Tuberc Respir Dis > Accepted Articles
Pulmonary Infection
DOI: https://doi.org/10.4046/trd.2021.0075    [Accepted]
Published online May 20, 2021.
Efficacy and Safety of Azithromycin for the Treatment of COVID-19: A Systematic Review and Meta-analysis
Ghea Mangkuliguna1  , Glenardi 2  , Natalia Susanto3, Laurentius A. Pramono4,5 
1School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Pluit Raya No. 2, North Jakarta 14440, Indonesia
2School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Pluit Raya No. 2, North Jakarta 14440, Indonesia
3School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Pluit Raya No. 2, North Jakarta 14440, Indonesia
4Department of Public Health and Nutrition, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Pluit Raya No. 2, North Jakarta 14440, Indonesia
5Department of Internal Medicine, Saint Carolus Hospital, Salemba Raya No.41, Senen, Jakarta 10440, Indonesia
Correspondence:  Ghea Mangkuliguna, Tel: +6221) 6693168, Fax: (+6221) 6606123, 
Email: mangkuligunaVG1402@yahoo.com
Received: 4 May 2021   • Revised: 13 May 2021   • Accepted: 19 May 2021
Abstract
The lack of effective medications for COVID-19 has led to a trend of drug repurposing, such as the case of Azithromycin, which showed an immunomodulatory and anti-viral effect. Several clinical trials have shown conflicting results and it is not clear whether the available evidence is in favour or against the use of Azithromycin in COVID-19 patients. We aim to investigate the efficacy and safety of Azithromycin in COVID-19 patients. Four independent reviewers selected relevant studies from PubMed, ScienceDirect, EBSCO, and ProQuest published prior to March 2021. The protocol used in this study has been registered in PROSPERO (CRD42020224967). We included 17 studies and demonstrated that the mortality rate (OR=0.95, 95% CI [0.76, 1.19]), need of respiratory support (OR=1.30, 95% CI [0.98, 1.73]), hospitalization rate (SMD=0.12, 95% CI [-0.02, 0.27]) and ICU transfer (OR=1.21, 95% CI [0.79, 1.86]) of Azithromycin-treated group did not differ (P>0.05) from control group. Azithromycin treatment did not significantly increase the risk of getting secondary infection (OR=1.23, 95% CI [0.83, 1.82]), hypoglycemia (OR=0.73, 95% CI [0.38, 1.40]), gastrointestinal problems (OR=1.03, 95% CI [0.73, 1.45]) and electrocardiogram (ECG) abnormalities (OR=1.16, 95% CI [0.94, 1.42]). The overall quality of evidence was ranging from low-to-very low. Azithromycin did not give a superior clinical improvement in COVID-19 patients, even though it was well-tolerated and safe to use.
Key Words: Azithromycin, COVID-19, Meta-analysis, Systematic Review, Treatment


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