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“KIT COVID, É KIT ILUSÃO – Associação Médica Brasileira diz que uso de cloroquina e outros remédios sem eficácia contra Covid-19 deve ser banido


Bolsonaro mostrando medicamento de hidroxicloroquina para “tratamento precoce”.

A Associação Médica Brasileira (AMB) divulgou um boletim nesta terça-feira (23) na qual condena, entre outros pontos, o uso de remédios sem eficácia contra a Covid-19. O posicionamento é oposto a um anterior, de julho do ano passado, quando a entidade defendeu a “autonomia do médico” ao receitar os medicamentos.

“Reafirmamos que, infelizmente, medicações como hidroxicloroquina/cloroquina, ivermectina, nitazoxanida, azitromicina e colchicina, entre outras drogas, não possuem eficácia científica comprovada de benefício no tratamento ou prevenção da COVID-19, quer seja na prevenção, na fase inicial ou nas fases avançadas dessa doença, sendo que, portanto, a utilização desses fármacos deve ser banida”, diz o novo texto da AMB.

No documento, a entidade cita 13 pontos para enfrentamento da pandemia e reforça a necessidade de prevenção da Covid-19. Entre eles estão a necessidade de acelerar a vacinação, manter o isolamento social, o uso de máscaras e, também, a necessidade de ação das autoridades para solucionar a falta de medicamentos no atendimento de pacientes internados com Covid (veja íntegra da carta ao final desta reportagem), principalmente daqueles necessários para a intubação.

A associação destaca que, sem esses medicamentos, “não é possível oferecer atendimento adequado para salvar vidas”.

Na semana passada, a AMB já havia divulgado outra carta pedindo vacinas, isolamento e o uso de máscaras para combater a pandemia.

O documento desta terça (23) encerra uma polêmica que envolvia a associação: no ano passado, ao lado da Sociedade Brasileira de Cardiologia (SBC) e do Conselho Federal de Medicina (CFM), a AMB se posicionou entre as entidades médicas que ainda tinham posicionamentos neutros ou favoráveis ao direito dos médicos de escolher o tratamento para pacientes com Covid.

Posicionamento anterior

Em 20 de julho de 2020, a AMB chegou a divulgar nota na qual afirmava que ainda não existiam “estudos seguros, robustos e definitivos sobre a questão”. À época, a AMB declarava: “O derby político em torno da hidroxicloroquina deixará um legado sombrio para a medicina brasileira, caso a autonomia do médico seja restringida, como querem os que pregam a proibição da prescrição da hidroxicloroquina.”

Em março, meses antes da nota da AMB, entretanto, a Anvisa já havia emitido parecer no qual não recomendava o uso da hidroxicloroquina. Ao longo dos meses seguintes, antes do posicionamento da AMB, vários estudos já mostravam que a hidroxicloroquina não funcionava contra a Covid-19:

  • no início de maio, um estudo feito nos Estados Unidos mostrou que a hidroxicloroquina não melhorou o quadro de pacientes hospitalizados com Covid-19;
  • também em maio, uma pesquisa feita na China mostrou que o remédio não funcionava em casos leves a moderados;
  • em junho, uma pesquisa com 821 pacientes mostrou que a hidroxicloroquina também não funcionava para prevenção da Covid-19;
  • em julho, quatro dias antes da publicação da nota, uma pesquisa feita nos Estados Unidos reforçou o achado de que a hidroxicloroquina não funcionava em casos leves de Covid;
  • no mesmo dia, um ensaio coordenado pela Universidade de Oxford associou a hidroxicloroquina ao agravamento de casos de Covid-19 e mortes.

Três dias antes da nota da AMB, a Sociedade Brasileira de Infectologia (SBI) também divulgou posicionamento afirmando que a hidroxicloroquina deveria ser abandonada no tratamento da Covid-19.

Três dias após o posicionamento da AMB, um estudo brasileiro também mostrou que o remédio não tinha eficácia em casos leves a moderados.

