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Know which is better – Azithromycin standalone V/s Azithromycin + Hydroxychloroquine

Is azithromycin effective in the treatment of covid - what research says?

Is azithromycin effective in the treatment of covid

Every effort is being made to treat covid-19. But, the way the virus is continuously mutating, is a problem for both scientists and doctors. But these days the vaccines being used to protect against covid are proving to be most effective.

During the treatment of covid-19, some medicines were also given for prevention. In this, doxycycline and azithromycin have also been present. These medicines are used to prevent bacterial infection.

Recently research has revealed that these medicines doxycycline and azithromycin given to covid patients is not effective in dangerous infection. It cannot be used in severe conditions. A better alternative by addition of Hydroxychloroquine +Azithromycin proves more effective than standalone Doxycycline

What is azithromycin and the Mechanism of Action (MOA)?

azithromycin and the Mechanism of Action
  • This medicine is mainly used during infection, typhoid, eye, throat, and ear infection.
  • It is also used during the nose, tonsils, sinus, lung, and bacterial infections.
  • Azithromycin is an antibiotic that belongs to the class of macrolide antibiotics. 
  • This medicine inhibits the growth of bacteria by inhibiting the synthesis of essential proteins which is needed by the bacteria to carry out the necessary functions. 
  • This drug has been effective against other viruses such as Ebola and Zika. Also, this medicine is effective for infections like flu and cold. (Cavalcanti AB 2020Sultana J 2020)

Efficacy of administering Azithromycin standalone in COVID patients

Azithromycin standalone in COVID patients

A report was published in the Journal of the American Association. It claimed that the effect of azithromycin on patients infected with the SARS-CoV-2 virus was less visible. First, it also increased the rate of admission of patients and it was not very effective.

An ICMR official warned about the use of this drug in the year 2020. The reason was that heart problems may arise. Earlier azithromycin was given but it was not needed. This medicine depends on the case. It can be given only as per the guidelines. Initially, this drug was being used to prevent covid, but it could also increase the risk of bacterial infection, so it was not considered inappropriate to give it. Here, there was a need for the introduction of Azithromycin + Hydroxychloroquine.

(Chaudhry ZS, et al 2020)

Azithromycin + Hydroxychloroquine - The Corona medicine

Corona medicine! The whole world is struggling with the crisis of Coronavirus. People are looking for medicine for corona. Amidst all this, two medicines are being discussed the most as a treatment to give instant relief. Their names are hydroxychloroquine and azithromycin. This medicine is being treated in most countries including France, China, India, and patients are also recovering fast. Due to which many countries of the world including America, Brazil are demanding this medicine.

 

According to a study, Hydroxychloroquine and azithromycin were given to 1061 patients, 98% of patients were cured.

 

In France, 1061 patients of Corona were treated with both these drugs for 3 consecutive days. When tested on the ninth day, 973 patients (91.7%) became completely infection-free. The results also showed that there was no cardiac risk associated with this treatment and 98% of the patients were completely cured by its use.

 

Professor Didier Rault, a well-known infectious disease specialist at IHU Mediterranean Infection in Marseille, France, said that we did a study to find out whether hydroxychloroquine and azithromycin were effective drugs against corona.

Conclusion of the study for efficacy of Azithromycin + Hydroxychloroquine

conclusion of Azithromycin + Hydroxychloroquine
  • Rault said that after examining 59,655 samples from 3 March to 9 April 2020, we examined 38,617 patients for Covid-19. 
  • Out of this, 3165 patients were found to be corona positive. 
  • He told that we treated 1061 of these patients in our institute.
  • The mean age of all patients was 43.6 years and 492 of these were male. 
  • When we were treated with this medicine for 10 days, we found that 973 patients were completely cured. 
  • No risk of cardiac arrest was found in any of the patients.

