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Sars-Cov-2 Infection in Patients on Long-Term Treatment with Macrolides in Spain: A National Cross-Sectional Study
Carmen Marina Meseguer Barros1, Natalia Alzueta Isturiz2, Rita Sainz de Rozas Aparicio3
1Service of Pharmacy, Ouest Primary Health Care Area, Madrid Health Service, Madrid C/Alonso Canonum 8, 28933 Madrid, Spain.
Abstract:
The aim of this study was to know the prevalence and severity of COVID-19 in patients treated with long-term macrolides and to describe the factors associated with worse outcomes. A cross-sectional study was conducted in Primary Care setting. Patients with macrolides dispensed continuously from 1 October 2019 to 31 March 2020, were considered. Main outcome: diagnosis of coronavirus disease-19 (COVID-19). Secondary outcomes: symptoms, severity, characteristics of patients, comorbidities, concomitant treatments. A total of 3057 patients met the inclusion criteria. Median age: 73 (64-81) years; 55% were men; 62% smokers/ex-smokers; 56% obese/overweight. Overall, 95% of patients had chronic respiratory diseases and four comorbidities as a median. Prevalence of COVID-19: 4.8%. This was in accordance with official data during the first wave of the pandemic. The most common symptoms were respiratory: shortness of breath, cough, and pneumonia. Additionally, 53% percent of patients had mild/moderate symptoms, 28% required hospital admission, and 19% died with COVID-19. The percentage of patients hospitalized and deaths were 2.6 and 5.8 times higher, respectively, in the COVID-19 group (p < 0.001). There was no evidence of a beneficial effect of long-term courses of macrolides in preventing SARS-CoV-2 infection or the progression to worse outcomes in old patients with underlying chronic respiratory diseases and a high burden of comorbidity.
Insights
Long-term macrolide use did not prevent coronavirus disease-19 (COVID-19) or severe outcomes in patients with chronic respiratory conditions. This study found no benefit, with higher hospitalization and death rates in COVID-19 patients on macrolides.
Area of Science:
- Primary Care Research
- Infectious Diseases
- Pharmacology
Background:
- Long-term macrolide use is common in patients with chronic respiratory diseases.
- The impact of macrolides on coronavirus disease-19 (COVID-19) outcomes remains unclear.
- Understanding risk factors for severe COVID-19 in vulnerable populations is crucial.
Purpose of the Study:
- To determine the prevalence and severity of COVID-19 in patients on long-term macrolides.
- To identify factors associated with worse COVID-19 outcomes in this cohort.
- To assess the potential protective or detrimental effects of macrolides on SARS-CoV-2 infection.
Main Methods:
- A cross-sectional study involving 3057 patients receiving continuous macrolides from October 2019 to March 2020.
- Data collection included COVID-19 diagnosis, symptoms, severity, patient characteristics, comorbidities, and treatments.
- Statistical analysis compared outcomes between COVID-19 positive and negative groups.
Main Results:
- The prevalence of COVID-19 was 4.8%, aligning with first-wave pandemic data.
- Patients with COVID-19 experienced significantly higher rates of hospitalization (2.6x) and death (5.8x) (p < 0.001).
- Common symptoms included shortness of breath, cough, and pneumonia; 19% of COVID-19 patients died.
Conclusions:
- Long-term macrolide therapy showed no benefit in preventing SARS-CoV-2 infection or severe COVID-19 outcomes.
- Patients on macrolides with chronic respiratory diseases and comorbidities faced higher risks.
- Further research is needed to clarify macrolide's role in respiratory infections and COVID-19.
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