Novo posicionamento

Sob nova presidência, a AMB agora defende que os remédios sem eficácia sejam abandonados. Além disso, entre os 13 pontos do comunicado divulgado nesta terça, a AMB ainda orienta médicos sobre o uso de corticoides e anticoagulantes, que devem ser reservados exclusivamente para pacientes hospitalizados e que precisem de oxigênio suplementar. “Não devendo ser prescritos na COVID leve, conforme diversas diretrizes científicas nacionais e internacionais”, escreve a AMB.

Veja abaixo a íntegra da carta

“São Paulo, 23 de março de 2021

O Brasil soma 25% das mortes mundiais por Covid-19, no período de 15 a 21 de março de 2021. No planeta, segundo a Organização Mundial da Saúde (OMS), houve 60,2 mil óbitos, dos quais 15,6 mil em nosso país.

Ainda nessa semana, atingiremos outra triste marca: chegaremos a 300 mil mortes, com a agravante de atravessarmos um quadro de curva ascendente.

Faltam medicamentos para intubação de pacientes acometidos pela Covid-19, não existe um calendário consistente de vacinação, não há leitos em Unidades de Terapia Intensiva.

Fake news desorientam pacientes. Médicos e profissionais de saúde, exaustos, já são em número insuficiente em diversas regiões do País.

Em meio à gravidade do quadro e a tantos outros desafios, o Comitê Extraordinário de Monitoramento Covid-19 – CEM COVID_AMB vem a público para orientações aos pacientes de todo o Brasil, em particular sobre a importância da prevenção, para esclarecimentos sobre condutas aos médicos, e para conclamar as autoridades responsáveis à urgente resolução de casos que exclusivamente delas dependem:

Boletim 02/2021

Comitê Extraordinário de Monitoramento Covid-19 (CEM COVID_AMB)

  1. O Brasil deve vacinar com celeridade todos os cidadãos. Vacinação em massa é a medida ideal para controlar a velocidade de propagação do vírus;
  2. A variante P1 do Coronaviírus, que já circula em grande parte do Brasil, possui capacidade de transmissão consideravelmente maior do que o vírus original, impondo risco adicional a todos os brasileiros – de todas as faixas etárias, o que reforça a necessidade do isolamento e de normativas de lockdown por regiões críticas, para conter o crescimento da curva de casos e de mortes;
  3. O isolamento social, com a menor circulação possível de pessoas, segue sendo imperioso para conter a propagação viral, hoje agravada pela variante brasileira P1 do coronavírus;
  4. Todos, sem exceção, temos de seguir à risca as medidas preventivas: uso correto de máscara, distanciamento social, evitar aglomerações, manter o ambiente bem ventilado e higienizando, ficar em isolamento respiratório assim que houver suspeita de Covid-19, identificar os contactantes, higienizar frequentemente as mãos, com água e sabão ou álcool gel a 70%.
  5. São urgentes esforços políticos, diplomáticos e a utilização de normativas/leis de excepcionalidade, para solucionar a falta de medicamentos ao atendimento emergencial de pacientes hospitalares acometidos pela COVID-19, em especial de bloqueadores neuromusculares, opioides e hipnóticos – indispensáveis ao processo de intubação de doentes em fase crítica;
  6. Por compromisso ético e zelando pela transparência, informamos que, na ausência destes fármacos, não é possível oferecer atendimento adequado para salvar vidas. Uma Unidade de Terapia Intensiva (UTI) é composta por espaço físico, equipamentos, medicamentos, materiais e recursos humanos. A falta de qualquer desses elementos inviabiliza a execução dos procedimentos;