Pro. Rault said that of the remaining 88 patients, symptoms of infection continued for a long time in 47 patients, while 10 patients had to be kept in the ICU. During this, 5 patients died in the ICU. While the remaining patients are kept under the supervision of doctors in the hospital itself till they recover.

The coronavirus which started from Wuhan city of China has wreaked havoc in every corner of the world. No country has escaped this. 

After ration and vegetables, now the concern of the administration has increased regarding the storage of medicines. The data of these drugs has also been prepared after the fact that chloroquine, paracetamol, and antibiotic tablets given in malarial fever are effective in fighting corona. 

The Drug Administration Department has made these three medicines available with them. These include hydroxychloroquine tablets given to patients with malarial fever, paracetamol tablets used in fever, and azithromycin given as an antibiotic.

Recently, it came to light that the drug chloroquine (Plaquenil) works effectively especially in the treatment of corona-infected patients. (Chaudhry ZS, et al 2020)

Dosage of Azithromycin

  • Azithromycin is available as tablets and suspensions that can be taken by mouth, as eye drops, and as injections. 
  • Azithromycin tablets and syrup are to be taken by mouth with water as directed by the doctor and can be taken daily with food or even after meals. For best results, Azithromycin should be taken at equal intervals of time.
  • Even if all symptoms are gone, continue taking azithromycin for 5 or 7 days without missing the dosage.
  • Stopping the medicine abruptly can cause the infection to recur and relapse with a greater aggravation which can complicate the case 
  • You should ask your doctor or pharmacist for further questions by reading the patient information leaflet provided by the pharmacist 
  • The dosage and mode of administration of this medicine are decided by the doctor keeping in mind the following factors:
  1. Patient’s age and body weight
  2. Patient’s health status and medical condition
  3. Disease severity
  4. Response to the first dose
  5. History of allergies and drug reactions

Azithromycin Dosage for adults and children 

  • For adults: 500 mg for 3 days, every day. The doctor prescribes 500 mg from the first day. Prescribes as a single dose and then 250 mg for the next 4 days every day
  • Dosage for children: 5 mg to 20 mg daily and it is taken for 3 to 5 days depending on the weight of the child.
  • Do not use this antibiotic unnecessarily as it reduces its efficacy.

Azithromycin Side-Effects 

  • Diarrhea
  • Getting nausea
  • Upper abdominal pain
  • Vomiting 
  • Headache with chest pain
  • Dizziness
  • Fainting
  • Heartbeat fast
  • Fever
  • Sore throat
  • Dark urine
  • clay-colored stools
  • Itching
  • swelling
  • Tiredness 
  • unusual muscle weakness

Azithromycin Drug Interactions –

  • It is not possible to list all the drugs that can interact with them. Therefore the patient should tell their doctor about all the drugs and products you are using such as blood thinners- warfarin, coumadin
  • Tell your doctor even if you have been taking quinine for a long time.
  • Antacids containing magnesium or aluminum also decrease the effect of azithromycin in the body. Hence it should be taken 2 hours before or after taking azithromycin.
  • You should not receive any vaccines while using azithromycin unless your doctor tells you to.
  • You should also tell your doctor about the herbal products you are taking.

Azithromycin Effects

When you start taking azithromycin, the effect starts within the first few days. But still, take the full dose as prescribed by your doctor so that the infection is completely eradicated from your body.

