COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

Treatment Gbinigie K, Frie K Should azithromycin be used to treat COVID-19? A rapid review. BJGP Open. 2020 Jun 23;4(2). pii: bjgpopen20X101094. doi: 10.3399/bjgpopen20X101094. Print 2020.

BACKGROUND: There are no established effective treatments for COVID-19. While novel drugs are being developed, azithromycin has been identified as a candidate treatment in the interim.

AIM: To review the evidence for the effectiveness and safety of azithromycin in treating COVID-19.

DESIGN & SETTING: A rapid review of the literature was conducted.

METHOD: Electronic searches were conducted on 16 April 2020 of PubMed, TRIP, EPPI COVID Living Map, MedRxiv, GoogleScholar, and Google. In vivo and in vitro studies were included assessing the safety and effectiveness of azithromycin for treatment of COVID-19, and/or the activity of azithromycin against SARS-CoV-2. In vivo studies needed to include a comparator group.

RESULTS: Three studies were identified, two in vitro and one in vivo, which were suitable for inclusion. All three were published as pre-prints. The in vitro studies revealed conflicting results, with one finding anti-SARS-CoV-2 activity for azithromycin alone, while the other found activity against SARS-CoV-2 only when azithromycin was combined with hydroxychloroquine. A small trial of 36 patients, with high risk of bias, found superior viral clearance in patients with COVID-19 treated with azithromycin and hydroxychloroquine combined, compared with hydroxychloroquine alone.

CONCLUSION: There is no evidence to support the use of azithromycin for the treatment of COVID-19 outside of the context of clinical trials, unless it is used to treat bacterial super-infection. There is extremely limited evidence of a possible synergy between azithromycin and hydroxychloroquine. The adverse events profile of azithromycin in the context of COVID-19 has not yet been established. Well-conducted clinical trials are urgently needed in this area.

Discipline / Specialty Area Score
Public Health
Infectious Disease
Family Medicine (FM)/General Practice (GP)
General Internal Medicine-Primary Care(US)
Hospital Doctor/Hospitalists
Internal Medicine
Comments from MORE raters

Hospital Doctor/Hospitalists rater

As a review this is not very helpful because there are no RCTs.

Infectious Disease rater

Recent information suggests risky adverse events profile: Mehra MR Desai SS Ruschitzka F Patel AN. Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis. Lancet. 2020; (published online May 22.)

Internal Medicine rater

This is a very important study. Azithromycin has been used to treat COVID-19 in the USA without FDA approval. The risk for QT elongation and VT by chloroquine and hydroxychloroquine, however, has been suspected to increase in patients with cardiac and renal diseases as well as when used with azithromycin. Further research is expected.

Public Health rater

Given the uncertainties and desperation for treatment for Covid 19, multiple drugs have been championed albeit prematurely by various sources. This rapid review clarifies the available (no) evidence for the use of Azithromycin in Covid 19. It delves into preprints, previewed articles as well and presents an updated information about the oft touted treatment.

Public Health rater

As an Infectious Disease physician, a quick and practical review of controversial aspects and appraisal of COVID-19 management evidence is valuable when facing a fluid and constantly changing situation.