To determine safety profile of azithromycin in Covid-19 patients

Abstract

At the end of the year 2019, a novel virus named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV or COVID-19) first appeared in the Chinese city of Wuhan and the WHO declared the novel coronavirus disease as a global pandemic on March, 11th 2020. Corona Virus is RNA virus, major virus that affects respiratory system and can result in acute respiratory distress syndrome, so there emerged several management strategies to combat the challenge of the disease. Azithromycin is one of those treatment options. Azithromycin have been used widely and generally considered as safe medication. The design of this study is Cross-Sectional Study. The 80 Covid-19 positive in ICU were given Azithromycin along with other standard treatment, Side effects were divided into mild serious and allergic reactions. These were noted down in pre designed proforma. Data analysis was done in SPSS version 25. 80 patients were studied 38 (46.2%) patients experienced side effects, majority of which were mild in nature, Out of 80 patients Abdominal Pain was 37.5%, diarrhea 22.7% nausea 25%, transaminitis 2.5%, anorexia 26.3%, taste perversion 36.3%, dyspepsia 15%, vomiting 17.5%, headache 6.3% and somnolence 1.3%. Only 1 (1.25%) patients had arrhythmia and 1 (1.25%) had urticaria that was successfully treated. After this study this can be concluded that Azithromycin is safe drug as majority of side effects experienced were mild in nature and it can be safely used to treat Covid-19 positive patients.

Keywords

• 2019-nCoV
• Azithromycin
• COVID-19
• SARS-CoV-2

References

1. 1. Waris A, Atta UK, Ali M, Asmat A, Baset A. COVID-19 outbreak: current scenario of Pakistan. New Microbes New Infect. 2020 Apr 14;35:100681. doi: 10.1016/j.nmni.2020.100681. PMID: 32322403; PMCID: PMC7171524.
2. 2. Sahin AR , Erdogan A, Agaoglu PM, Dineri Y, Cakirci AY, Senel ME, Tasdogan AM. 2019 novel coronavirus (COVID-19) outbreak: a review of the current literature. Eurasian J Med. 2020; 4 (1): 1-7. doi: 10.14744/ejmo.2020.12220.
3. 3. Hoehl S, Rabenau H, Berger A, Kortenbusch M, Cinatl J, Bojkova D, Behrens P, Böddinghaus B, Götsch U, Naujoks F, Neumann P, Schork J, Tiarks-Jungk P, Walczok A, Eickmann M, Vehreschild MJGT, Kann G, Wolf T, Gottschalk R, Ciesek S. Evidence of SARS-CoV-2 Infection in Returning Travelers from Wuhan, China. N Engl J Med. 2020 Mar 26;382(13):1278-1280. doi: 10.1056/NEJMc2001899. Epub 2020 Feb 18. PMID: 32069388; PMCID: PMC7121749.
4. 4. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, Zhao X, Huang B, Shi W, Lu R, Niu P, Zhan F, Ma X, Wang D, Xu W, Wu G, Gao GF, Tan W; China Novel Coronavirus Investigating and Research Team. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020 Feb 20;382(8):727-733. doi: 10.1056/NEJMoa2001017. Epub 2020 Jan 24. PMID: 31978945; PMCID: PMC7092803.
5. 5. Zu ZY, Jiang MD, Xu PP, Chen W, Ni QQ, Lu GM, Zhang LJ. Coronavirus disease 2019 (COVID-19): a perspective from China. Radiology 2020; 200490-200490.
6. 6. To KK, Tsang OT, Yip CC, Chan KH, Wu TC, Chan JM, Leung WS, Chik TS, Choi CY, Kandamby DH, Lung DC, Tam AR, Poon RW, Fung AY, Hung IF, Cheng VC, Chan JF, Yuen KY. Consistent Detection of 2019 Novel Coronavirus in Saliva. Clin Infect Dis. 2020 Jul 28;71(15):841-843. doi: 10.1093/cid/ciaa149. PMID: 32047895; PMCID: PMC7108139.
7. 7. Lai CC, Shih TP, Ko WC, Tang HJ, Hsueh PR. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges. Int J Antimicrob Agents. 2020 Mar;55(3):105924. doi: 10.1016/j.ijantimicag.2020.105924. Epub 2020 Feb 17. PMID: 32081636; PMCID: PMC7127800.
8. 8. Schwartz RA, Suskind RM. Azithromycin and COVID-19: Prompt early use at first signs of this infection in adults and children, an approach worthy of consideration. Dermatol Ther. 2020 Jul;33(4):e13785. doi: 10.1111/dth.13785. Epub 2020 Jul 12. PMID: 32510734; PMCID: PMC7300563.

