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Azithromycin in COVID-19 Patients: Pharmacological Mechanism, Clinical Evidence and Prescribing Guidelines

Author

Listed:
  • Janet Sultana

    (University of Messina)

  • Paola Maria Cutroneo

    (University of Messina)

  • Salvatore Crisafulli

    (University of Messina)

  • Gabriele Puglisi

    (University of Messina)

  • Gaetano Caramori

    (University of Messina)

  • Gianluca Trifirò

    (University of Messina)

Abstract

The global COVID-19 pandemic has led to a race to find medications that can improve the prognosis of the disease. Azithromycin, in association with hydroxychloroquine or chloroquine, has been proposed as one such medication. The aim of this review is to describe the pharmacological mechanism, clinical evidence and prescribing guidelines concerning azithromycin in COVID-19 patients. There is weak evidence on the antiviral and immunomodulating effects of azithromycin, which in addition is not based on results from COVID-19 patients specifically. Therefore, this antibacterial should be considered only as empirical treatment of community-acquired pneumonia (CAP), although not all current treatment guidelines are in agreement. After the initial expectations raised by a small trial, more recent evidence has raised serious safety concerns on the use of hydroxychloroquine or chloroquine with azithromycin to treat COVID-19 patients, as all these drugs have arrhythmogenic potential. The World Health Organization has not made recommendations suggesting the use of azithromycin with hydroxychloroquine or chloroquine as treatment for COVID-19, but some national organisations have taken a different position, recommending this as first-line treatment. Several scientific societies, including the American College of Cardiology, have cautioned about the risks of this treatment in view of the lack of evidence concerning its benefits.

Suggested Citation

  • Janet Sultana & Paola Maria Cutroneo & Salvatore Crisafulli & Gabriele Puglisi & Gaetano Caramori & Gianluca Trifirò, 2020. "Azithromycin in COVID-19 Patients: Pharmacological Mechanism, Clinical Evidence and Prescribing Guidelines," Drug Safety, Springer, vol. 43(8), pages 691-698, August.
    • Handle: RePEc:spr:drugsa:v:43:y:2020:i:8:d:10.1007_s40264-020-00976-7
    DOI: 10.1007/s40264-020-00976-7
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    Cited by:

    1. Iqra Mehmood & Munazza Ijaz & Sajjad Ahmad & Temoor Ahmed & Amna Bari & Asma Abro & Khaled S. Allemailem & Ahmad Almatroudi & Muhammad Tahir ul Qamar, 2021. "SARS-CoV-2: An Update on Genomics, Risk Assessment, Potential Therapeutics and Vaccine Development," IJERPH, MDPI, vol. 18(4), pages 1-23, February.

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