  7. Reafirmamos que, infelizmente, medicações como hidroxicloroquina/cloroquina, ivermectina, nitazoxanida, azitromicina e colchicina, entre outras drogas, não possuem eficácia científica comprovada de benefício no tratamento ou prevenção da COVID-19, quer seja na prevenção, na fase inicial ou nas fases avançadas dessa doença, sendo que, portanto, a utilização desses fármacos deve ser banida.
  8. Aos médicos, reafirmamos que o uso de corticoides e anticoagulantes devem ser reservados exclusivamente para pacientes hospitalizados e que precisem de oxigênio suplementar, não devendo ser prescritos na COVID leve, conforme diversas diretrizes científicas nacionais e internacionais. Aos pacientes com suspeita ou com COVID confirmada, alertamos que não se automediquem, em especial não utilizem corticoides (dexametasona, predinisona e outros); estes fármacos utilizados fora do período correto, especialmente no início dos sintomas, podem piorar a evolução da doença. Procure atendimento médico em uma Unidade Básica de Saúde dando preferência, se possível, à telemedicina, se apresentar sintomas leves, como dor de garganta, tosse, dor no corpo, náuseas, perda de apetite, perda do olfato ou paladar. Porém, se apresentar manifestações clínicas que podem representar Covid grave, destancando falta de ar, respiração rápida (mais que 30 movimentos respiratórios por minuto), saturação de oxigênio menor que 94% ou febre persistente por 3 dias ou mais, procure uma UPA (Unidade de Pronto Atendimento) ou Serviço de Emergência;
  9. A falta de vagas em UTIs e o aumento anormal da demanda por vagas de leitos fazem urgentes também a adoção de critérios técnicos-científicos de triagem dos pacientes que devem ocupar os leitos disponíveis, com fundamentos éticos em defesa das vidas dos brasileiros, com diretrizes para todos os médicos do País;
  10. A escassez de recursos humanos, de insumos farmacológicos e de material de apoio transcende a simplicidade da utilização dos centros cirúrgicos como terapia intensiva. A transformação da sala de cirurgia em UTI deve ser pontual. É uma exceção, não regra;
  11. Devido ao drama vivido no Brasil, se faz ainda mais relevante o papel do Judiciário como poder de guarda dos direitos constitucionais, entre os quais à saúde e à vida. Assim, registramos o crédito de que os tribunais seguirão se manifestando, ao estrito cumprimento da Lei, para garantir que todas as normas de isolamento sejam cumpridas à risca;
  12. Reiteramos que o Brasil requer ações unificadas e coordenadas de combate a Covid, dos governantes das esferas federal, estadual e municipal incluindo ações coordenadas de todos os ministérios, e gestores públicos e privados da saúde, sem qualquer resquício de ideologias e interesses políticos;
  13. Firmamos votos especiais ao novo Ministro da Saúde. Os brasileiros almejam que vossa gestão ecoe e se guie exclusivamente pela voz da Ciência; que seja um exemplo de independência na implantação de políticas/medidas consistentes e necessárias à resolubilidade e qualidade do sistema; de conduta ética; de compromisso com a melhor Medicina; e, acima de tudo, com a saúde de todos os cidadãos.