Is Azithromycin addictive?
No
Can I take azithromycin with alcohol?
Alcohol can temporarily damage the liver, which can further increase the side effects of Azithromycin 500. Hence the chances of increasing the side effects due to alcohol on the body increases.
Are there any particular foods to be avoided?
No
Can I take azithromycin while pregnant?
There is little research on the use of azithromycin in pregnancy, but this research does not indicate any harmful effects of azithromycin in pregnancy. However, azithromycin should not be used during pregnancy.
Can I have azithromycin while breastfeeding?
If you are breastfeeding a baby, be sure to inform your doctor. However, there is no evidence that azithromycin can be excreted in human breast milk.
Can I drive after taking Azithromycin?
Studies suggest that azithromycin may cause impaired driving ability in some people, especially women over the age of 60 who have been on the drug for more than 2 to 5 years.
What happens if you overdose on Azithromycin?
An overdose of azithromycin can cause an irregular heart rate or liver damage. If you have also taken an overdose, consult your doctor immediately.
What happens if I eat expired Azithromycin?
This antibiotic will not work so make sure to check the expiry date
What happens if I miss a dose of Azithromycin?
This medicine will not work well if a dose is missed because a certain amount of medicine must remain in the body for the medicine to work effectively. As soon as you remember the forgotten medicine, take its dose immediately.

Reference

 

(1) Cavalcanti AB, Zampieri FG, Rosa RG, Azevedo LCP, N Engl J Med. 2020 Nov 19;383(21):2041-2052. doi: 10.1056/NEJMoa2019014. Epub 2020 Jul 23. Erratum in: N Engl J Med. 2020 Nov 19;383(21):e119. PMID: 32706953; PMCID: PMC7397242. https://pubmed.ncbi.nlm.nih.gov/32706953/ Accessed on 14/9/2021

 

(2)Sultana J, Cutroneo PM, Crisafulli S, Puglisi G, Caramori G, Trifirò G. Azithromycin in COVID-19 Patients: Pharmacological Mechanism, Clinical Evidence and Prescribing Guidelines. Drug Saf. 2020 Aug;43(8):691-698. doi: 10.1007/s40264-020-00976-7. PMID: 32696429; PMCID: PMC7371963.Azithromycin in COVID-19 Patients: Pharmacological Mechanism, Clinical Evidence and Prescribing Guidelines – PubMed (nih.gov) Accessed on 15/9/2021

 

(3)Arshad S, Kilgore P, Chaudhry ZS, Jacobsen G, Wang DD, Huitsing K, Brar I, Alangaden GJ, Ramesh MS, McKinnon JE, O’Neill W, Zervos M; Henry Ford COVID-19 Task Force. Treatment with hydroxychloroquine, azithromycin, and combination in patients hospitalized with COVID-19. Int J Infect Dis. 2020 Aug;97:396-403. doi: 10.1016/j.ijid.2020.06.099. Epub 2020 Jul 2. PMID: 32623082; PMCID: PMC7330574.Treatment with hydroxychloroquine, azithromycin, and combination in patients hospitalized with COVID-19 – PubMed (nih.gov) Accessed on 16/9/2021

 

(4)Fiolet T, Guihur A, Rebeaud ME, Mulot M, Peiffer-Smadja N, Mahamat-Saleh Y. Effect of hydroxychloroquine with or without azithromycin on the mortality of coronavirus disease 2019 (COVID-19) patients: a systematic review and meta-analysis. Clin Microbiol Infect. 2021 Jan;27(1):19-27. doi: 10.1016/j.cmi.2020.08.022. Epub 2020 Aug 26. PMID: 32860962; PMCID: PMC7449662.Effect of hydroxychloroquine with or without azithromycin on the mortality of coronavirus disease 2019 (COVID-19) patients: a systematic review and meta-analysis – PubMed (nih.gov) Accessed on 17/9/2021

 

(5)Gautret P, Lagier JC, Parola P, Hoang VT, Meddeb L,  Mailhe M, Doudier B, Courjon J, Giordanengo V, Vieira VE, Tissot Dupont H, Honoré S, Colson P, Chabrière E, La Scola B, Rolain JM, Brouqui P, Raoult D. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents. 2020 Jul;56(1):105949. doi: 10.1016/j.ijantimicag.2020.105949. Epub 2020 Mar 20. PMID: 32205204; PMCID: PMC7102549.Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial – PubMed (nih.gov) Accessed on 18/9/2021

I am a community pharmacist working in UK. I blog about drugs, health and pharmacy.

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