para diagnóstico e tratamento da COVID-19. [cited 2020 Fev 11]. 73 p. Available from: Available from:


Brazilian Society of Infectology. BSI. Scientific clarifications on guidelines that propose the universal use of chloroquine or hydroxychloroquine for the treatment of COVID-19; 2020 [cited 2020 Fev 11]. Available from: Available from: br/2020/07/17/atualizacao-sobre-a-hidroxicloroquina-no-tratamento-precoce-da-covid-19/

» br/2020/07/17/atualizacao-sobre-a-hidroxicloroquina-no-tratamento-precoce-da-covid-19/

Cavalcanti AB, Zampieri FG, Rosa RG, Azevedo LCP, Veiga VC, Avezum A, et al. Hydroxychloroquine with or without azithromycin in mild-to-moderate Covid-19. N Engl J Med. 2020;383(21):2041-52.

Cao B, Wang Y, Wen D, Liu W, Wang J, Fan G, et al. A trial of lopinavir-ritonavir in adults hospitalized with severe Covid-19. N Engl J Med . 2020;382(19):1787-99.

Cardoso CRB, Fernandes APM, Santos IKFM. What happens in Brazil? A pandemic of misinformation that culminates in an endless disease burden. Rev Soc Bras Med Trop. 2021;54:e07132020.

Centers for Disease Control and Prevention (CDC). Provisional death counts for coronavirus disease (COVID-19): Distribution of deaths by race and hispanic origin; 2021 [cited 2021 April 16]. Available from: Available from:


Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13.

Clark M, Steger-Hartmann T. A big data approach to the concordance of the toxicity of pharmaceuticals in animals and humans. Regul Toxicol Pharmacol. 2018;96:94-105.

Coronavirus Disease 2019 (COVID-19) - Associated Hospitalization Surveillance Network (COVID-NET); 2020 [cited 2021 April 16]. Available from: Available from:


D’Alessandro S, Scaccabarozzi D, Signorini L, Perego F, Ilboudo DP, Ferrante P, et al. The use of antimalarial drugs against viral infection. Microorg. 2020;8(1):85-95.

Devaux CA, Rolain JM, Colson P, Raoult D. New insights on the antiviral effects of chloroquine against coronavirus: what to expect for COVID-19? Int J Antimicrob Agents. 2020;55(5):105938.

Fan J, Zhang X, Liu J, Yang Y, Zheng N, Liu Q, et al. Connecting hydroxychloroquine in vitro antiviral activity to in vivo concentration for prediction of antiviral effect: a critical step in treating COVID-19 patients. Clin Infect Dis. 2020;71(12):3232-3236.

Ferigato S, Fernandez M, Amorim M, Ambrogi I, Fernandes LMM, Pacheco R. The Brazilian Government’s mistakes in responding to the COVID-19 pandemic. Lancet. 2020;396(10263):1636.

Ferreira PMP, Sousa RWR, Ferreira JRO, Militão GCG, Bezerra DP. Chloroquine and hydroxychloroquine in antitumor therapies based on autophagy-related mechanisms. Pharmacol Res . 2021;168:105582.

Gao J, Tian Z, Yang X. Breakthrough: Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. Biosci Trends. 2020;14:72-3.

Garg S, Kim L, Whitaker M, O’Halloran A, Cummings C, Holstein R, et al. Hospitalization rates and characteristics of patients hospitalized with laboratory-confirmed Coronavirus Disease 2019 - COVID-NET, 14 States, March 1-30, 2020. Morb Mortal Wkly Rep. 2020;69(15):458-64.

Garulli B, Di Mario G, Sciaraffia E, Accapezzato D, Barnaba V, Castrucci MR. Enhancement of T cell-mediated immune responses to whole inactivated influenza virus by chloroquine treatment in vivo Vaccine. 2013;31(13):1717-24.

Gautret P, Lagier JC, Parola P, Hoang VT, Meddeb L, Mailhe M, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents . 2020a;56(1):105949.

Gautret P, Lagier JC, Parola P, Hoang VT, Meddeb L, Sevestre J, et al. Clinical and microbiological effect of a combination of hydroxychloroquine and azithromycin in 80 COVID-19 patients with at least a six-day follow up: a pilot observational study. Travel Med Infect Dis. 2020b;34:101663.

Geleris J, Sun Y, Platt J, Zucker J, Baldwin M, Hripcsak G, et al. Observational study of hydroxychloroquine in hospitalized patients with Covid-19. N Engl J Med . 2020;382(25):2411-18.

