Management of SARS-CoV-2 Infection: Key Focus in Macrolides Efficacy for COVID-19

Batiha, Gaber El-Saber; Zayed, Marwa A.; Awad, Aya A.; Shaheen, Hazem M.; Mustapha, Suleiman; Herrera-Calderon, Oscar; Pagnossa, Jorge Pamplona; Algammal, Abdelazeem M.; Zahoor, Muhammad; Adhikari, Achyut; Pandey, Ishan; Elazab, Sara T.; Rengasamy, Kannan R. R.; Cruz-Martins, Natália; Hetta, Helal F.

Macrolides (e.g., erythromycin, fidaxomicin, clarithromycin, and azithromycin) are a class of bacteriostatic antibiotics commonly employed in medicine against various gram-positive and atypical bacterial species mostly related to respiratory tract infections, besides they possess anti-inflammatory and immunomodulatory effects. Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome of coronavirus 2 (SARS-CoV-2). It was first detected in Wuhan, Hubei, China, in December 2019 and resulted in a continuing pandemic. Macrolides have been extensively researched as broad adjunctive therapy for COVID-19 due to its immunostimulant abilities. Among such class of drugs, azithromycin is described as azalide and is well-known for its ability to decrease the production of pro-inflammatory cytokines, including matrix metalloproteinases, tumor necrosis factor-alpha, interleukin (IL)-6, and IL-8. In fact, a report recently published highlighted the effectiveness of combining azithromycin and hydroxychloroquine for COVID-19 treatment. Indeed, it has been underlined that azithromycin quickly prevents SARS-CoV-2 infection by raising the levels of both interferons and interferon-stimulated proteins at the same time which reduces the virus replication and release. In this sense, the current review aims to evaluate the applications of macrolides for the treatment of COVID-19.