Effect of Hydroxychloroquine and Azithromycin Combination Use in COVID-19 Patients - An Umbrella Review - PubMed (original) (raw)

Review

Effect of Hydroxychloroquine and Azithromycin Combination Use in COVID-19 Patients - An Umbrella Review

Kaushik Nag et al. Indian J Community Med. 2024 Jan-Feb.

Abstract

Background: Hydroxychloroquine and Azithromycin combination was used rampantly in management of COVID-19 patients in different countries. Present review was conducted to evaluate the efficacy of Hydroxychloroquine and Azithromycin combination compared to the control (standard care) and any adverse effect following this combination use in COVID-19 patients if any.

Material and methods: We included all the systematic review with or without meta-analysis reporting the effect of Hydroxychloroquine (HCQ) and Azithromycin (AZM) combination use in COVID-19 patient using three databases namely PubMed, medline, CINHAL, Web of Science from July 2020 till Jan 2022.

Results: The systematic search strategy has identified 104 studies in total, after removal of duplicates only 4 systematic reviews were included in the qualitative synthesis. The various tools for assessing and reporting the data in the reviews were PRISMA, ROBINS-I, Robs2, AMSTAR, MASTER checklists. Mortality among the hydroxychloroquine with azithromycin combination group was significantly higher than among the Standard Care group. The duration of hospital stay in days was shorter in the Standard Care group in comparison with the hydroxychloroquine group or the hydroxychloroquine and azithromycin combination group. Of the 4 systematic reviews included, 3 had low risk of bias and one had unclear risk of bias using the ROBIS tool. Chloroquine or Hydroxychloroquine combination did not shorten the duration of hospital stay.

Conclusion: Rampant use of Chloroquine or Hydroxychloroquine alone or with Azithromycin combination caused adverse effects like QT prolongation. Finally, there is no evidence to support use of either Hydroxychloroquine with or without Azithromycin, for the treatment of COVID-19.

Keywords: Azithromycin; COVID-19; PRISMA; hydroxychloroquine; patients; umbrella review.

Copyright: © 2024 Indian Journal of Community Medicine.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1

PRISMA flow chart

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References

1. 1. Duška F, Waldauf P, Halačová M, Zvoníček V, Bala J, Balík M, et al. Azithromycin added to hydroxychloroquine for patients admitted to intensive care due to coronavirus disease 2019 (COVID-19)—protocol of randomised controlled trial AZIQUINE-ICU. Trials. 2020;21:631. - PMC - PubMed
2. 1. Gautret P, Lagier J-C, Parola P, Hoang VT, Meddeb L, Mailhe M, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: Results of an open-label non-randomized clinical trial. Int J Antimicrob Agents. 2020;56:105949. doi: 10.1016/j.ijantimicag.2020.105949. - PMC - PubMed
3. 1. Choudhary R, Sharma AK. Potential use of hydroxychloroquine, ivermectin and azithromycin drugs in fighting COVID-19: Trends, scope and relevance. New Microbes New Infect. 2020;35:100684. doi: 10.1016/j.nmni.2020.100684. - PMC - PubMed
4. 1. Chang T-H, Wang Li-F, Lin Y-S, Yang C-H, Yu C-Y, Lin Y-L. Hydroxychloroquine activates host antiviral innate immunity. Cytokine. 2014;70:33–4.
5. 1. Pani A, Lauriola M, Romandini A, Scaglione F. Macrolides and viral infections: Focus on azithromycin in COVID-19 pathology. Int J Antimicrob Agents. 2020;56:106053. doi: 10.1016/j.ijantimicag.2020.106053. - PMC - PubMed

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