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

Abstract

The world is facing a frightening pandemic due to coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) with thousands of severe infections and fatalities. Since no therapy has proven effective, an extraordinary race is taking place to identify an effective and safe treatment able to limit the disease progression and severity. Two nonrandomized open-label trials conducted in France and China1,2 established the effectiveness of hydroxychloroquine alone or combined with azithromycin in decreasing nasopharyngeal viral load and carriage duration in patients with COVID-19, although evidence to support clinical benefits remained low. Thereafter, many studies, still unpublished in peer-reviewed journals for the majority, showed contrasting results and revealed potential safety hazards (Table 1).3-11 To date, multiple trials aiming at investigating chloroquine or hydroxychloroquine at various dose regimens to treat COVID-19 (N = 81) or prevent the disease in high-risk populations (N = 19) are cited on clinicaltrials.gov (accessed April 21, 2020). Interestingly, only 14 trials (17%) will investigate the azithromycin-hydroxychloroquine combination.