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Clinical
studies have found that the combined therapy with hydroxychloroquine and
azithromycin is effective for COVID-19 infection.
Clinical studies have found that the combined therapy with
hydroxychloroquine and azithromycin is effective for COVID-19 infection. The
combination acts as an antiviral therapy against SARS-CoV-2 and prevents
bacterial super-infections during viral laods. Addition of azithromycin to
hydroxychloroquine was found to be significantly more efficient for virus
elimination.1
Pharmacological
Class: Anti-malarial and Antibiotic
Combination: WHO supports consideration of hydroxychloroquine for reducing the post-exposure prophylaxis and longer-term prophylactic use in COVID-19 infection.2 Azithromycin has been found to reinforce the effect of hydroxychloroquine in SARS CoV-2 patients. It also prevents severe respiratory tract infections.1 However; more clinical trials with large sample size are needed to confirm the efficacy and safety of the combination.
Monotherapy:
The anti-viral effect of hydroxychloroquine can be
attributed to its ability to inhibit the binding efficiency between ACE-2
receptors on host cells and the spike protein on the surface of corona virus,
through which progression of the disease from mild to severe might be
attenuated.6 Azithromycin acts synergistically with
hydroxychloroquine and also has been found to be active against Zika and Ebola
viruses. Azithromycin also prevent severe respiratory tract infections when
administrated to patients suffering viral infection. 1
Dosage as per clinical study on SARS-CoV-2 patients1
*As per WHO, the dosage and treatment schedules for hydroxychloroquine that are currently under consideration do not reflect those used for treating patients with malaria. The ingestion of high doses of hydroxychloroquine may be associated with adverse or seriously adverse health outcomes.3
Recommended dosage for treating Malaria4
Recommended dosage for treating Bacterial infections5
Hydroxychloroquine has variable bioavailability of
approximately 74%, it has complex and extensive metabolism. The plasma
half-life increases proportionally with increasing dose. The main route of
excretion is renal, with 23-25% of the excreted compound in its unmodified
form, along with the metabolites.7
The
oral absolute bioavailability of azithromycin 250 mg is approximately 38%. It
is widely distributed throughout the body and has terminal elimination
half-life of 68 hours which is due to extensive update and subsequent release
of drug from the tissues.5
Contraindicated in
Common;
Uncommon:
Very rare:
Should be used with caution in
A recent study evaluated the role of hydroxychloroquine and
azithromycin on respiratory viral loads in Chinese Covid-19 patients. Out of 36
inclduded patients, 6 patients were asymptomatic, 22 had upper respiratory
tract infection symptoms and eight had lower respiratory tract infection
symptoms. The patients were administered with hydroxychloroquine 600 mg daily
for 5 days and azithromycin 500 mg on day 1 followed by 250 mg through day 5. The
study results showed a significant reduction of the viral carriage at day 6-post
inclusion in most of the patients which indicate that hydroxychloroquine and azithromycin treatment
is significantly associated with viral load reduction/disappearance in Coronavirus
infected patients.1
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