Therapeutic efficacy of macrolides in management of patients with mild COVID-19

Abstract

Evidence on the efficacy of adding macrolides (azithromycin or clarithromycin) to the treatment regimen for COVID-19 is limited. We testify whether adding azithromycin or clarithromycin to a standard of care regimen was superior to standard of supportive care alone in patients with mild COVID-19.This randomized trial included three groups of patients with COVID-19. The azithromycin group included, 107 patients who received azithromycin 500 mg/24 h for 7 days, the clarithromycin group included 99 patients who received clarithromycin 500 /12 h for 7 days, and the control group included 99 patients who received standard care only. All three groups received only symptomatic treatment for control of fever and cough .Clinical and biochemical evaluations of the study participants including assessment of the symptoms duration, real-time reverse transcription-polymerase chain reaction (rRT-PCR), C-reactive protein (CRP), serum ferritin, D-dimer, complete blood count (CBC), in addition to non-contrast chest computed tomography (CT), were performed. The overall results revealed significant early improvement of symptoms (fever, dyspnea and cough) in patients treated with either azithromycin or clarithromycin compared to control group, also there was significant early conversion of SARS-CoV-2 PCR to negative in patients treated with either azithromycin or clarithromycin compared to control group (p < 0.05 for all).There was no significant difference in time to improvement of fever, cough, dyspnea, anosmia, gastrointestinal tract "GIT" symptoms and time to PCR negative conversion between patients treated with azithromycin compared to patients treated with clarithromycin (p > 0.05 for all). Follow up chest CT done after 2 weeks of start of treatment showed significant improvement in patients treated with either azithromycin or clarithromycin compared to control group (p < 0.05 for all).Adding Clarithromycin or azithromycin to the therapeutic protocols for COVID-19 could be beneficial for early control of fever and early PCR negative conversion in Mild COVID-19.Trial registration: (NCT04622891) www.ClinicalTrials.gov retrospectively registered (November 10, 2020).

Antibiotics Use in COVID-19 Patients: A Systematic Literature Review

“…The findings from the large RECOVERY trial confirmed several previous studies that found modest or no benefit in azithromycin use in patients admitted to hospital with COVID-19 [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ].…”

“…Two-hundred-forty-five studies were excluded for not reporting data on antibiotic use in COVID-19 patients. From the remaining 118 studies, 36 studies were included in this systematic review ( Figure 1 ) [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ].…”

“…Of the 36 studies included in the systematic review, 32 studies were on the use of antibiotics in COVID-19 inpatients [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ]; 4 reported on antibiotic use in COVID-19 outpatients [ 37 , 38 , 39 , 40 ].…”

“…Of these studies, 8 were clinical trials: 4 phase IIII trials evaluating antibiotic use in COVID-19 inpatients [ 17 , 18 , 20 , 24 ] and 4 phase III clinical trials evaluating antibiotic use in COVID-19 outpatients [ 37 , 38 , 39 , 40 ]. A summary description of the included clinical studies is reported in Table 1 and Table 2 .…”

Ecofriendly high‐performance thin‐layer chromatography‐densitometric method for determination of a new triple pharmaceutical combination targeting Helicobacter pylori eradication along with greenness profile assessment

“…It is one of the most useful antimicrobials against H. pylori [15]. It is recently integrated in the treatment protocol of COVID-19 [16,17]. LAN is a PPI that reduces gastric acidity [18].…”