COVID-19 outpatients: early risk-stratified treatment with zinc plus low-dose hydroxychloroquine and azithromycin: a retrospective case series study

Int J Antimicrob Agents. 2020 Dec;56(6):106214. doi: 10.1016/j.ijantimicag.2020.106214. Epub 2020 Oct 26.

Abstract

The aim of this study was to describe the outcomes of patients with coronavirus disease 2019 (COVID-19) in the outpatient setting after early treatment with zinc, low-dose hydroxychloroquine and azithromycin (triple therapy) dependent on risk stratification. This was a retrospective case series study in the general practice setting. A total of 141 COVID-19 patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the year 2020 were included. The main outcome measures were risk-stratified treatment decision and rates of hospitalisation and all-cause death. A median of 4 days [interquartile range (IQR) 3-6 days; available for n = 66/141 patients] after the onset of symptoms, 141 patients (median age 58 years, IQR 40-67 years; 73.0% male) received a prescription for triple therapy for 5 days. Independent public reference data from 377 confirmed COVID-19 patients in the same community were used as untreated controls. Of 141 treated patients, 4 (2.8%) were hospitalised, which was significantly fewer (P < 0.001) compared with 58 (15.4%) of 377 untreated patients [odds ratio (OR) = 0.16, 95% confidence interval (CI) 0.06-0.5]. One patient (0.7%) in the treatment group died versus 13 patients (3.4%) in the untreated group (OR = 0.2, 95% CI 0.03-1.5; P = 0.12). No cardiac side effects were observed. Risk stratification-based treatment of COVID-19 outpatients as early as possible after symptom onset using triple therapy, including the combination of zinc with low-dose hydroxychloroquine, was associated with significantly fewer hospitalisations.

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

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Azithromycin / administration & dosage*
  • Azithromycin / adverse effects
  • COVID-19 / drug therapy*
  • Drug Therapy, Combination
  • Female
  • Humans
  • Hydroxychloroquine / administration & dosage*
  • Hydroxychloroquine / adverse effects
  • Male
  • Middle Aged
  • Outpatients
  • Retrospective Studies
  • SARS-CoV-2*
  • Young Adult
  • Zinc / administration & dosage*
  • Zinc / adverse effects

Substances

  • Hydroxychloroquine
  • Azithromycin
  • Zinc

Supplementary concepts

  • COVID-19 drug treatment