A recommendation for the use of chloroquine, hydroxychloroquine, primaquine, or tafenoquine for prophylaxis against the 2019 novel coronavirus (COVID-19) with note to the ophthalmic considerations

Fouad Alshaban


With the ongoing pandemic of infectious disease termed coronavirus disease 2019 (COVID-19) caused by the novel coronavirus identified as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), prevention of infection and spread is critical in preventing morbidity and mortality.  Prophylaxis, specifically chemoprophylaxis, is particularly critical to breaking the spread and rapid rate of increase of SARS-CoV-2.  Pre-exposure and post-exposure prophylaxis are both required components of this public health measure.  As the use of anti-malarial agents, specifically the 4-aminoquinolones, chloroquine and hydroxychloroquine, for the treatment of SARS-CoV-2 is now being reported, attention must be turned to their role in the chemoprophylaxis of SARS-CoV-2.  In a search of the peer-reviewed medical literature (using MEDLINE and cross-referenced literature), this report is first peer-reviewed publication to present the use of these anti-malarial agents as prophylaxis against SARS-CoV-2.  The ophthalmic consideration of the use of these drugs is highlighted in this report.


coronavirus, novel coronavirus, coronavirus 2, SARS-CoV-2, 19-CoV, COVID-19, COVID, chloroquine, hydroxychloroquine, primaquine, tafenoquine, quinine, 4-aminoquinoline, 8-aminioquinoline, aminoquinolines, Aralen, Plaquenil, Krintafel, Arakoda, Remaquin


Kouznetsov V, Amado Torres DF. Antimalaricos: contruccion de hibridos moleculares de la cloroquina. Universitas Scientariarum 2008; 13(3): 306-320.

Krafts K, Hempelmann E, Skorska-Stania A. From methylene blue to chloroquine: a brief review of the development of an antimalarial therapy. Parasitology Research 2012; 111:1-6.

Pareja-Coronel A. Treatment of viral hepatitis with chloroquine. American Journal of Gastroenterology 1963; 39: 288-98.

Mallucci L. Effect of chloroquine on lysosomes and on growth of mouse hepatitis virus (MHV-3). Virology 1966; 28(3): 355-62.

Yielding KL. Inhibition of the replication of a bacterial DNA virus by chloroquine and other 4-aminoquinoline drugs. Proceedings of the Society for Experimental Biology and Medicine 1967; 125(3): 780-3.

Kono S, Kohase M, Suganuma M. Inhibition of interferon production by chloroquine diphosphate. Japanese Journal of Medical Science and Biology 1968; 21(4): 239-48.

Devaux CA, Rolain JM, Colson P, et al. New insights on the antiviral effects of chloroquine against choronavirus: what to expect for COVID-19. International Journal of Antimicrobial Agents 2020; In Press.

Wang M, Cao R, Zhang L, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Research 2020; 30(3): 269-71.

Colson P., Rolain JM, Lagier JC, et al. Chloroquine and hydroxychloroquine as available weapons to fight COVID-19. International Journal of Antimicrobial Agents 2020; In Press.

Yao X, Ye F, Zhang M, et al. In vitro antiviral activity and projection of optimized dosing design of hydroxychloroquine for the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Clinical Infectious Diseases 2020; In Press.

Gao J, Tian Z, Yang T. Breakthrough: chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. BioScience Trends 2020; 14(1):72-3.

Gautret P, Lagier JC, Parola P. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. International Journal of Antimicrobial Agents 2020; In Press.

Tortorici MA, Walls AC, Lang Y, et al. Structural basis for human coronavirus attachment to sialic acid receptors. Nature Structural and Molecular Biology 2019; 26: 481-9.

Lim HS, Im JS, Cho JY, et al. Pharmacokinetics of hydroxychloroquine and its clinical implications in chemoprophylaxis against malaria caused by Plasmodium vivax. Antimicrobial Agents and Chemotherapy 2009; 53(4): 1468-75.

Staines HM, Krishna S, eds. Treatment and Prevention of Malaria: Antimalarial Drug Chemcistry, Action and Use. Basel: Springer, 2012.

Fraunfelder FT, Fraunfelder FW, Chambers WA. Drug-Induced Ocular Side Effects, 7 Ed. London: Elsevier, 2015.

Berman J, Brown, T, Dow G, et al. Tqfenoquine and primaquine do not exhibit clinical neurological signs associated with central nervous system lesions in the same manner as earlier 8-aminoquinolines. Malaria Journal 2014; 17: 407-19.

Dow GS, McCarthy WF, Reid M, et al. A retrospective analysis of the protective efficacy of tafenoquine and mefloquine as prophylactic anti-malarials in non-immune individuals during deployment to malaria-endomic area. Malaria Journal 2014; 13: 49-62.

Warrasak S, Euswas A, Fukuda MM, et al. Comparative ophthalmic assessment of patients receiving tafenoquine or chloroquine/primaquine in a randomized clinical trial for Plasmodium vivax malaria radical cure. International Ophthalmology 2019 39: 1767-82.

Ackert J, Mohamed K, Slakter JS, et al. Drug Safety 2019; 42: 1103-14.

Li G, de Clercq E. Therapeutic options for the 2019 novel coronavirus (2019-nCoV). Nature Reviews 2020; 19:149-50.

Taylor WRJ, Thriemer K, von Seidlein L, et al. Short-course primaquine for the radical cure of Plasmodium vivax malaria: a multicentre, randomised, placebo-controlled non-inferiority trial. The Lancet 2019; 394: 929-38.

Lacerda MVG, Llanos-Cuentas A, Krudsood S, et al. Single-dose tafenoquine to prevent relapse of Plasmodium vivax malaria. The New England Journal of Medicine 2020; 380(3): 215-28.

DOI: http://dx.doi.org/10.16964/er.v6i1.99


  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution 3.0 License.

Eye Reports [eISSN 2039-4756] is a new Open Access, online-only, peer-reviewed journal.