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Could azithromycin play a role in the treatment of COVID-19? A review
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  • Daniel Echeverria-Esnal,
  • Clara Martin-Ontiyuelo,
  • María Eugenia Navarrete-Rouco,
  • Marta De-Antonio,
  • Olivia Ferrandez,
  • Juan Pablo Horcajada,
  • Santiago Grau
Daniel Echeverria-Esnal
Hospital del Mar
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Clara Martin-Ontiyuelo
Hospital del Mar
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María Eugenia Navarrete-Rouco
Hospital del Mar
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Marta De-Antonio
Hospital del Mar
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Olivia Ferrandez
Hospital del Mar
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Juan Pablo Horcajada
Hospital del Mar
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Santiago Grau
Hospital Universitari del Mar
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Abstract

Azithromycin has shown antiviral and immunomodulatory actions that may be of interest in coronavirus disease-19 (COVID-19). The objective of this review was to summarize the potential usefulness of azithromycin in the COVID-19. Azithromycin has shown in vitro activity against SARS-CoV-2. The potential mechanisms of action include the impairment of virus binding and of membrane fusion, endocytosis, and lysosomal protease activation due to its lysosomotropic character. Among other immunomodulatory actions, azithromycin downregulates the production of proinflammatory cytokines, maintains epithelial cell integrity and may prevent lung fibrosis. These properties, which have been related to positive clinical outcomes in other settings as influenza pneumonia, may be beneficial throughout the course of COVID-19. However, scientific evidence is still scarce. Azithromycin has mostly been studied with hydroxychloroquine/chloroquine. In outpatients, this combination showed a reduction in time to clinical recovery or need for hospitalization without safety concerns. In hospitalized patients presented an increased risk of mortality and cardiovascular events. In the few studies that assessed the efficacy of azithromycin monotherapy, a reduction in the time to clinical recovery in outpatients and a trend towards a reduction in mortality in inpatients was observed. Data on critically ill patients are lacking. The quality of data was low, as most of the studies were observational and retrospective. Azithromycin may play a role in the treatment of COVID-19. Despite the paucity of data and associated limitations, azithromycin has shown promising results that deserve further study. The upcoming clinical trials will elucidate the role of this macrolide in COVID-19.