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. 2020 Jul;60(7):808-814.
doi: 10.1002/jcph.1646. Epub 2020 May 20.

Hydroxychloroquine and Azithromycin to Treat Patients With COVID-19: Both Friends and Foes?

Bruno Mégarbane  1 , Jean-Michel Scherrmann  2
Affiliations

Hydroxychloroquine and Azithromycin to Treat Patients With COVID-19: Both Friends and Foes?

Bruno Mégarbane et al. J Clin Pharmacol. 2020 Jul.
No abstract available

Keywords: COVID-19; azithromycin; hydroxychloroquine; risk/benefit; toxicity.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Suggested mechanisms for the antiviral and immunomodulatory activities of hydroxychloroquine and azithromycin in COVID‐19 highlighting possible synergic effects between the 2 drugs if prescribed in combination (adapted from Savarino et al, with permission). Possible hydroxychloroquine‐attributed effects include (1) interference with ACE2 glycosylation and reduction of viral binding, (2) endosome and lysosome alkalization limiting viral uncoating and assembly, (3) alteration of antigen processing and MHC class II–mediated autoantigen presentation, (4) disruption of RNA interaction with TLRs and nucleic acid sensors, (5) inhibition of proinflammatory genes transcription, (6) inhibition of T‐cell activation, and (7) inhibition of cytokine production. Possible azithromycin‐attributed effects include (1) interference with ACE2 and reduction of viral binding, (2) endosome and lysosome alkalization limiting viral uncoating and assembly, and (3) role of lysosomal P‐glycoprotein that enhances intralysosomal concentrations of azithromycin. ACE2, angiotensin‐converting enzyme 2; AZ, azithromycin; COVID‐19, coronavirus 2019 disease; HCQ, hydroxychloroquine; IL, interleukin; MHC, major histocompatibility complex; P‐gp, P‐glycoprotein; RNA, ribonucleic acid; SARS‐CoV‐2, severe acute respiratory syndrome coronavirus 2; TNF‐α, tumor necrosis factor‐α; TLR, Toll‐like receptor.
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