Abstract
Azithromycin has shown antiviral and immunomodulatory actions that may
be of interest in coronavirus disease-19 (COVID-19). The objective of
this review was to summarize the potential usefulness of azithromycin in
the COVID-19. Azithromycin has shown in vitro activity against
SARS-CoV-2. The potential mechanisms of action include the impairment of
virus binding and of membrane fusion, endocytosis, and lysosomal
protease activation due to its lysosomotropic character. Among other
immunomodulatory actions, azithromycin downregulates the production of
proinflammatory cytokines, maintains epithelial cell integrity and may
prevent lung fibrosis. These properties, which have been related to
positive clinical outcomes in other settings as influenza pneumonia, may
be beneficial throughout the course of COVID-19. However, scientific
evidence is still scarce. Azithromycin has mostly been studied with
hydroxychloroquine/chloroquine. In outpatients, this combination showed
a reduction in time to clinical recovery or need for hospitalization
without safety concerns. In hospitalized patients presented an increased
risk of mortality and cardiovascular events. In the few studies that
assessed the efficacy of azithromycin monotherapy, a reduction in the
time to clinical recovery in outpatients and a trend towards a reduction
in mortality in inpatients was observed. Data on critically ill patients
are lacking. The quality of data was low, as most of the studies were
observational and retrospective. Azithromycin may play a role in the
treatment of COVID-19. Despite the paucity of data and associated
limitations, azithromycin has shown promising results that deserve
further study. The upcoming clinical trials will elucidate the role of
this macrolide in COVID-19.