Guimarães R. Vacinas Anticovid: um olhar da saúde coletiva. Cienc Saúde Coletiva . 2020;25(9):3579-85.

Hoffmann M, Mösbauer K, Hofmann-Winkler H, Kaul A, Kleine-Weber H, Krüger N, et al. Chloroquine does not inhibit infection of human lung cells with SARS-CoV-2. Nature 2020a; 585(7826):588-590.

Hoffmann M, Kleine-Weber H, Schroeder S, Krüger N, Herrler T, Erichsen S, et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell 2020b;181(2):271-280.

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10233):497-506.

Jang C, Choi J, Byun M, Jue D. Chloroquine inhibits productionof TNF-α, IL-1ßand IL-6 fromlipopolysaccharide-stimulated human monocytes/macrophages by different modes. Rheumatol. 2006;45(6):703-10.

Keyaerts E, Vijgen L, Maes P, Neyts J, Van Ranst M. In vitro inhibition of severe acute respiratory syndrome coronavirus by chloroquine. Biochem Biophys Res Commun. 2004;323(1):264-8.

Laaksonen AL, Koskiahde V, Juva K. Dosage of antimalarial drugs for children with juvenile rheumatoid arthritis and systemic lupus erythematosus. A clinical study with determination of serum concentrations of chloroquine and hydroxychloroquine. Scand J Rheumatol . 1974;3(2):103-8.

Li W, Moore MJ, Vasilieva N, Sui J, Wong SK, Berne MA, et al. Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus. Nature. 2003;426(6965):450-4.

Liu J, Cao R, Xu M, Wang X, Zhang H, Hu H, et al. Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro Cell Discov. 2020;6:16.

Magagnoli J, Narendran S, Pereira F, Cummings TH, Hardin JW, Sutton SS, et al. Outcomes of hydroxychloroquine usage in United States veterans hospitalized with Covid-19. Med. 2020;1(1):114-127.

Mahévas M, Tran VT, Roumier M, Chabrol A, Paule R, Guillaud C, et al. Clinical efficacy of hydroxychloroquine in patients with covid-19 pneumonia who require oxygen: observational comparative study using routine care data. BMJ. 2020;369:m1844.

Marik PE, Taeb AM. SIRS, qSOFA and new sepsis definition. J Thoracic Dis. 2017;9(4):943-5.

Mathian A, Mahevas M, Rohmer J, Roumier M, Cohen-Aubart F, Amador-Borrero B, et al. Clinical course of coronavirus disease 2019 (COVID-19) in a series of 17 patients with systemic lupus erythematosus under long-term treatment with hydroxychloroquine. Ann Rheum Dis. 2020;79(6):837-9.

Mehra MR, Desai SS, Ruschitzka F, Patel AN. Retraction - Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis. Lancet. 2020;395(10240):1820.

Menni C, Valdes AM, Freidin MB, Sudre CH, Nguyen LH, Drew DA, et al. Real-time tracking of self-reported symptoms to predict potential COVID-19. Nat Med. 2020;26(7):1037-40.

Mercuro NJ, Yen CF, Shim DJ, Maher TR, McCoy CM, Zimetbaum PJ, et al. Risk of QT interval prolongation associated with use of hydroxychloroquine with or without concomitant azithromycin among hospitalized patients testing positive for coronavirus 2019 (COVID-19) infection. JAMA Cardiol . 2020;5(9):1036-41.

Million M, Lagier JC, Gautret P, Colson P, Fournier PE, Amrane S, et al. Early treatment of COVID-19 patients with hydroxychloroquine and azithromycin: a retrospective analysis of 1061 cases in Marseille, France. Travel Med Infect Dis . 2020;35:101738.

Mitjà O, Corbacho-Monné M, Ubals M, Tebe C, Peñafiel J, Tobias A, et al. Hydroxychloroquine for early treatment of adults with mild Covid-19: A randomized-controlled trial. Clin Infect Dis . 2020;ciaa1009.

Molina JM, Delaugerre C, Le Goff J, Mela-Lima B, Ponscarme D, Goldwirt L, et al. No evidence of rapid antiviral clearance or clinical benefit with the combination of hydroxychloroquine and azithromycin in patients with severe COVID-19 infection. Méd Mal Infect. 2020;50(4):384.

Murgolo N, Therien AG, Howell B, Klein D, Koeplinger K, Lieberman LA, et al. SARS-CoV-2 tropism, entry, replication, and propagation: Considerations for drug discovery and development. PLoS Pathog. 2021;17(2):e1009225.

