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.The study 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 laboratory 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), 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, 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

Early Start of Oral Clarithromycin Is Associated with Better Outcome in COVID-19 of Moderate Severity: The ACHIEVE Open-Label Single-Arm Trial

“…In another trial from Egypt, patients with mild COVID-19 were randomized to 7 days of oral treatment with azithromycin ( n = 106), clarithromycin ( n = 99) or standard of care ( n = 99). Both macrolide antibiotics exhibited equal efficacy (which was superior to of standard of care) on time to achievement of negative viral load and of radiological improvement [ 22 ].…”

Pneumolysin as a target for new therapies against pneumococcal infections: A systematic review

“…Clarithromycin is used in the treatment of pneumococcal infections in combination with β-lactams and in some clinical trials using clarithromycin as treatment (revised by Anderson & Feldman, (2017) [59]); the results supported its beneficial role in the anti-inflammatory/immunomodulatory activities. More recently, in a clinical trial in patients with COVID-19, it appears that it could be beneficial for early control of fever and early negative conversion of PCR [125]. However, increasing macrolide resistance in some CAP ethological agents (S. pneumoniae and M. pneumoniae) and its effect on decreasing the natural T-cell immune response [126], is contributing to reconsideration of their use in the future.…”

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].…”