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Review
. 2023 Jul-Aug:60:127-132.
doi: 10.1016/j.hrtlng.2023.03.004. Epub 2023 Mar 16.

Clinical efficacy of Azithromycin for COVID-19 management: A systematic meta-analysis of meta-analyses

Ali Danish Khan Yousafzai  1 , Ali Haider Bangash  2 , Saleha Yurf Asghar  1 , Syed Mohammad Mehmood Abbas  1 , Hashir Fahim Khawaja  1 , Saiqa Zehra  1 , Asjad Ullah Khan  1 , Musa Kamil  1 , Noor Ayesha  1 , Ayesha Khalid Khan  1 , Rabia Mohsin  1 , Osama Ahmed  1 , Arshiya Fatima  1 , Aliya Ali  1 , Ain Ul Badar  1 , Maryum Naveed Abbasi  1 , Mohammad Ashraf  3 , Ali Haider Shah  1 , Tahir Iqbal  4
Affiliations
Review

Clinical efficacy of Azithromycin for COVID-19 management: A systematic meta-analysis of meta-analyses

Ali Danish Khan Yousafzai et al. Heart Lung. 2023 Jul-Aug.

Abstract

Background: Azithromycin has been adopted as a component of the COVID-19 management protocol throughout the global healthcare settings but with a questionable if not downright unsubstantiated evidence base.

Objectives: In order to amalgamate and critically appraise the conflicting evidence around the clinical efficacy of Azithromycin (AZO) vis a vis COVID-19 management outcomes, a meta-analysis of meta-analyses was carried out to establish an evidence-based holistic status of AZO vis a vis its efficacy as a component-in-use of the COVID-19 management protocol.

Methods: A comprehensive systematic search was carried out through PubMed/Medline, Cochrane and Epistemonikos with a subsequent appraisal of abstracts and full-texts, as required. The Quality of Reporting of Meta-analyses (QUOROM) checklist and the Assessment of Multiple Systematic Reviews (AMSTAR) methodology were adopted to assess the methodological quality of the included meta-analyses. Random-effects models were developed to calculate summarized pool Odds Ratios (with 95% confidence interval) for the afore determined primary and secondary outcomes.

Results: AZO, when compared with best available therapy (BAT) including or excluding Hydroxychloroquine, exhibited statistically insignificant reduction in mortality [(n= 27,204 patients) OR= 0.77 (95% CI: 0.51-1.16) (I2= 97%)], requirement of mechanical ventilation [(n= 14,908 patients) OR= 1.4 (95% CI: 0.58-3.35) (I2= 98%)], induction of arrhythmia [(n= 9,723 patients) OR= 1.21 (95% CI: 0.63-2.32) (I2= 92%)] and QTc prolongation (a surrogate for torsadogenic effect) [(n= 6,534 patients) OR= 0.62 (95% CI: 0.23-1.73) (I2= 96%)].

Conclusion: The meta-analysis of meta-analyses portrays AZO as a pharmacological agent that does not appear to have a comparatively superior clinical efficacy than BAT when it comes to COVID-19 management. Secondary to a very real threat of anti-bacterial resistance, it is suggested that AZO be discontinued and removed from COVID-19 management protocols.

Keywords: Arrhythmia; Azithromycin; COVID-19; Mortality; Torsades de pointes.

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Conflict of interest statement

Declaration of Competing Interest The authors have no conflict of interest.

Figures

Fig 1
Fig. 1
PRISMA flow-chart illustrating search, selection and inclusion of meta-analyses.
Fig 2
Fig. 2
Pooled Odds ratio (with 95% Confidence Interval) for (a) mortality (b) requirement of mechanical ventilation (c) arrhythmic induction and (d) torsadogenic effect comparing Azithromycin to the Standard of Care.
See this image and copyright information in PMC

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