Clinical Experience With Ivermectin and Nitazoxanide in the Management of COVID-19 Among Mexican Out- and Inpatients

Background and objective The use of ivermectin and nitazoxanide in the treatment of coronavirus disease 2019 (COVID-19) has been a subject of controversy. In this study, we aimed to describe our clinical experience in treating COVID-19 patients with these drugs in Mexico. Material and methods The study involved out- and inpatient clinical assessments of COVID-19 patients conducted in Mexico City from September 2020 to November 2021. Outpatients were treated with either ivermectin, nitazoxanide, or both drugs, while all inpatients received both. Clinical and laboratory analyses were used to assess the results. Results Of the 228 subjects in the outpatient group, 26.8% received ivermectin, 25.4% nitazoxanide, and 47.8% both. The proportion of negative polymerase chain reaction (PCR) was highest in patients treated late with ivermectin (≥5 days after symptom onset; p=0.004), followed by those receiving late treatment with nitazoxanide, and those with the combination at any time. The inpatient group had 179 subjects. A significant increase was seen in neutrophil, lymphocyte, monocyte, ferritin, and D-dimer levels, while an opposite trend was observed for C-reactive protein (CRP) and fibrinogen levels. Mechanical ventilation requirement was 15.5%, and 5% died during hospitalization. Conclusions Despite the limitations of our study, based on its findings, ivermectin and nitazoxanide could be useful in reducing the viral load, the requirement for mechanical ventilation, proinflammatory and procoagulant parameters, and the fatality rate in COVID-19 patients. Controlled clinical trials evaluating this combination should be carried out to determine its true usefulness and safety profile.