ABSTRACT
Background Coronavirus infection (COVID-19) typically presents with mild symptoms;however, 15% of patients develop significant illness with up to 5% overall mortality. Hence, there is an urgent and unmet need for identifying definitive pharmacological interventions. Repurposing of Azithromycin presents encouraging early findings given its antiinflammatory properties and proven antiviral efficacy during the Ebola and Zika virus outbreaks. To date, studies are limited to using Azithromycin and Hydroxychloroquine in conjunction. Here, we present our findings on the isolated use of Azithromycin in the management of COVID-19. Methods We performed retrospective analysis of patients admitted between 1st March and 20th June 2020 to one of the most pressurised Greater London District General Hospitals during the early stages of the pandemic. Pearson's Chisquared test was utilised to compare mortality outcomes between two patient groups;those receiving Azithromycin (500 mg once daily, prescribed for five days) and those of a non-Azithromycin control group, comprising those with contraindication or allergy. Independent T-test analysed length of stay. Results Overall, 628 patients were analysed (mean age 71.6;41.9% female);448 (71.3%) were COVID-19 PCR swab positive, and an additional 70 (11.1%) had negative PCR but positive radiology. 394 (62.7%) received Azithromycin, whilst 234 (37.3%) constituted the non-Azithromycin control group. We observed notably improved mortality rates in Azithromycin patients (41.1%;162/394) compared to control patients (50.4%;118/234;p=0.14). Interestingly, length of stay was similar between Azithromycin administration (11.92±10.85) and control groups (10.82±12.30). Conclusion To our knowledge, this is the first large-scale analysis of Azithromycin as a stand-alone pharmacological treatment of COVID-19. The combination of Hydroxychloroquine and Azithromcyin has been widely discussed, however mortality data is adversely skewed by significant antagonistic cardiac side-effects which hinders interpretation of their individual therapeutic efficacy. Our preliminary results suggest, whilst just shy of statistical significance, a short course of Azithromycin in COVID-19 patients may reduce mortality, without negatively impacting length of stay. This highlights the need for prospective validation of this data with randomised control trials;preceding this, we advocate the use of Azithromycin in clinically selected patient populations until other licensed therapies become available.