• François Lamontagne, Thomas Agoritsas, Reed Siemieniuk, Bram Rochwerg, Jessica Bartoszko, Lisa Askie, Helen Macdonald, Wagdy Amin, Frederique Jacquerioz Bausch, Erlina Burhan, Maurizio Cecconi, Duncan Chanda, Vu Quoc Dat, Bin Du, Heike Geduld, Patrick Gee, Harley Nerina, Madiha Hashimi, Beverley J Hunt, Sushil Kabra, Seema Kanda, Leticia Kawano-Dourado, Yae-Jean Kim, Niranjan Kissoon, Arthur Kwizera, Yee-Sin Leo, Imelda Mahaka, Hela Manai, Greta Mino, Emmanuel Nsutebu, Natalia Pshenichnaya, Nida Qadir, RanganathanShalini SriSSUniversity of Colombo, Colombo, Sri Lanka., Saniya Sabzwari, Rohit Sarin, Michael Sharland, Yinzhong Shen, Joao Paulo Souza, Miriam Stegemann, Sebastian Ugarte, Sridhar Venkatapuram, Dubula Vuyiseka, Jacobus Preller, Romina Brignardello-Petersen, Elena Kum, Anila Qasim, Dena Zeraatkar, Andrew Owen, Gordon Guyatt, Lyubov Lytvyn, Janet Diaz, Per Olav Vandvik, and Michael Jacobs.
• Université de Sherbrooke, Centre de recherche due CHU de Sherbrooke, Sherbrooke, Quebec, Canada.
• BMJ. 2021 Mar 1; 372: n526.

Clinical QuestionWhat is the role of drugs in preventing covid-19? WHY DOES THIS MATTER?: There is widespread interest in whether drug interventions can be used for the prevention of covid-19, but there is uncertainty about which drugs, if any, are effective. The first version of this living guideline focuses on the evidence for hydroxychloroquine. Subsequent updates will cover other drugs being investigated for their role in the prevention of covid-19.RecommendationThe guideline development panel made a strong recommendation against the use of hydroxychloroquine for individuals who do not have covid-19 (high certainty).How This Guideline Was CreatedThis living guideline is from the World Health Organization (WHO) and provides up to date covid-19 guidance to inform policy and practice worldwide. Magic Evidence Ecosystem Foundation (MAGIC) provided methodological support. A living systematic review with network analysis informed the recommendations. An international guideline development panel of content experts, clinicians, patients, an ethicist and methodologists produced recommendations following standards for trustworthy guideline development using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.Understanding The New RecommendationThe linked systematic review and network meta-analysis (6 trials and 6059 participants) found that hydroxychloroquine had a small or no effect on mortality and admission to hospital (high certainty evidence). There was a small or no effect on laboratory confirmed SARS-CoV-2 infection (moderate certainty evidence) but probably increased adverse events leading to discontinuation (moderate certainty evidence). The panel judged that almost all people would not consider this drug worthwhile. In addition, the panel decided that contextual factors such as resources, feasibility, acceptability, and equity for countries and healthcare systems were unlikely to alter the recommendation. The panel considers that this drug is no longer a research priority and that resources should rather be oriented to evaluate other more promising drugs to prevent covid-19.UpdatesThis is a living guideline. New recommendations will be published in this article and signposted by update notices to this guideline.Readers NoteThis is the first version of the living guideline for drugs to prevent covid-19. It complements the WHO living guideline on drugs to treat covid-19. When citing this article, please consider adding the update number and date of access for clarity.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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