Is Hydroxychloroquine with Azithromycin a Good Combination in COVID-19 Compared to Hydroxychloroquine Alone from
Pravash Budhathoki1, Dhan Bahadur Shrestha2, Sitaram Khadka3
1Department of Emergency Medicine, Dr Iwamura Memorial Hospital, Bhaktapur-44800, Nepal.
Insights
The combination of hydroxychloroquine and azithromycin for COVID-19 treatment showed a slight, non-significant increase in mortality and cardiac events compared to hydroxychloroquine alone. QT prolongation odds also increased slightly but were not statistically significant.
Area of Science:
- Infectious Diseases
- Cardiology
- Pharmacology
Background:
- The COVID-19 pandemic created a global health crisis with limited treatment options.
- Evaluating the safety and efficacy of repurposed drugs is crucial.
Purpose of the Study:
- To assess the outcomes and cardiac safety of hydroxychloroquine plus azithromycin versus hydroxychloroquine alone for COVID-19.
- To compare the risk of mortality, cardiac events, and QT interval changes between the two treatment groups.
Main Methods:
- A systematic literature search was conducted across major databases (PubMed, Medline, Google Scholar, Cochrane Library, clinicaltrials.gov, WHO registry).
- Six studies were identified and analyzed using PRISMA guidelines.
- Quantitative synthesis employed fixed or random effects models based on heterogeneity.
Main Results:
- The combination therapy showed a non-significant increase in mortality (RR=1.16) and adverse cardiac events (OR=1.06).
- No significant increase in mechanical ventilation or QTc prolongation was observed.
- While not statistically significant, increased odds of critical QTc threshold and absolute QTc changes warrant consideration.
Conclusions:
- Hydroxychloroquine and azithromycin combination therapy resulted in slightly increased odds of mortality and cardiac events compared to hydroxychloroquine monotherapy.
- The combination therapy also showed increased odds of QT prolongation, though not statistically significant, necessitating clinical caution.
Background:
The global spread of COVID-19 and the lack of definite treatment have caused an alarming crisis in the world. We aimed to evaluate the outcome and potential harmful cardiac effects of hydroxychloroquine and azithromycin compared to hydroxychloroquine alone for COVID-19 treatment.
Methods:
PubMed, Medline, Google Scholar, Cochrane Library, clinicaltrials.gov, and World Health Organization clinical trial registry were searched using appropriate keywords and identified six studies using PRISMA guidelines. The quantitative synthesis was performed using fixed or random effects for the pooling of studies based on heterogeneities.
Results:
The risk of mortality (RR=1.16; CI: 0.92-1.46) and adverse cardiac events (OR=1.06; CI: 0.82-1.37) demonstrated a small increment though of no significance. There were no increased odds of mechanical ventilation (OR=0.84; CI: 0.33-2.15) and significant QTc prolongation (OR=0.84, CI: 0.59-1.21). Neither the critical QTc threshold (OR=1.92, CI: 0.81-4.56) nor absolute ?QTc ?60ms (OR=1.95, CI:0.55-6.96) increased to the level of statistical significance among hydroxychloroquine and azithromycin arm compared to hydroxychloroquine alone, but the slightly increased odds need to be considered in clinical practice.
Conclusions:
The combination of hydroxychloroquine and azithromycin leads to small increased odds of mortality and cardiac events compared to hydroxychloroquine alone. The use of hydroxychloroquine and azithromycin led to increased odds of QT prolongation, although not statistically significant.
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