Study advocates cautious use of ammonium chloride as adjunctive COVID-19 therapy

While the addition ammonium chloride to standard of care falls short of significantly reducing mortality in COVID-19, it can lead to shorter time to recovery, according to a study.

Quaternary ammonium compounds have shown notable antiviral effects and may be of use against SARS-CoV-2 infections. In the current study, a team of researchers tested whether adding ammonium chloride to standard treatment regimen for COVID-19 would improve the outcome of the infection.

A total of 120 patients were randomized to receive standard of care plus either diphenhydramine and ammonium chloride (10-ml oral syrup three times a day for 7 days; n=60) or diphenhydramine alone (10-ml oral syrup three times a day for 7 days) as placebo (n=60). The standard treatment regimen also included concomitant atazanavir (300 mg taken orally twice a day in hospitalized patients) and methylprednisolone (1 g/day for 3 days in patients admitted to intensive care unit).

The primary outcome of all-cause mortality within 30 days of randomization did not significantly differ between the two treatment groups (hazard ratio, 3.02, 95 percent confidence interval [CI], 0.57–16.06; p=0.195).

However, patients who received ammonium chloride were more likely to have a shorter recovery time (odds ratio [OR], 1.8, 95 percent CI, 1.15–2.83; p=0.01) and lower viral burden (OR, 7.90, 95 percent CI, 1.62–14.17; p=0.014) compared with those who received the control treatment.

The findings advocate the careful addition of ammonium chloride to standard of care for COVID-19 patients.