Ivermectin is Not Recommended for COVID-19 Treatment
The IDSA panel strongly recommends against using ivermectin for COVID-19 treatment in both hospitalized and ambulatory patients. 1
Evidence Summary
The Infectious Diseases Society of America (IDSA) has thoroughly evaluated the use of ivermectin for COVID-19 and made clear recommendations:
- For hospitalized patients: Conditional recommendation against ivermectin (very low certainty of evidence)
- For ambulatory patients: Strong recommendation against ivermectin (moderate certainty of evidence) 1
Why Ivermectin Was Considered
Ivermectin initially gained attention because:
- It showed in vitro activity against SARS-CoV-2 in laboratory studies
- It has established anti-parasitic properties (FDA-approved for onchocerciasis and strongyloidiasis)
- It demonstrated some anti-inflammatory effects in laboratory studies 1
However, the concentrations required to achieve antiviral effects against SARS-CoV-2 are considerably higher than what can be safely achieved in human plasma and lung tissue 1.
Clinical Evidence Analysis
The IDSA guidelines reviewed 21 studies involving patients with COVID-19, including:
- 11 RCTs for hospitalized patients
- 12 RCTs for ambulatory patients 1
These studies used various ivermectin doses (100-400 mcg/kg/day) and treatment durations (1-7 days).
Key Findings:
- Mortality: No proven benefit in reducing mortality in either hospitalized or ambulatory patients
- Clinical improvement: No significant benefit compared to placebo or standard care
- Viral clearance: No meaningful reduction demonstrated
- Safety concerns: While ivermectin is generally well-tolerated at approved parasitic doses, its safety profile for COVID-19 treatment remains uncertain 1
Cochrane Review Confirmation
A comprehensive Cochrane review also concluded that based on very low to low-certainty evidence, there is uncertainty about the efficacy and safety of ivermectin for COVID-19 treatment or prevention 2. The review noted that "the reliable evidence available does not support the use of ivermectin for treatment or prevention of COVID-19 outside of well-designed randomized trials."
Appropriate Clinical Use of Ivermectin
It's important to note that ivermectin does have legitimate medical uses:
- FDA-approved for onchocerciasis and strongyloidiasis
- Used off-label for many other parasitic infections 1
For patients with COVID-19 who are receiving immunomodulatory therapies (corticosteroids, IL-6 inhibitors) and may be at risk for Strongyloides infection, ivermectin may be appropriate to prevent hyperinfection syndrome 3. However, this is not for treating COVID-19 itself but for preventing a potentially fatal parasitic complication.
Conclusion
Based on the most recent and highest quality evidence from the IDSA guidelines, ivermectin should not be prescribed for COVID-19 treatment. The inappropriate use of ivermectin for COVID-19 may reduce its availability for patients with legitimate parasitic infections who would benefit from its use 3.
The search for effective COVID-19 treatments should focus on therapies with proven efficacy rather than repurposing medications without sufficient supporting evidence.