9. 9. Yao X, Ye F, Zhang M, Cui C, Huang B, Niu P, Liu X, Zhao L, Dong E, Song C, Zhan S, Lu R, Li H, Tan W, Liu D. In Vitro Antiviral Activity and Projection of Optimized Dosing Design of Hydroxychloroquine for the Treatment of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Clin Infect Dis. 2020 Jul 28;71(15):732-739. doi: 10.1093/cid/ciaa237. PMID: 32150618; PMCID: PMC7108130.
10. 10. Andreani J, Le Bideau M, Duflot I, Jardot P, Rolland C, Boxberger M, Wurtz N, Rolain JM, Colson P, La Scola B, Raoult D. In vitro testing of combined hydroxychloroquine and azithromycin on SARS-CoV-2 shows synergistic effect. Microb Pathog. 2020 Aug;145:104228. doi: 10.1016/j.micpath.2020.104228. Epub 2020 Apr 25. PMID: 32344177; PMCID: PMC7182748.
11. 11. Xu P, Zeng L, Xiong T, Choonara I, Qazi S, Zhang L. Safety of azithromycin in paediatrics: a systematic review protocol. BMJ Paediatr Open. 2019 Jun 19;3(1):e000469. doi: 10.1136/bmjpo-2019-000469. PMID: 31321320; PMCID: PMC6598555.
12. 12. Tran DH, Sugamata R, Hirose T, Suzuki S, Noguchi Y, Sugawara A, Ito F, Yamamoto T, Kawachi S, Akagawa KS, Ōmura S, Sunazuka T, Ito N, Mimaki M, Suzuki K. Azithromycin, a 15-membered macrolide antibiotic, inhibits influenza A(H1N1)pdm09 virus infection by interfering with virus internalization process. J Antibiot (Tokyo). 2019 Oct;72(10):759-768. doi: 10.1038/s41429-019-0204-x. Epub 2019 Jul 12. PMID: 31300721.
13. 13. Gérard A, Romani S, Fresse A, Viard D, Parassol N, Granvuillemin A, Chouchana L, Rocher F, Drici MD; French Network of Pharmacovigilance Centers. "Off-label" use of hydroxychloroquine, azithromycin, lopinavir-ritonavir and chloroquine in COVID-19: A survey of cardiac adverse drug reactions by the French Network of Pharmacovigilance Centers. Therapie. 2020 Jul-Aug;75(4):371-379. doi: 10.1016/j.therap.2020.05.002. Epub 2020 May 7. PMID: 32418730; PMCID: PMC7204701.
14. 14. Panteix G, Guillaumond B, Harf R, Desbos A, Sapin V, Leclercq M, Perrin-Fayolle M. In-vitro concentration of azithromycin in human phagocytic cells. J Antimicrob Chemother. 1993 Jun;31 Suppl E:1-4. doi: 10.1093/jac/31.suppl_e.1. PMID: 8396080.
15. 15. Zuckerman JM, Qamar F, Bono BR. Macrolides, ketolides, and glycylcyclines: azithromycin, clarithromycin, telithromycin, tigecycline. Infect Dis Clin North Am. 2009 Dec;23(4):997-1026, ix-x. doi: 10.1016/j.idc.2009.06.013. PMID: 19909895.
16. 16. Brown BA, Griffith DE, Girard W, Levin J, Wallace RJ Jr. Relationship of adverse events to serum drug levels in patients receiving high-dose azithromycin for mycobacterial lung disease. Clin Infect Dis. 1997 May;24(5):958-64. doi: 10.1093/clinids/24.5.958. PMID: 9142801.