Nicholson KG, Aoki FY, Osterhaus AD, Trottier S, Carewicz O, Mercier CH, et al. Efficacy and safety of oseltamivir in treatment of acute influenza: a randomised controlled trial. Neuraminidase Inhibitor Flu Treatment Investigator Group. Lancet. 2000;355(9218):1845-50.

Pal A, Pawar A, Goswami K, Sharma P, Prasad R. Hydroxychloroquine and COVID-19: A cellular and molecular biology based update. Indian J Clin Biochem. 2020;35(3):274-84.

Park JE, Li K, Barlan A, Fehr AR, Perlman S, et al. Proteolytic processing of Middle East respiratory syndrome coronavirus spikes expands virus tropism. Proc Natl Acad Sci USA. 2016;113(43):12262-12267.

Parnham MJ, Haber VE, Giamarellos-Bourboulis EJ, Perletti G, Verleden GM, Vos R. Azithromycin: Mechanisms of action and their relevance for clinical applications. Pharmacol Therap. 2014;143(2):225-45.

Paumgartten FJR, Delgado IF, Pitta LR, Oliveira ACAX. Chloroquine and hydroxychloroquine repositioning in times of COVID-19 pandemics, all that glitters is not gold. Cad Saúde Pública. 2020;36(5):1-3.

Perinel S, Launay M, Botelho-Nevers É, Diconne É, Louf-Durier A, et al. Towards optimization of hydroxychloroquine dosing in intensive care unit COVID-19 patients. Clin Infect Dis . 2020;71(16):2227-9.

Qiu H, Wu J, Hong L, Luo Y, Song Q, Chen D. Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study. Lancet Infect Dis. 2020;20(6):689-96.

Randomised Evaluation of COVid-19 thERapY (RECOVERY). No clinical benefit from use of hydroxychloroquine in hospitalised patients with COVID-19; 2020 [cited 2020 Dec 2]. Available from: Available from: -therapy-recover y-trial-on-hydroxychloroquine-5-june-2020-no-clinical-benefit-from-use-of-hydroxychloroquine-in-hospitalised-patients-with-covid-19

» -therapy-recover y-trial-on-hydroxychloroquine-5-june-2020-no-clinical-benefit-from-use-of-hydroxychloroquine-in-hospitalised-patients-with-covid-19

Ranzani OT, Bastos LSL, Gelli JGM, Marchesi JF, Baião F, Hamacher S, et al. Characterisation of the first 250,000 hospital admissions for COVID-19 in Brazil: a retrospective analysis of nationwide data. Lancet Respir Med. 2021;9(4):407-18.

Resende L. Falhas em testagem de Covid-19 contribuíram para mortes no Brasil, diz Fiocruz; 2021. [cited 21 April 2021]. Available from: Available from:


Roques P, Thiberville SD, Dupuis-Maguiraga L, Lum FM, Labadie K, Martinon F, et al. Paradoxical effect of chloroquine treatment in enhancing Chikungunya virus infection. Viruses 2018;10(5):268.

Rosenberg ES, Dufort EM, Udo T, Wilberschied LA, Kumar J, Tesoriero J, et al. Association of treatment with hydroxychloroquine or azithromycin with in-hospital mortality in patients with COVID-19 in New York state. JAMA 2020;323(24):2493-502.

Sabino EC, Buss LF, Carvalho MPS, Prete CA Jr, Crispim MAE, Fraiji NA, et al. Resurgence of COVID-19 in Manaus, Brazil, despite high seroprevalence. Lancet 2021;397(10273):452-5.

Savarino A, Boelaert JR, Cassone A, Majori G, Cauda R. Effects of chloroquine on viral infections: an old drug against today’s diseases? Lancet Infect Dis . 2003;3(11):722-7.

Shereen MA, Khan S, Kazmi A, Bashir N, Siddique R. COVID-19 infection: Origin, transmission, and characteristics of human coronaviruses. J Adv Res. 2020;24:91-98.

Schrezenmeier E, Dörner T. Mechanisms of action of hydroxychloroquine and chloroquine: implications for rheumatology. Nat Rev Rheumatol. 2020;16(3):155-66.

Singh AK, Singh A, Singh R, Misra A. Hydroxychloroquine in patients with COVID-19: A Systematic review and meta-analysis. Diabetes Metab Syndr. 2020;14(4):589-96.

Singh J. Critical appraisal skills programme. J Pharmacol Pharmacother. 2013;4(1):76-7.

Skipper CP, Pastick KA, Engen NW, Bangdiwala AS, Abassi M, Lofgren SM, et al. Hydroxychloroquine in nonhospitalized adults with early COVID-19: A randomized trial. Ann Intern Med. 2020;173(8):623-31.