SOCIEDADES DE ESPECIALIDADES

Academia Brasileira de Neurologia Associação Brasileira de Alergia e Imunologia Associação Brasileira de Cirurgia Pediátrica Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular Associação Brasileira de Medicina de Emergência Associação Brasileira de Medicina de Tráfego Associação Brasileira de Medicina Física e Reabilitação Associação Brasileira de Medicina Legal e Perícias Médicas Associação Brasileira de Medicina Preventiva e Administração em Saúde Associação Brasileira de Nutrologia Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial Associação Brasileira de Psiquiatria Associação de Medicina Intensiva Brasileira Associação Médica Homeopática Brasileira

“Nós, os médicos, estaremos sempre disponíveis para ajudar; e ajudaremos. Mas não trazemos a solução; hoje não a temos. A solução para a Covid não está nas mãos de mais de meio milhão de médicos do Brasil. Será resultado das atitudes responsáveis e solidárias de cada um dos cidadãos do País e das autoridades públicas responsáveis por implantar as medidas efetivas que se fazem necessárias para mitigar a enorme dor e sofrimento da população brasileira.”

ENTIDADES SIGNATÁRIAS DESSE DOCUMENTO

Associação Nacional de Medicina do Trabalho Colégio Brasileiro de Cirurgia Digestiva Colégio Brasileiro de Cirurgiões Colégio Brasileiro de Radiologia Colégio Médico Brasileiro de Acupuntura Conselho Brasileiro de Oftalmologia Federação Brasileira das Associações de Ginecologia e Obstetrícia Federação Brasileira de Gastroenterologia Sociedade Brasileira de Anestesiologia Sociedade Brasileira de Angiologia e Cirurgia Vascular Sociedade Brasileira de Cardiologia Sociedade Brasileira de Cirurgia Cardiovascular Sociedade Brasileira de Cirurgia da Mão Sociedade Brasileira de Cirurgia de Cabeça e Pescoço Sociedade Brasileira de Cirurgia Oncológica Sociedade Brasileira de Cirurgia Plástica Sociedade Brasileira de Cirurgia Torácica Sociedade Brasileira de Clínica Médica Sociedade Brasileira de Coloproctologia Sociedade Brasileira de Dermatologia Sociedade Brasileira de Endocrinologia e Metabologia Sociedade Brasileira de Endoscopia Digestiva Sociedade Brasileira de Genética Médica e Genômica Sociedade Brasileira de Geriatria e Gerontologia Sociedade Brasileira de Infectologia Sociedade Brasileira de Mastologia Sociedade Brasileira de Medicina de Familia e Comunidade Sociedade Brasileira de Medicina do Exercício e do Esporte Sociedade Brasileira de Medicina Nuclear

Sociedade Brasileira de Nefrologia Sociedade Brasileira de Neurocirurgia Sociedade Brasileira de Oncologia Clínica Sociedade Brasileira de Ortopedia e Traumatologia Sociedade Brasileira de Patologia Sociedade Brasileira de Patologia Clínica e Medicina Laboratorial Sociedade Brasileira de Pediatria Sociedade Brasileira de Pneumologia e Tisiologia Sociedade Brasileira de Radioterapia Sociedade Brasileira de Reumatologia Sociedade Brasileira de Urologia

FEDERADAS AMB

Associação Médica do Acre Sociedade de Medicina de Alagoas Associação Médica do Amazonas Associação Médica do Amapá Associação Bahiana de Medicina Associação Médica Cearense Associação Médica de Brasília Associação Médica do Espírito Santo Associação Médica de Goiás Associação Médica do Maranhão Associação Médica de Minas Gerais Associação Médica do Mato Grosso do Sul Associação Médica do Mato Grosso Sociedade Médico-Cirúrgica do Pará Associação Médica de Pernambuco Associação Piauiense de Medicina

Associação Médica da Paraíba Associação Médica do Paraná Sociedade Médica do Estado do Rio de Janeiro Associação Médica do Rio Grande do Norte Associação Médica de Rondônia Associação Médica de Roraima Associação Médica do Rio Grande do Sul Associação Catarinense de Medicina Sociedade Médica de Sergipe Associação Paulista de Medicina Associação Médica de Tocantins

• Antonio Carlos Lopes, Sociedade Brasileira de Clínica Médica

• Alexandre Naime Barbosa, Sociedade Brasileira de Infectologia*

• Augusto Key Karazawa Takaschima, Sociedade Brasileira de Anestesiologia

• Bruno de Lima Naves, Sociedade Brasileira de Angiologia e de Cirurgia Vascular

• Carlos André Uehara, Sociedade Brasileira de Geriatria e Gerontologia

• César Eduardo Fernandes, Associação Médica Brasileira

• Clóvis Arns da Cunha, Sociedade Brasileira de Infectologia

NÚCLEO EXECUTIVO – CEM COVID_AMB

• Dante Mário Langhi Júnior, Associação Brasileira de Hematologia, Hemoterapia e TerapiaCelular

• Emanuel Savio Cavalcanti Sarinho, Associação Brasileira de Alergia e Imunologia

• Hélio Penna Guimarães, Associação Brasileira de Medicina de Emergência

• Irma de Godoy, Sociedade Brasileira de Pneumologia e Tisiologia

• José Eduardo Lutaif Dolci, Associação Médica Brasileira

• José Luiz Gomes do Amaral, Associação Paulista de Medicina

• Ricardo Machado Xavier, Sociedade Brasileira de Reumatologia

• Suzana Margareth Ajeje Lobo, Associação de Medicina Intensiva Brasileira

• Zeliete Linhares Leite Zambon, Sociedade Brasileira de Medicina de Família e Comunidade

• Consultor do Núcleo Executivo”

Sobre admin

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