The trial shows that the antibiotic azithromycin does not prevent mild cases of COVID from progressing to hospitalization and death

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A new study (the ATOMIC2 trial), presented at this year’s European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) and published simultaneously in Respiratory Medicine Lancet, shows that the antimicrobial drug azithromycin — already approved for use in multiple infections — does not prevent mild cases of COVID-19 from going to hospital or death.

The study, conducted by Dr. Timothy Hinks of John Radcliffe Hospital and the University of Oxford, UK, and colleagues, shows that azithromycin should not be used as a treatment for COVID. -19 and that all countries should stop using it for this purpose, to avoid resistance. developing into azithromycin in other infections.

The SARS-CoV-2 pandemic has not only started a rush to develop new treatments, but also research on already approved drugs to determine if they can also be used to treat COVID-19. Azithromycin is an antibiotic used to treat serious chest infections, including pneumonia and drug-resistant tuberculosis, trachoma – a common cause of preventable blindness – sinus infections, Lyme , skin infections and some sexually transmitted infections such as chlamydia.

The antibacterial, anti-inflammatory, and antiviral properties of azithromycin suggested that it may have therapeutic potential against COVID-19. However, there is a lack of data from randomized controlled trials of azithromycin to treat mild to moderate COVID-19 disease. In this study, the authors evaluated whether azithromycin is effective in reducing hospitalization in patients with mild to moderate COVID-19. These were people with symptoms of COVID-19 severe enough to request hospitalization, but not severe enough, initially, to require admission for oxygen therapy.

This randomized clinical trial in 19 centers in the UK enrolled adults aged 18 years and older, who presented to hospitals with highly probable or confirmed COVID-19 with a clinical diagnosis. , with less than 14 days of symptoms, is considered suitable for initial hospital evaluation and then treatment and / or observation at home. Patients were randomized (1: 1) to azithromycin (500 mg daily orally for 14 days) or to observation at home only. The main result was the difference in the proportion of participants with death or hospital admission for any cause over the next 28 days.

A total of 298 participants were registered from June 2020 to January 2021 and 292 were included in the final analysis. The authors found no difference between azithromycin and control groups in the risk of COVID-19 progressing to hospitalization or death.

They explain that, unlike other studies, the high dose of azithromycin was selected in this new study (500 mg daily) and long-term (14 days) to ensure that the trial properly evaluated the antiviral, antibacterial, and antibacterial benefits. potential anti-inflammatory drugs. COVID-19 is considered to have a different early “viremic” phase with a high viral load and a late inflammatory phase in some individuals, and therefore the evaluation of antiviral activity had to be early during the course of disease before the onset of serious illness.

At the same time, it was not known what doses might be needed to produce an appropriate anti-inflammatory effect and therefore it was necessary to give a long-term high dose to ensure that the anti-inflammatory effect was tested throughout the phase. end of the innate acute phase of inflammatory cytokine dysregulation (known as the cytokine storm, which overwhelms the affected people and is often fatal).

The authors say, “In this trial of people with mild-to-moderate clinically diagnosed COVID-19 managed without hospital admission, adding azithromycin to standard care treatment did not reduce the risk of subsequent hospitalization or death, nor of time to hospitalization. .. this finding, combined with clear negative results from other studies throughout the course of the disease, from early and low-risk patients to serious hospitalized illnesses, strongly confirms that is not effective in the treatment of COVID-19. It is essential that clinicians around the world stop using this drug as a treatment for COVID-19. We now know that it is not effective against COVID-19 and we urgently need to protect ourselves against the real threat of driving drug resistance against this precious class of antibiotics. ”


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More information:
Timothy SC Hinks et al, Azithromycin versus standard care in patients with mild to moderate COVID-19 (ATOMIC2): a randomized open-label trial, Respiratory Medicine Lancet (2021). DOI: 10.1016 / S2213-2600 (21) 00263-0

Provided by the European Society of Clinical Microbiology and Infectious Diseases

Citation: The trial shows that the antibiotic azithromycin does not prevent mild cases of COVID from progressing to hospitalization, death (2021, July 10), recovered on July 11, 2021 at https://medicalxpress.com / news / 2021-07-trial-antibiotic-azithromycin-mild -covid.html

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