I found the article by James Roberts, MD, on COVID-19 a great read. (EMN. 2021;43:12; https://bit.ly/2MMglKB.)
Why was Ivermectin not mentioned? In a pandemic, we emergency physicians don't have time to wait for validated studies before we try something. The oath we all took, do no harm, fits here.
In the war named pandemic, our ammo box should be full of whatever may help lessen the severity of infection and possibly save a life. That is, after all, what we do.
Douglas Nederostek, MD
Dr. Roberts responds: Ivermectin, an FDA-approved anti-parasitic agent, was found to be an inhibitor of SARS-CoV-2 replication in the laboratory. The drug has been minimally studied for a possible benefit in treating COVID-19 infections. Some clinicians support its use, and it has few adverse side effects, but it is not universally recommended.
The Infectious Diseases Society of America's typical conservative guidelines suggest against ivermectin use outside of a clinical trial in outpatients or hospitalized patients with COVID-19. The guideline states that additional sufficiently designed clinical trials are needed to support recommendations for routine use by clinicians.
Most of the published studies have incomplete information and significant methodological limitations. Many emergency clinicians would agree with Dr. Nederostek's argument for such a drug, but for ivermectin to be used in the ED, it likely would require support from a variety of hospital resources and an emergency clinician who has a personal interest in moving it forward.