Management of SARS-CoV-2 Infection: Key Focus in Macrolides Efficacy for COVID-19

Abstract

Macrolides (e.g., erythromycin, fidaxomicin, clarithromycin, and azithromycin) are a class of bacteriostatic antibiotics commonly employed in medicine against various gram-positive and atypical bacterial species mostly related to respiratory tract infections, besides they possess anti-inflammatory and immunomodulatory effects. Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome of coronavirus 2 (SARS-CoV-2). It was first detected in Wuhan, Hubei, China, in December 2019 and resulted in a continuing pandemic. Macrolides have been extensively researched as broad adjunctive therapy for COVID-19 due to its immunostimulant abilities. Among such class of drugs, azithromycin is described as azalide and is well-known for its ability to decrease the production of pro-inflammatory cytokines, including matrix metalloproteinases, tumor necrosis factor-alpha, interleukin (IL)-6, and IL-8. In fact, a report recently published highlighted the effectiveness of combining azithromycin and hydroxychloroquine for COVID-19 treatment. Indeed, it has been underlined that azithromycin quickly prevents SARS-CoV-2 infection by raising the levels of both interferons and interferon-stimulated proteins at the same time which reduces the virus replication and release. In this sense, the current review aims to evaluate the applications of macrolides for the treatment of COVID-19.

Wastewater surveillance of SARS-CoV-2 and chemical markers in campus dormitories in an evolving COVID − 19 pandemic

“…Macrolides such as AZT [10] , [28] , [35] and ERY-H 2 O [7] were suggested for COVID-19 treatment. Earlier studies also suggested combining AZT and hydroxychloroquine for COVID-19 treatment [35] .…”

Immunomodulatory role of azithromycin: Potential applications to radiation-induced lung injury

“…And another report also demonstrated that the macrolide erythromycin decreases airway NET formation in mice ( 41 ). Azithromycin has also been shown in pre-clinical studies to decrease IL-8 release and neutrophil airway infiltration, cause degranulation and degradation of extracellular myeloperoxidase, and reduce neutrophil oxidative burst ( 42 ). Indeed, azithromycin, frequently used in asthmatic children with lower respiratory tract infection, inhibits the accumulation of neutrophils in pulmonary airways by affecting interleukin-17 downstream signal, and by inhibiting the release of neutrophil mobilizing cytokines: macrophage inflammatory protein-2(MIP-2), CXC chemokine ligand-5(CXCL-5), and granulocyte macrophage colony-stimulating factor(GM-CSF) ( 43 ).…”

Immunological interactions in helminths‐SARS CoV‐2 coinfection: Could old enemy be a friend today?

“…ACE2 results in the down-regulation of the protective ACE2 with the initiation of hyper-inflammation and oxidative stress, that cause acute lung injury (ALI), acute respiratory distress syndrome (ARDS) and multi-organ failure (MOF). [20][21][22] In addition, the SARS-CoV-2 infection can simultaneously provoke both adaptive and innate host immunity. 23,24 However, an impaired adaptive immune response and an unrestrained innate immune response could result in extensive local and systemic immune-mediated tissue damage.…”