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

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

doi:10.1016/j.hrtlng.2023.03.004

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

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

Authors

Ali Danish Khan Yousafzai¹, Ali Haider Bangash², Saleha Yurf Asghar¹, Syed Mohammad Mehmood Abbas¹, Hashir Fahim Khawaja¹, Saiqa Zehra¹, Asjad Ullah Khan¹, Musa Kamil¹, Noor Ayesha¹, Ayesha Khalid Khan¹, Rabia Mohsin¹, Osama Ahmed¹, Arshiya Fatima¹, Aliya Ali¹, Ain Ul Badar¹, Maryum Naveed Abbasi¹, Mohammad Ashraf³, Ali Haider Shah¹, Tahir Iqbal⁴

Affiliations

¹ Shifa International Hospital, Islamabad, Pakistan.
² Shifa International Hospital, Islamabad, Pakistan. Electronic address: hhaider4@gmail.com.
³ Rawalpindi Medical College, Rawalpindi Medical University, Rawalpindi, Pakistan.
⁴ Head of Department, Department of Medicine, Shifa College of Medicine, Islamabad, Pakistan.

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.

Publication types

Meta-Analysis
Review

MeSH terms

Azithromycin / therapeutic use
COVID-19 Drug Treatment
COVID-19*
Humans
SARS-CoV-2
Treatment Outcome

Substances

Azithromycin