Azithromycin, clarithromycin help patients recover faster from mild COVID-19

The inclusion of macrolides, such as azithromycin or clarithromycin, to treatment regimens for mild cases of the coronavirus disease 2019 (COVID-19) may help improve early control of fever, a recent trial has found.

Researchers randomly assigned 305 mild COVID-19 patients to receive standard of care alone (n=99) or with either azithromycin (500 mg every day for 7 days; n=107) or clarithromycin (500 mg every 12 hours for 7 days; =99). Patient assessments included symptom duration, C-reactive protein, serum ferritin, D-dimer, chest computed tomography (CT), complete blood count, and real-time reverse transcription polymerase chain reaction (rRT-PCR).

Patients treated with azithromycin or clarithromycin took an average of 5.2±2.3 and 4.9±1.5 days, respectively, to recover from their fever, as opposed to 12.9±2.2 days in the control group (p<0.000). Similarly, the duration of cough was significantly shorter for both macrolide group (5.4±2.7 and 5.1±2 vs 12.9±2.2 days, respectively; p<0.0001).

Dyspnoea likewise showed significantly earlier improvement in the azithromycin and clarithromycin arms relative to controls (4.6±3.3 and 4.7±2.9 vs 9.3±2.7 days; p<0.0001). Conversion to a negative rRT-PCR test was also quicker in both macrolide groups (8.7±2.8 and 8.3±2.6 vs 13.2±4.2 days; p<0.0001).

After 2 weeks since treatment initiation, follow-up chest CT was performed, which found significant improvements in 65 percent and 77 percent of patients treated with azithromycin and clarithromycin, respectively, as opposed to only 54 percent of controls (p<0.0001).

No differences in outcomes were reported between the azithromycin and clarithromycin groups.