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Rationale for azithromycin in COVID-19: an overview of existing evidence.
Gyselinck, Iwein; Janssens, Wim; Verhamme, Peter; Vos, Robin.
  • Gyselinck I; Respiratory Diseases, KU Leuven University Hospitals, Leuven, Flanders, Belgium iwein.gyselinck@kuleuven.be.
  • Janssens W; Department CHROMETA - Research group BREATHE, KU Leuven, Leuven, Flanders, Belgium.
  • Verhamme P; Respiratory Diseases, KU Leuven University Hospitals, Leuven, Flanders, Belgium.
  • Vos R; Department CHROMETA - Research group BREATHE, KU Leuven, Leuven, Flanders, Belgium.
BMJ Open Respir Res ; 8(1)2021 01.
Article in English | MEDLINE | ID: covidwho-1066893
ABSTRACT
Azithromycin has rapidly been adopted as a repurposed drug for the treatment of COVID-19, despite the lack of high-quality evidence. In this review, we critically appraise the current pharmacological, preclinical and clinical data of azithromycin for treating COVID-19. Interest in azithromycin has been fuelled by favourable treatment outcomes in other viral pneumonias, a documented antiviral effect on SARS-CoV-2 in vitro and uncontrolled case series early in the pandemic. Its antiviral effects presumably result from interfering with receptor mediated binding, viral lysosomal escape, intracellular cell-signalling pathways and enhancing type I and III interferon expression. Its immunomodulatory effects may mitigate excessive inflammation and benefit tissue repair. Currently, in vivo reports on azithromycin in COVID-19 are conflicting and do not endorse its widespread use outside of clinical trials. They are, however, mostly retrospective and therefore inherently biased. The effect size of azithromycin may depend on when it is started. Also, extended follow-up is needed to assess benefits in the recovery phase. Safety data warrant monitoring of drug-drug interactions and subsequent cardiac adverse events, especially with hydroxychloroquine. More prospective data of large randomised controlled studies are expected and much-needed. Uniform reporting of results should be strongly encouraged to facilitate data pooling with the many ongoing initiatives.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Azithromycin / COVID-19 Drug Treatment / Anti-Bacterial Agents Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Humans Language: English Year: 2021 Document Type: Article Affiliation country: Bmjresp-2020-000806

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Azithromycin / COVID-19 Drug Treatment / Anti-Bacterial Agents Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Humans Language: English Year: 2021 Document Type: Article Affiliation country: Bmjresp-2020-000806