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      Antihistamines and azithromycin as a treatment for COVID-19 on primary health care – A retrospective observational study in elderly patients

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Background

          Between March and April 2020, 84 elderly patients with suspected COVID-19 living in two nursing homes of Yepes, Toledo (Spain) were treated early with antihistamines (dexchlorpheniramine, cetirizine or loratadine), adding azithromycin in the 25 symptomatic cases. The outcomes are retrospectively reported. The primary endpoint is the fatality rate of COVID-19. The secondary endpoints are the hospital and ICU admission rates. Endpoints were compared with the official Spanish rates for the elderly. The mean age of our population was 85 and 48% were over 80 years old. No hospital admissions, deaths, nor adverse drug effects were reported in our patient population. By the end of June, 100% of the residents had positive serology for COVID-19. Although clinical trials are needed to determine the efficacy of both drugs in the treatment of COVID-19, this analysis suggests that primary care diagnosis and treatment with antihistamines, plus azithromycin in selected cases, may treat COVID-19 and prevent progression to severe disease in elderly patients.

          Highlights

          • •

            Early treatment of COVID-19 in Primary Care with antihistamines and azithromycin.

          • •

            Antihistamines may also be considered a prophylactic treatment for COVID-19.

          • •

            Decrease in hospital admissions and fatality rate in elderly population.

          • •

            Antihistamines may control the immune response and cytokine storm in COVID-19.

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          Most cited references37

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          Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

          Fei Zhou, Ting Yu, Ronghui Du … (2020)
          Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.
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            Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial

            Philippe Gautret, Jean-Christophe Lagier, Philippe Parola … (2020)
            Background Chloroquine and hydroxychloroquine have been found to be efficient on SARS-CoV-2, and reported to be efficient in Chinese COV-19 patients. We evaluate the role of hydroxychloroquine on respiratory viral loads. Patients and methods French Confirmed COVID-19 patients were included in a single arm protocol from early March to March 16th, to receive 600mg of hydroxychloroquine daily and their viral load in nasopharyngeal swabs was tested daily in a hospital setting. Depending on their clinical presentation, azithromycin was added to the treatment. Untreated patients from another center and cases refusing the protocol were included as negative controls. Presence and absence of virus at Day6-post inclusion was considered the end point. Results Six patients were asymptomatic, 22 had upper respiratory tract infection symptoms and eight had lower respiratory tract infection symptoms. Twenty cases were treated in this study and showed a significant reduction of the viral carriage at D6-post inclusion compared to controls, and much lower average carrying duration than reported of untreated patients in the literature. Azithromycin added to hydroxychloroquine was significantly more efficient for virus elimination. Conclusion Despite its small sample size our survey shows that hydroxychloroquine treatment is significantly associated with viral load reduction/disappearance in COVID-19 patients and its effect is reinforced by azithromycin.
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              COVID-19 infection: Origin, transmission, and characteristics of human coronaviruses

              Muhammad Adnan Shereen, Suliman Khan, Abeer Kazmi … (2020)
              Graphical abstract
              Article 0 comments Cited 1296 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Pulm Pharmacol Ther
                Journal ID (iso-abbrev): Pulm Pharmacol Ther
                Title: Pulmonary Pharmacology & Therapeutics
                Publisher: Elsevier Ltd.
                ISSN (Print): 1094-5539
                ISSN (Electronic): 1522-9629
                Publication date PMC-release: 16 January 2021
                Publication date (Print): April 2021
                Publication date (Electronic): 16 January 2021
                Volume: 67
                Page: 101989
                Affiliations
                [a ]Servicio de Salud de Castilla-La Mancha (SESCAM), Toledo, Spain
                [b ]Centro de Salud de Yepes, Av. Santa Reliquia, 26, 45313, Yepes, Toledo, Spain
                [c ]Department of Advanced and Integrated Interstitial Lung Diseases Research, School of Medicine, Toho University, Ota-ku, Tokyo, 143-8540, Japan
                [d ]Asia International Institute of Infectious Disease Control, and Department of Health Protection, Graduate School of Medicine, Teikyo University, Itabashi-ku, Tokyo, 173-8605, Japan
                [e ]Massachusetts Institute of Technology Lincoln Laboratory, Lexington, MA, USA
                [f ]Delegación Provincial de la Consejería de Sanidad. Servicio de Salud Pública, C/ Río Guadalmena, 2, 45007, Toledo, Spain
                Author notes
                [∗ ]Corresponding author. Delegación Provincial de Sanidad Servicio de Salud Pública. Sección de Promoción de la Salud C/ Río Guadalmena, 2 - 45007, Toledo, Spain.
                Article
                Publisher Item ID: S1094-5539(21)00001-8 Publisher ID: 101989
                DOI: 10.1016/j.pupt.2021.101989
                PMC ID: 7833340
                PubMed ID: 33465426
                SO-VID: 8c2de1a4-8999-4574-aa1e-d1952d688d25
                Copyright © © 2021 Elsevier Ltd. All rights reserved.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                Date received : 16 September 2020
                Date revision received : 29 December 2020
                Date accepted : 11 January 2021
                Categories
                Subject: Article

                Keywords: sars-cov-2,coronavirus,azithromycin,antihistamines,elderly
                Data availability:
                Keywords: sars-cov-2, coronavirus, azithromycin, antihistamines, elderly

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