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What antibiotics kill Covid-19 (coronavirus)?

Medically reviewed by Drugs.com Last updated on Mar 27, 2020.

Official Answer

by Drugs.com

What antibiotics kill coronavirus?

Azithromycin (Zithromax) is a macrolide antibiotic that is being investigated as a potential treatment for people with COVID-19, the disease caused by the new coronavirus (SARS-CoV-2). It is already used for the treatment of community-acquired pneumonia caused by designated, susceptible bacteria, and for the treatment of other bacterial infections.

Why are antibacterial agents being used in patients infected with the new coronavirus?

The World Health Organization (WHO) is very clear that antibiotics do not work against viruses, only bacteria, and yet health care providers are using antibiotics in some patients with COVID-19. This is because:

  • Patients with viral pneumonia can develop a secondary bacterial infection that may need to be treated with an antibiotic, although, this complication is reported to be uncommon early on in the course of COVID-19 pneumonia.

    If treatment is required for a secondary bacterial infection then a range of antibiotics can be used such as penicillins (ampicillin plus sulbactam [Unasyn], piperacillin plus tazobactam [Zosyn]), macrolides (azithromycin), cephalosporins (ceftriaxone [Rocephin]), aminoglycosides (tobramycin) and glycopeptides (vancomycin [Vancocin HCL]) for example. Often a combination of two different antibiotics is used. 
  • Azithromycin is also thought to have antiviral and anti-inflammatory activity and may work synergistically with other antiviral treatments. In in vitro laboratory studies azithromycin has demonstrated antiviral activity against Zika virus and against rhinoviruses, which cause the common cold.

What is the current clinical evidence for using azithromycin to treat COVID-19?

Interesting results have been reported from a very small clinical trial, which enrolled 20 patients with COVID-19 in France. Patients were treated with hydroxychloroquine (Plaquenil) alone or in combination with azithromycin. Viral loads were significantly reduced in patients receiving hydroxychloroquine compared with those who did not receive the treatment. Patients taking hydroxychloroquine also appeared to clear the virus from their system more quickly. Virus elimination was even more efficient in the 6 patients in the trial who received both azithromycin and hydroxychloroquine.

However, results from another small trial conducted in 30 patients in China do not back up the results from the trial in France. In the Chinese trial patients did not receive azithromycin, but were treated with hydroxychloroquine or standard care. Unlike in the other trial, treatment with hydroxychloroquine did not appear to reduce viral load or shorten the time to viral elimination.

Hydroxychloroquine belongs to a group of drugs called quinolines. It  is an older drug that is currently used to treat rheumatoid arthritis and discoid or systemic lupus erythematosus. It can also be used to prevent or treat malaria. 

Will the antibiotic azithromycin be used to treat COVID-19?

While the results from the trial conducted in France suggest the antibiotic azithromycin may have potential in the treatment of COVID-19 when used in combination with hydroxychloroquine, larger clinical trials are clearly needed to confirm the drug combination is actually effective. 

Clinical trials investigating azithromycin and hydroxychloroquine are set to begin in patients with COVID-19 in New York and Brazil and researchers are also calling for further trials to be conducted.

References
  1. World Health Orgainzation (WHO). Coronavirus disease (COVID-19) advice for the public: Myth busters. [Accessed March 27, 2020]. Available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters
  2. Michigan Medicine University of Michigan. Inpatient guidance for treatment of COVID-19 in adults and children. [Accessed March 27, 2020]. Available online at: http://www.med.umich.edu/asp/pdf/adult_guidelines/COVID-19-treatment.pdf
  3. Michigan Medicine University of Michigan. Treatment pathway for adult patients with pneumonia. [Accessed March 27, 2020]. Available online at: http://www.med.umich.edu/asp/pdf/adult_guidelines/Pneumonia_ADULT.pdf
  4. Iannetta M, Ippolito G, Nicastri E. 2017. Azithromycin shows anti-Zika virus activity in human glial cells. Antimicrob Agents Chemother 61:e01152-17. https://doi.org/10 .1128/AAC.01152-17
  5. Gielen V, Johnston SL, Edwards MR. Azithromycin induces anti-viral responses in bronchial epithelial cells. European Respiratory Journal 2010 36: 646-654; DOI: 10.1183/09031936.00095809
  6. Schogler A, Kopf BS, Edwards MR et al. Novel antiviral properties of azithromycin in cystic fibrosis airway epithelial cells. European Respiratory Journal 2015 45: 428-439; DOI: 10.1183/09031936.00102014
  7. Gautret P, Lagier J-C, Parola P et al. (2020) Hydroxychloroquine and azithromycin as a treatment of  COVID‐19: results of an open‐label non‐randomized clinical trial. International Journal of Antimicrobial Agents – In Press 17 March 2020 – DOI : 10.1016/j.ijantimicag.2020.105949
  8. Jun C, Danping L, Li L, et al. A pilot study of hydroxychloroquine in treatment of patients with common coronavirus disease-19 (COVID-19). Journal of Zhejiang University. [Accessed March 27, 2020]. DOI : 10.3785/j.issn.1008-9292.2020.03.03
  9. NIH. National Library of Medicine. Clinicaltrials.govt. Safety and efficacy of hydroxychloroquine associate with azithromycin in SARS-COV2 virus (Alliance COVID-19 Brasil II). [Accessed March 27, 2020]. Available online at: https://clinicaltrials.gov/ct2/show/NCT04321278?term=azithromycin&cond=covid-19&draw=2&rank=1
  10. UPI. New York launches new COVID-19 drug trials; more underway in China. March 23, 2020. Available online at: https://www.upi.com/Health_News/2020/03/23/New-York-launches-new-COVID-19-drug-trials-more-underway-in-China/3681584975924/

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