Efficacy and Safety of Azithromycin for the Treatment of COVID-19: A Systematic Review and Meta-analysis

Mangkuliguna, Ghea; Glenardi,; Natalia,; Pramono, Laurentius A.

BACKGROUND: The lack of effective medications for coronavirus disease 2019 (COVID-19) has led to a trend of drug repurposing such as the case of azithromycin which shows immunomodulatory and anti-viral effect. Several clinical trials have shown conflicting results. It is currently unclear whether the available evidence is in favor or against the use of azithromycin in COVID-19 patients. Thus, the aim of this study was to investigate the efficacy and safety of azithromycin in COVID-19 patients. METHODS: 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). RESULTS: We included 17 studies and found that the mortality rate (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.76–1.19), need of respiratory support (OR, 1.30; 95% CI, 0.98–1.73), hospitalization rate (standardized mean difference, 0.12; 95% CI, −0.02 to 0.27), and intensive care unit transfer (OR, 1.21; 95% CI, 0.79–1.86) of azithromycin-treated group did not differ significantly (p>0.05) from those of the 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) or electrocardiogram abnormalities (OR, 1.16; 95% CI, 0.94–1.42). The overall quality of evidence ranged from low to very low. CONCLUSION: Azithromycin did not result in a superior clinical improvement in COVID-19 patients, although it was well-tolerated and safe to use.