Macrolides for the treatment of COVID-19: A living systematic review protocol

Abstract

<p>ObjectiveThis living systematic review aims to provide a timely, rigorous and continuously updated summary of the evidence available on the role of macrolides for the treatment of patients with COVID-19.Data sources We will conduct searches in PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), grey literature and in a centralised repository in L·OVE (Living OVerview of Evidence). L·OVE is a platform that maps PICO questions to evidence from Epistemonikos database. In response to the COVID-19 emergency, L·OVE was adapted to expand the range of evidence it covers and customised to group all COVID-19 evidence in one place. The search will cover the period until the day before submission to a journal.Eligibility criteria for selecting studies and methods We adapted an already published common protocol for multiple parallel systematic reviews to the specificities of this question. We will include randomised trials evaluating the effect of macrolides — as monotherapy or in combination with other drugs — versus placebo or no treatment in patients with COVID-19. Randomised trials evaluating macrolides in infections caused by other coronaviruses, such as MERS-CoV and SARS-CoV, and non-randomised studies in COVID-19 will be searched in case we find no direct evidence from randomised trials, or if the direct evidence provides low- or very low-certainty for critical outcomes.Two reviewers will independently screen each study for eligibility, extract data, and assess the risk of bias. We will pool the results using meta-analysis and will apply the GRADE system to assess the certainty of the evidence for each outcome. A living, web-based version of this review will be openly available during the COVID-19 pandemic. We will resubmit it every time the conclusions change or whenever there are substantial updates.Ethics and dissemination No ethics approval is considered necessary. The results of this review will be widely disseminated via peer-reviewed publications, social networks and traditional media.PROSPERO Registration number CRD42020181032</p>

Impact of the COVID-19 Pandemic on Antimicrobial Resistance (AMR) Surveillance, Prevention and Control: A Global Survey

“…azithromycin) were also seen despite conflicting evidence for COVID-19 patients. 15 Meta-analyses by Langford et…”

“…azithromycin) were also seen despite conflicting evidence for COVID-19 patients. 15 Meta-analyses by Langford et al and Rawson et al found that approximately three quarters of hospitalized COVID-19 patients received antibiotics, although 3.5% and 8.5% were estimated to have bacterial co-infections on presentation and bacterial/fungal co-infections during admission, respectively. 16, 17 Hospital-based studies have shown significant increases in total antibiotic use, including broad-spectrum antibiotic use such as cefepime, piperacillin/tazobactam and carbapenems.…”

Macrolides for the treatment of COVID-19: a living, systematic review

“…A protocol stating the shared objectives and methodology of multiple evidence syntheses (systematic reviews and overviews of systematic reviews) to be conducted in parallel for different questions relevant to COVID-19 was published elsewhere 21 . This systematic review protocol was adapted to the specificities of the question 22 and submitted to PROSPERO CRD42020181032.…”

“…In this review, some methods were not implemented. We did not implement either the search in other sources specified in the original protocol 22 or the screening in Collaboratron™ because we considered L•OVE platform as a comprehensive tool that gathers both processes, including diverse databases and registries, as we specified in our methods. We neither needed to express continuous outcomes as a standardized mean difference because we only included one randomized clinical trial in our review.…”