Letter to the Editor

I read the editorial on COVID-19 and the quality use of medicines1 with great interest and found it very balanced and rational. I liked the approach of the editorial.

I have a question – can COVID-19 treatment be left to antipyretic and other symptomatic treatment for young adults with no comorbidities and taking other precautions such as isolation? Are there any studies reported? Is experimental prescribing with hydroxychloroquine, antivirals and antibiotics absolutely necessary? In the early phase of the pandemic, many patients with mild disease might have self-treated or were medically treated as if they had flu and came out of it in 4–5 days without knowing that it was COVID. Their immune system must have worked well.

Manjiri Gharat
Prin KM Kundnani Pharmacy Polytechnic, Ulhasnagar, India
Vice-President, Indian Pharmaceutical Association 
Vice-President, FIP Community Pharmacy Section


Author's response

Darren Roberts and Alexandra Bennett, the authors of the editorial, comment:

These questions are important, but the harms and benefits of these treatments for COVID-19 in this age group are poorly defined.

It is increasingly clear that the natural history of COVID-19 reflects risk factors whereby younger age and fewer comorbidities are favourable.2-4 For example, despite a high number of cases of adults under 50 years of age in Australia, only 7% were hospitalised and 0.03% died.5 In India, mortality has been reported as 0.4% in those under 40 years of age.6

Randomised controlled trials are needed to quantify the efficacy of antiviral treatments for reducing COVID-19 disease progression.1 To our knowledge there are no trials in young adults with mild disease. However, death and other adverse effects to antivirals in COVID-19 have been reported, but mostly in patients with severe disease so the observation may be confounded by indication.7 Therefore, more data are required to confirm the safety and efficacy of antivirals in lower severity COVID-19. In Australia, the use of antiviral treatments outside a clinical trial is not recommended8 and we support this.

It seems reasonable to assume that general health advice for other mild infections, as described by Manjiri Gharat, also apply in COVID-19. We are not aware of data supporting a benefit of antipyretics in COVID-19. However, some authors have questioned their safety in COVID-19 including paracetamol-associated acute hepatitis9 and non-steroidal anti-inflammatory drug-associated systemic infection.10 These risks appear theoretical so are insufficient to advise against the use of antipyretics, but more data are required.



  1. Roberts DM, Bennett A. COVID-19 and the quality use of medicines: evidence, risks and fads. Aust Prescr 2020;43:78-80.
  2. Petrilli CM, Jones SA, Yang J, Rajagopalan H, O’Donnell L, Chernyak Y, et al. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study. BMJ 2020;369:m1966.
  3. Docherty AB, Harrison EM, Green CA, Hardwick HE, Pius R, Norman L, et al.; ISARIC4C investigators. Features of 20133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. BMJ 2020;369:m1985.
  4. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al.; China Medical Treatment Expert Group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382:1708-20.
  5. COVID-19 National Incident Room Surveillance Team. COVID-19, Australia: Epidemiology Report 15 (Reporting week ending 23:59 AEST 10 May 2020). Commun Dis Intell (2018) 2020;44.
  6. Narayan P, Nagarajan R. Average age of India’s Covid deaths 60; diabetes, BP common co-ailments. The Times of India 2020 Apr 8. [cited 2020 Aug 1]
  7. Hernandez AV, Roman YM, Pasupuleti V, Barboza JJ, White CM. Hydroxychloroquine or chloroquine for treatment or prophylaxis of COVID-19: a living systematic review. Ann Intern Med 2020 May 27 [Epub ahead of print].
  8. National COVID-19 Clinical Evidence Taskforce. Caring for people with COVID-19. Living guidelines.
  9. Rodríguez-Morales AJ, Cardona-Ospina JA, Murillo-Muñoz MM. Gastroenterologists, hepatologists, COVID-19 and the use of acetaminophen. Clin Gastroenterol Hepatol 2020 May 7 [Epub ahead of print].
  10. Micallef J, Soeiro T, Jonville-Béra AP; French Society of Pharmacology, Therapeutics (SFPT). Non-steroidal anti-inflammatory drugs, pharmacology, and COVID-19 infection. Therapie 2020 May 7 [Epub ahead of print].

The Editorial Executive Committee welcomes letters, which should be less than 250 words. Before a decision to publish is made, letters which refer to a published article may be sent to the author for a response. Any letter may be sent to an expert for comment. When letters are published, they are usually accompanied in the same issue by any responses or comments. The Committee screens out discourteous, inaccurate or libellous statements. The letters are sub-edited before publication. Authors are required to declare any conflicts of interest. The Committee's decision on publication is final.

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Manjiri Gharat

Prin KM Kundnani Pharmacy Polytechnic, Ulhasnagar, India

Vice-President, Indian Pharmaceutical Association

Vice-President, FIP Community Pharmacy Section

Darren M Roberts

Clinical pharmacologist, Department of Clinical Pharmacology and Toxicology, St Vincent’s Hospital, Sydney

Nephrologist, Department of Renal Medicine and Transplantation, St Vincent’s Hospital, Sydney

Conjoint associate professor, St Vincent’s Clinical School, University of New South Wales, Sydney

Alexandra Bennett

Executive officer, NSW Therapeutic Advisory Group, Sydney