COVID-19 outpatients: early risk-stratified treatment with zinc plus low-dose hydroxychloroquine and azithromycin: a retrospective case series study

Abstract

The aim of this study was to describe the outcomes of patients with coronavirus disease 2019 (COVID-19) in the outpatient setting after early treatment with zinc, low-dose hydroxychloroquine and azithromycin (triple therapy) dependent on risk stratification. This was a retrospective case series study in the general practice setting. A total of 141 COVID-19 patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the year 2020 were included. The main outcome measures were risk-stratified treatment decision and rates of hospitalisation and all-cause death. A median of 4 days [interquartile range (IQR) 3-6 days; available for n = 66/141 patients] after the onset of symptoms, 141 patients (median age 58 years, IQR 40-67 years; 73.0% male) received a prescription for triple therapy for 5 days. Independent public reference data from 377 confirmed COVID-19 patients in the same community were used as untreated controls. Of 141 treated patients, 4 (2.8%) were hospitalised, which was significantly fewer (P < 0.001) compared with 58 (15.4%) of 377 untreated patients [odds ratio (OR) = 0.16, 95% confidence interval (CI) 0.06-0.5]. One patient (0.7%) in the treatment group died versus 13 patients (3.4%) in the untreated group (OR = 0.2, 95% CI 0.03-1.5; P = 0.12). No cardiac side effects were observed. Risk stratification-based treatment of COVID-19 outpatients as early as possible after symptom onset using triple therapy, including the combination of zinc with low-dose hydroxychloroquine, was associated with significantly fewer hospitalisations.

Keywords: Azithromycin; COVID-19; Hydroxychloroquine; Outpatients; SARS-CoV-2; Zinc.

Fig. 1

Study population. N = 141 COVID-19 patients, all with a laboratory-confirmed SARS-CoV-2 infection, were included in the analysis as the treated group. N = 377 positively tested COVID-19 patients of the public reference were included in the analysis as the untreated group. COVID-19, coronavirus disease 2019; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.

Fig. 2

Hospitalisation. Treatment with triple therapy of zinc, low-dose hydroxychloroquine and azithromycin was associated with significantly fewer hospitalisations compared with untreated patients of the public reference data. χ² (1, N = 518) = 14.17; * P < 0.001.

Fig. 3

All-cause deaths. Treatment with triple therapy of zinc, low-dose hydroxychloroquine and azithromycin was associated with numerically fewer all-cause deaths compared with untreated patients of the public reference data. n.s., not significant. χ² (1, N = 518) = 1.98; P = 0.12.

Fig. 4

Odds ratios (ORs). The odds of hospitalisation in the treated patient group was 84% less than in the untreated patient group and was statistically significant (P < 0.001). The odds of all-cause death in the treated patient group was 80% less than in the untreated patient group but did not reach statistical significance (P = 0.12). COVID-19, coronavirus disease 2019; CI, confidence interval.