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For (pre-exposure) prophylaxis in pregnancy, where vaccines may be contraindicated, the alternative of hydroxychloroquine has been advocated Order Stromectol over the counter.125,126 In addition to safety and relative efficacy, different risk-benefit judgments may be presented for prophylaxis (pre- and post-exposure), and for treatment, with pregnancy a high-risk status for COVID-19. RCTs in this review did not specifically examine use of ivermectin in the elderly, although this is a known high-risk group for severe COVID-19. In the setting of care homes, it is also notorious for rapid contagion. A standard indication for ivermectin in the elderly is scabies. We identified 2 recent reports suggesting that ivermectin may be efficacious as prevention and treatment of COVID-19 in this age group.50,127 A letter on positive experience in 7 elder care facilities in Virginia covering 309 patients was sent to NIH127 and has recently been submitted for publication. There is also evidence emerging from countries where ivermectin has been implemented. 129 However, factors such as change in behavior, social distancing, and face-mask use could have played a role in this reduction. In the intervening years, the effectiveness of ivermectin and its derivatives in treating parasitic worm infections transformed human and veterinary medicine, leading to a Nobel Prize for its discoverers, William C Campbell and Satoshi Ömura. In humans, ivermectin is currently prescribed in tablet form to treat certain roundworm infections that cause illnesses such as river blindness. It may also be applied as a cream to control the common inflammatory skin condition papulopustular rosacea. But ivermectin is most commonly used for veterinary parasitic diseases, especially gastrointestinal worm infestations. Consequently, it is readily available and relatively inexpensive. As ivermectin is more extensively used in veterinary than human medicine, however, the US Food and Drug Administration found it necessary to issue a warning in April 2020 against use of veterinary preparations in human patients with COVID-19. Why might it be used to treat COVID? How did a drug mainly used to treat intestinal parasites in cows come to be of interest to doctors treating humans with COVID-19? Dr Tess Lawrie – a medical doctor who specialises in pregnancy and childbirth – founded the British Ivermectin Recommendation Development (Bird) Group. She has called for a pause to the Covid-19 vaccination programme and has made unsubstantiated claims implying the Covid vaccine had led to a large number of deaths based on a common misreading of safety data. Around the world it was originally not opposition to vaccines but a lack of them that led people to ivermectin. The drug has at various points been approved, recommended or prescribed for Covid in India, South Africa, Peru and much of the rest of Latin America, as well as in Slovakia. Health authorities in Peru and India have stopped recommending ivermectin in treatment guidelines. In February, Merck – one of the companies that makes the drug – said there was “no scientific basis for a potential therapeutic effect against Covid-19”. In South Africa, the drug has become a battleground – doctors point out the lack of evidence but many patients desperately want access as the vaccine rollout has been patchy and problematic. One GP in the country described a relative, a registered nurse, who didn’t book a coronavirus vaccine she was eligible for and then caught the virus. And the patients given the placebo turned out to have had much lower levels of oxygen in their blood before the trial started than those given ivermectin. So they were already sicker and statistically more likely to die. But this pattern was repeated across a wide range of different measurements. The people with “bad” measurements ended up in the placebo group, the ones with “good” measurements in the ivermectin group. The likelihood of this happening randomly across all these different measurements was vanishingly small, Dr Sheldrick said. Dr Morteza Niaee, who led the Iran study, defended the results and the methodology and disagreed with problems pointed out to him, adding that it was “very normal to see such randomisation” when lots of different factors were considered and not all of them had any bearing on participants’ Covid risk. But the Lebanon and Iran trials were excluded from a paper for Cochrane – the international experts in reviewing scientific evidence – because they were “such poorly reported studies” McAllen.