Impact of Azithromycin and/or Hydroxychloroquine on Hospital Mortality in COVID-19

Abstract

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has led to widespread use of hydroxychloroquine and azithromycin despite the lack of conclusive evidence for their safety and efficacy. We evaluated the association between treatment with hydroxychloroquine and/or azithromycin and hospital mortality as the primary outcome. We compared the hospital mortality of patients treated with hydroxychloroquine alone, azithromycin alone, or their combination to the mortality of patients who received neither drug. A logistic multivariate model with overlap weight propensity score was used for estimation of odds ratios (ORs) with 95% confidence intervals (95% CIs). One thousand four hundred and three patients with SARS-CoV-2 infection were admitted to the hospital. At the time of the analysis, the outcome was available for 1376 (98%) of them. Five hundred and eighty-seven patients (42%) received azithromycin and 377 patients (27%) received hydroxychloroquine, alone or in combination. In-hospital mortality was 26%. After the adjusted analysis, azithromycin alone was associated with lower mortality (OR 0.60, 95% CI 0.42–0.85) compared to no treatment. Hydroxychloroquine alone (OR 0.76, 95% CI 0.53–1.08) and the combination of azithromycin and hydroxychloroquine (OR 1.13, 95% CI 0.77–1.69) were not associated with hospital mortality. In this cohort of patients, azithromycin alone was associated with lower hospital mortality but hydroxychloroquine was not associated with increased or reduced mortality. While we await randomized clinical trials, these data support the use of azithromycin in novel coronavirus disease 2019 (COVID-19) and can contribute to better understanding of its role in further meta-analyses.

Rationale for azithromycin in COVID-19: an overview of existing evidence

“…Studies that assess azithromycin monotherapy versus standard of care in hospitalised patients report a wide effect range, from a decreased adjusted OR for mortality of 0.60 (95% CI 0.42 to 0.85) in the retrospective cohort of Albani et al 70 to a non-significantly increased adjusted OR of 1.30 (95% CI 0.65 to 2.64) in Kuderer et al . 71 Even more heterogeneity is seen in studies that assess the addition of azithromycin to hydroxychloroquine, with a survival benefit (adjusted HR of 0.294; 95% CI 0.218 to 0.396) seen by Arshad et al , 72 opposed to a significantly increased 30-day mortality (adjusted OR 2.93; 95% CI 1.79 to 4.79) reported again by Kuderer et al .…”

Effect of Hydroxychloroquine on Clinical Improvement and Mortality Among Patients with COVID-19 Admitted to Four General Hospitals in Saudi Arabia

“…Hydroxychloroquine in the current study was associated with longer length of stay in both univariate and multivariate analysis. Similarly, hydroxychloroquine with or without azithromycin was associated with longer length of stay in both univariate and multivariate analysis in a retrospective cohort design [20]. However, most of the previous studies either did not focus on the length of stay as an outcome or could not find benefit of hydroxychloroquine on the length of stay [21,22].…”

“…However, most of the previous studies either did not focus on the length of stay as an outcome or could not find benefit of hydroxychloroquine on the length of stay [21,22]. It should be mentioned that the length of stay may be easily affected by the hospital capacity and discharge polices [20].…”

Low Dose Hydroxychloroquine is Associated with Lower Mortality in COVID-19: A Meta-Analysis of 27 Studies and 44,684 Patients

“…Twenty-eight articles were identi ed [7,9,11,12,. For ten of them [11,15,17,19,21,23,25,31,32,34] it was possible to extract data necessary for comparing HCQ+AZM versus no HCQ+AZM. For the other studies, it was not possible to systematically distinguish if HCQ therapy was complemented or not with AZM.…”