Azithromycin in the treatment of COVID-19: a review

Expert Rev Anti Infect Ther. 2020 Aug 27. doi: 10.1080/14787210.2020.1813024. Online ahead of print.


Introduction: SARS-CoV-2 is a novel virus that causes coronavirus disease-19 (COVID-19). Antiviral and immunomodulatory agents have been proposed as potential treatments. Azithromycin exhibits both properties and therefore may play a role.

Areas covered: This article reviews the pharmacology, pharmacokinetics, clinical efficacy, and safety of azithromycin in viral infections, with emphasis on COVID-19. A literature search of PUBMED was conducted on May 30th and updated on July 28th.

Expert opinion: Azithromycin presents in vitro activity against SARS-CoV-2 and could act in different points of the viral cycle. Its immunomodulatory properties include the ability to downregulate cytokine production, maintain epithelial cell integrity or prevent lung fibrosis. In other settings, azithromycin use was associated with a reduction in mortality and ventilation-days. These properties could be beneficial throughout the course of COVID-19. However, the evidence of its use is still scarce and of low quality. Azithromycin has been assessed in retrospective observational studies mainly in combination with hydroxychloroquine, which has shown to provide no benefit. Azithromycin exhibits a well-known safety profile. The stage of the disease where it offers the greatest benefits and the effect of its combination with other drugs are important questions that need to be addressed in the upcoming clinical trials.

Keywords: Azithromycin; COVID-19; SARS-CoV-2; antivirals; cytokine release syndrome; immunomodulation; pneumonia.