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Updated: Dec 8, 2025

Using Zebrafish Models of Human Influenza A Virus Infections to Screen Antiviral Drugs and Characterize Host Immune Cell Responses

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Azithromycin in viral infections.

Madeleine E Oliver¹, Timothy S C Hinks²

¹New College, University of Oxford, Oxford, UK.

Reviews in Medical Virology

|September 24, 2020

Summary

Azithromycin (AZM) demonstrates broad antiviral and anti-inflammatory effects, inhibiting viral replication and suppressing key inflammatory pathways relevant to COVID-19. Further randomized trials are crucial to confirm its clinical efficacy.

Keywords:

COVID-19 SARS-CoV-2 azithromycin coronavirus macrolide mechanism review virus

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A Robust Pneumonia Model in Immunocompetent Rodents to Evaluate Antibacterial Efficacy against S. pneumoniae, H. influenzae, K. pneumoniae, P. aeruginosa or A. baumannii

A Robust Pneumonia Model in Immunocompetent Rodents to Evaluate Antibacterial Efficacy against S. pneumoniae, H. influenzae, K. pneumoniae, P. aeruginosa or A. baumannii

Published on: January 2, 2017

Area of Science:

Pharmacology
Virology
Immunology

Background:

Azithromycin (AZM), a macrolide antibiotic, possesses known antiviral and anti-inflammatory properties.
It has been explored for SARS-CoV and MERS-CoV infections and is under investigation for SARS-CoV-2.
No randomized trial data currently exist for AZM in novel coronavirus infections.

Purpose of the Study:

To review existing data on the antiviral and anti-inflammatory properties of macrolides, particularly AZM.
To assess AZM's potential as a therapeutic agent for SARS-CoV-2 (COVID-19).

Main Methods:

Review of in vitro, murine, and human clinical studies on macrolides and AZM.
Analysis of AZM's mechanisms of action against viral replication and inflammation.

Main Results:

AZM inhibits replication of various viruses, including coronaviruses, via multiple mechanisms.
It enhances antiviral responses, including interferon production.
AZM exhibits anti-inflammatory effects by suppressing cytokines (IL-1beta, IL-2, TNF, GM-CSF) and inhibiting T-cell activation and neutrophil functions.

Conclusions:

AZM shows significant in vitro antiviral and anti-inflammatory potential relevant to COVID-19.
Its safety, affordability, and availability make it a candidate for further investigation.
Well-designed randomized clinical trials are urgently needed to establish its efficacy and guide antimicrobial stewardship.