Ivermectin in Mild COVID-19: Panoramic Evaluation of the Evidence

The COVID-19 pandemic is still a major global challenge and had already caused significant mortality in many countries. Despite the urgent need for proven treatment option, there is still uncertainty about the treatment candidates of COVID-19. Many repurposed medicines have been tried against the SARS-CoV-2 virus. The antiparasitic ivermectin, with potential antiviral and anti-inflammatory properties, has also been employed for treatment of mild COVID-19. Different national and international guidelines have recommended its use. However, the cumulative evidence from subsequent clinical trials has shown no significant clinical benefits. A portion of the ivermectin supplied is excreted unchanged in the faeces and ends up in the soil, potentially exposing non-target species such as insects and other environmental matrices to ecotoxicological effects. Nevertheless, Ivermectin is continuously employed and should be avoided, since evidence from various clinical trials does not support its use and discrepancy in dosing could underlie the lack of robust clinical efficacy.