Spanish Agency of Drug and Health Products. Ministry of Health; 2020. [cited 20 May 2020]. Chloroquine/ Hydroxychloroquine: precautions and vigilance of possible adverse reactions in patients with COVID-19. Available from: Available from:


Srinivasa A, Tosounidou S, Gordon C. Increased incidence of gastrointestinal side effects in patients taking hydroxychloroquine: a brand-related issue? J Rheumatol . 2017;44(3):398.

Tang W, Cao Z, Han M, Wang Z, Chen J, Sun W, et al. Hydroxychloroquine in patients with mainly mild to moderate coronavirus disease 2019: open label, randomised controlled trial. BMJ. 2020;369:m1849.

The RECOVERY Collaborative Group. Effect of hydroxychloroquine in hospitalized patients with Covid-19. N Engl J Med . 2020;383(21):2030-40.

Toueg G. Brazil’s Bolsonaro on COVID-19: ‘stop whining’; 2021 [cited 2021 April 14]. Available from: Available from:


Treanor JJ, Hayden FG, Vrooman PS, Barbarash R, Bettis R, Riff D, et al. Efficacy and safety of the oral neuraminidase inhibitor oseltamivir in treating acute influenza: a randomized controlled trial. US Oral Neuraminidase Study Group. JAMA. 2000;283(8):1016-24.

Tukacs M. Pharmacokinetics and extracorporeal membrane oxygenation in adults: A literature review. AACN Adv Crit Care. 2018;29(3):246-58.

United States Food and Drug Administration. FDA. 2020. FDA cautions against use of hydroxychloroquine or chloroquine for COVID-19 outside of the hospital setting or a clinical trial due to risk of heart rhythm problems. Washington, United States: FDA; 2020.

Varisco TJ, Johnson ML, Thornton D. Comment on Arshad et al.: Treatment with Hydroxychloroquine, Azithromycin, and Combination in Patients Hospitalized with COVID-19. Int J Infect Dis. 2020;99:373.

Vincent MJ, Bergeron E, Benjannet S, Erickson BR, Rollin PE, Ksiazek TG, et al. Chloroquine is a potent inhibitor of SARS coronavirus infection and spread. Virol J. 2005;2:69.

Wallace DJ, Linker-Israeli M, Hyun S, Klinenberg JR, Stecher V. The effect of hydroxychloroquine therapy on serum levels of immunoregulatory molecules in patients with systemic lupus erythematosus. J Rheumatol . 1994;21(2):375-6.

Wang M, Cao R, Zhang L, Yang X, Liu J, Xu M, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro Cell Res. 2020;30(3):269-71.

World Health Organization (WHO). WHO discontinues hydroxychloroquine and lopinavir/ritonavir treatment arms for COVID-19; 2020a [cited 2021 April 17].


World Health Organization. SARS-CoV-2 variants; 2020b [cited 2021 April 20]. Available from: Available from:


WHO Solidarity Trial Consortium, Pan H, Peto R, Henao-Restrepo AM, Preziosi MP, Sathiyamoorthy V, et al. Repurposed antiviral drugs for Covid-19 - Interim WHO Solidarity Trial results. N Engl J Med . 2021;384(6):497-511.

World Health Organization (WHO). Brazil situation; 2021 [cited 2021 July 5]. Available from: Available from:


Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: Summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239-42.

Xie J, Tong Z, Guan X, Du B, Qiu H, Slutsky AS. Critical care crisis and some recommendations during the COVID-19 epidemic in China. Intensive Care Med. 2020;46(5):837-40.

Yang R, Gui X, Xiong Y. Patients with respiratory symptoms are at greater risk of COVID-19 transmission. Respir Med. 2020;165:105935.

Yao X, Ye F, Zhang M, Cui C, Huang B, Niu P, et al. 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 . 2020;71(15):732-39.

Zheng Y, Ma Y, Zhang J, Xie X. COVID-19 and the cardiovascular system. Nat Rev Cardiol. 2020;17:259-60.




How to Cite

Paulo Michel Pinheiro Ferreira, Rayran Walter Ramos de Sousa, Dalton Dittz, João Marcelo de Castro e Sousa, Francisco Leonardo Torres-Leal, & Daniel Pereira Bezerra. (2023). Antimalarials and macrolides: a review of off-label pharmacotherapies during the first wave of the SARS-CoV-2 pandemic. Brazilian Journal of Pharmaceutical Sciences, 59, e21067.