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. 2020 May 5;101738.
doi: 10.1016/j.tmaid.2020.101738. Online ahead of print.

Early Treatment of COVID-19 Patients With Hydroxychloroquine and Azithromycin: A Retrospective Analysis of 1061 Cases in Marseille, France

Free PMC article

Early Treatment of COVID-19 Patients With Hydroxychloroquine and Azithromycin: A Retrospective Analysis of 1061 Cases in Marseille, France

Matthieu Million et al. Travel Med Infect Dis. .
Free PMC article


Background: In France, the combination hydroxychloroquine (HCQ) and azithromycin (AZ) is used in the treatment of COVID-19.

Methods: We retrospectively report on 1061 SARS-CoV-2 positive tested patients treated for at least three days with the following regimen: HCQ (200 mg three times daily for ten days) + AZ (500 mg on day 1 followed by 250 mg daily for the next four days). Outcomes were death, clinical worsening (transfer to ICU, and >10 day hospitalization) and viral shedding persistence (>10 days).

Results: A total of 1061 patients were included in this analysis (46.4% male, mean age 43.6 years - range 14-95 years). Good clinical outcome and virological cure were obtained in 973 patients within 10 days (91.7%). Prolonged viral carriage was observed in 47 patients (4.4%) and was associated to a higher viral load at diagnosis (p < .001) but viral culture was negative at day 10. All but one, were PCR-cleared at day 15. A poor clinical outcome (PClinO) was observed for 46 patients (4.3%) and 8 died (0.75%) (74-95 years old). All deaths resulted from respiratory failure and not from cardiac toxicity. Five patients are still hospitalized (98.7% of patients cured so far). PClinO was associated with older age (OR 1.11), severity of illness at admission (OR 10.05) and low HCQ serum concentration. PClinO was independently associated with the use of selective beta-blocking agents and angiotensin II receptor blockers (p < .05). A total of 2.3% of patients reported mild adverse events (gastrointestinal or skin symptoms, headache, insomnia and transient blurred vision).

Conclusion: Administration of the HCQ+AZ combination before COVID-19 complications occur is safe and associated with a very low fatality rate in patients.

Keywords: Azithromycin; COVID-19; Hydroxychloroquine; SARS-CoV-2.

Conflict of interest statement

Declaration of competing interest The authors declare no competing interests. Funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. Our group used widely available generic drugs distributed by many pharmaceutical companies (Supplementary data).


Fig. 1
Fig. 1
Flowchart showing patients included in the analysis. HCQ, Hydroxychloroquine, AZ, azithromycin.
Fig. 2
Fig. 2
Phylogenetic tree of SARS-COV-2 genomes including isolates from five persistent viral shedders and ten treatment-responding patients (green branches). *** =poor clinical outcome and ¶ = poor virological outcome. Phylogenetic reconstruction was performed using NEXSTRAIN ( and GISAID (Global Initiative; with acknowledgments [24]. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

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