Hydroxychloroquine plus azithromycin may help cure COVID-19 patients

Treatment with hydroxychloroquine appears to significantly reduce viral load in patients with the novel coronavirus disease (COVID-19), with its beneficial effects reinforced by adding azithromycin, results of a recent study have shown.

“For ethical reasons and because our first results are so significant … we decide to share our findings with the medical community, given the urgent need for an effective drug against severe respiratory syndrome coronavirus 2 (SARS-CoV-2) in the current pandemic context,” the researchers said.

SARS-CoV-2 is the causative agent of COVID-19 and was first detected in Wuhan, the capital city of Hubei province, China, in December 2019.

French patients with confirmed COVID-19 were included in a single-arm protocol from early March to 16 March 2020 and received 600-mg hydroxychloroquine daily. Their viral load in nasopharyngeal swabs was tested daily in a hospital setting.

Azithromycin was also given to some patients depending on their clinical presentation. Those who were not treated from another centre and cases who refused the protocol were included as negative controls. The primary endpoint was the presence and absence of virus at day 6 postinclusion.

Of the confirmed COVID-19 patients, six were symptomatic, eight had lower respiratory tract infections, and 22 had upper respiratory tract infection symptoms. [Int J Antimicrob Agents 2020;doi:10.1016/j.ijantimicag.2020.105949]

Only 20 patients were treated in this study. At day 6 postinclusion, infected individuals had a significant decrease in viral carriage compared to controls and much lower average carrying duration than that reported by untreated patients in the literature. Moreover, the addition of azithromycin to hydroxychloroquine significantly increased the latter’s effectiveness for virus elimination.

“We therefore recommend that COVID-19 patients be treated with hydroxychloroquine and azithromycin to cure their infection and to limit the transmission of the virus to other people in order to curb the spread of COVID-19 in the world,” the researchers said.

These findings corroborated a recent China study, which demonstrated that chloroquine and hydroxychloroquine could inhibit SARS-CoV-2 in vitro, with the latter being more potent than the former. [Clin Infect Dis 2020;doi:10.1093/cid/ciaa237]

“Our preliminary results also suggest a synergistic effect of the combination of hydroxychloroquine and azithromycin,” the researchers noted.

“Azithromycin has been shown to be active in vitro against Zika and Ebola viruses and to prevent severe respiratory tract infections when administrated to patients suffering viral infection,” they added. [Proc Natl Acad Sci 2016;113:14408-14413; ACS Infect Dis 2015;1:317-326; J Antivirals Antiretrovirals 2018;10:6-11; JAMA 2015;314:2034-2044]

Further research is required to determine whether these agents could be used as chemoprophylaxis to prevent the transmission of the virus, particularly for frontline healthcare workers, according to the researchers. The current study was limited by its small sample size, inadequate long-term outcome follow-up and dropout of six patients.