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Efficacy and Safety of Azithromycin for the Treatment of COVID-19: A Systematic Review and Meta-analysis
Ghea Mangkuliguna1, Glenardi1, Natalia1
1School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, North Jakarta, Indonesia.
Background:
The lack of effective medications for coronavirus disease 2019 (COVID-19) has led to a trend of drug repurposing such as the case of azithromycin which shows immunomodulatory and anti-viral effect. Several clinical trials have shown conflicting results. It is currently unclear whether the available evidence is in favor or against the use of azithromycin in COVID-19 patients. Thus, the aim of this study was to investigate the efficacy and safety of azithromycin in COVID-19 patients.
Methods:
Four independent reviewers selected relevant studies from PubMed, ScienceDirect, EBSCO, and ProQuest published prior to March 2021. The protocol used in this study has been registered in PROSPERO (CRD42020224967).
Results:
We included 17 studies and found that the mortality rate (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.76-1.19), need of respiratory support (OR, 1.30; 95% CI, 0.98-1.73), hospitalization rate (standardized mean difference, 0.12; 95% CI, -0.02 to 0.27), and intensive care unit transfer (OR, 1.21; 95% CI, 0.79-1.86) of azithromycin-treated group did not differ significantly (p>0.05) from those of the control group. Azithromycin treatment did not significantly increase the risk of getting secondary infection (OR, 1.23; 95% CI, 0.83-1.82), hypoglycemia (OR, 0.73; 95% CI, 0.38-1.40), gastrointestinal problems (OR, 1.03; 95% CI, 0.73-1.45) or electrocardiogram abnormalities (OR, 1.16; 95% CI, 0.94-1.42). The overall quality of evidence ranged from low to very low.
Conclusion:
Azithromycin did not result in a superior clinical improvement in COVID-19 patients, although it was well-tolerated and safe to use.
Insights
Azithromycin did not improve clinical outcomes for COVID-19 patients. This drug repurposing study found no significant differences in mortality, respiratory support, or hospitalization rates, though it was well-tolerated.
Area of Science:
- Pharmacology
- Infectious Diseases
- Clinical Trials
Background:
- Drug repurposing is explored for COVID-19 due to limited effective treatments.
- Azithromycin, an antibiotic, exhibits potential immunomodulatory and antiviral properties.
- Conflicting clinical trial results necessitate a comprehensive evidence review.
Purpose of the Study:
- To evaluate the efficacy of azithromycin in treating COVID-19 patients.
- To assess the safety profile of azithromycin use in COVID-19.
- To synthesize existing evidence on azithromycin for COVID-19.
Main Methods:
- A systematic review and meta-analysis of relevant studies.
- Searched major databases including PubMed, ScienceDirect, EBSCO, and ProQuest.
- Four independent reviewers selected studies published before March 2021; protocol registered with PROSPERO.
Main Results:
- No significant differences observed in mortality (OR 0.95), respiratory support needs (OR 1.30), hospitalization rates (SMD 0.12), or ICU transfer (OR 1.21) between azithromycin and control groups.
- Azithromycin did not significantly increase risks of secondary infections, hypoglycemia, gastrointestinal issues, or ECG abnormalities.
- The overall quality of evidence supporting these findings was low to very low.
Conclusions:
- Azithromycin demonstrated no superior clinical benefit for COVID-19 patients.
- The antibiotic was found to be well-tolerated and safe for use in this patient population.
- Further high-quality research may be needed to definitively establish azithromycin's role, if any, in COVID-19 management.
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