Azithromycin and COVID‐19: Prompt early use at first signs of this infection in adults and children, an approach worthy of consideration

Abstract

The devastating effects of the coronavirus designated severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) have led to urgent attempts to find effective therapeutic agents for inpatient and outpatient treatment of COVID‐19. Initial enthusiasm for the combination of hydroxychloroquine and azithromycin has abated. However, as a result of positive clinical experience with azithromycin used alone during the first few days of the flu‐like illness caused by this coronavirus, we recommend formal clinical trials using azithromycin early in the course of a COVID‐19 infection. There is one clinical trial initiated, the individually randomized, telemedicine‐based, “Azithromycin for COVID‐19 Treatment in Outpatients Nationwide” based at the University of California San Francisco. This placebo‐controlled trial is designed to determine the efficacy of a single 1.2‐g dose of oral azithromycin to prevent COVID‐19 patient progression to hospitalization. We recommend formal clinical trials of azithromycin in its prepackaged form at the first sign of COVID‐19 infection in adults and children, using an initial adult dose of 500 mg followed by 250 mg per day for 4 days, a total cumulative dose of 1.5 g, and for children 5 to 18 years of age, 10 mg/kg on the first day followed by 5 mg/kg for 4 days.

Antihistamines and azithromycin as a treatment for COVID-19 on primary health care – A retrospective observational study in elderly patients

“…Although this study is descriptive, our results bear some similarities with other studies [ 26 , 36 , 37 ]. Mast cells seem to play an important role in the inflammatory responses by releasing granules of histamine, in addition to synthesizing and secrete inflammatory lipid mediators and pro-inflammatory cytokines TNF-α and IL-6 [ 38 ].…”

COVID-19–specific skin changes related to SARS-CoV-2: Visualizing a monumental public health challenge

“…COVID-19 disease may be associated with adverse reactions to anti-COVID-19 disease medications ( 11 , 34 , 37 , 38 , 39 ), particularly as there is an understandable and appropriate effort to find and explore inexpensive, safe, easy-to-use, and readily avoidable options such as azithromycin ( 37 ), some with years of clinical experience with both oral and topical administration ( 38 , 39 ). Many clinical trials are in progress.…”

What we have learned from the COVID-19 pandemic: Time to think outside the box, maybe far outside

“…The most important is probably a serious cardiac arrhythmia, occurring especially in patients with a prolonged Q–T interval on their electrocardiogram, which may be fatal. 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 Others include blindness, renal failure, worsening of psoriasis, 61 and an occasional severe cutaneous adverse drug reaction, known as generalized pustular figurate erythema. 11 , 12…”

“…It also has very uncommon but potentially serious side effects, however, including cardiac arrhythmias in the elderly and in those with pre-existing Q–T interval prolongation, bradycardia, low serum potassium, or low serum magnesium. 62 , 63 , 64 , 65 Azithromycin also is an effective drug against the closely related pathogenic viruses, influenza A (H1 N1) 66 and zika. 67 , 68 …”