Clinical and microbiological effect of a combination of hydroxychloroquine and azithromycin in 80 COVID-19 patients with at least a six-day follow up: A pilot observational study
Philippe Gautret, Jean-Christophe Lagier, Philippe Parola, Van Thuan Hoang, Line Meddeb, Jacques Sevestre, Morgane Mailhe, Barbara Doudier, Camille Aubry, Sophie Amrane, Piseth Seng, Marie Hocquart, Carole Eldin, Julie Finance, Vera Esteves Vieira, Hervé Tissot Tissot-Dupont, Stéphane Honoré, Andreas Stein, Matthieu Million, Philippe Colson, Bernard La Scola, Véronique Veit, Alexis Jacquier, Jean-Claude Deharo, Michel Drancourt, Pierre Edouard Fournier, Jean-Marc Rolain, Philippe Brouqui, Didier Raoult
Travel Medicine and Infectious Disease, doi:10.1016/j.tmaid.2020.101663
Background: We need an effective treatment to cure COVID-19 patients and to decrease virus carriage duration. Methods: We conducted an uncontrolled, non-comparative, observational study in a cohort of 80 relatively mildly infected inpatients treated with a combination of hydroxychloroquine and azithromycin over a period of at least three days, with three main measurements: clinical outcome, contagiousness as assessed by PCR and culture, and length of stay in infectious disease unit (IDU). Results: All patients improved clinically except one 86 year-old patient who died, and one 74 year-old patient still in intensive care. A rapid fall of nasopharyngeal viral load was noted, with 83% negative at Day7, and 93% at Day8. Virus cultures from patient respiratory samples were negative in 97.5% of patients at Day5. Consequently patients were able to be rapidly discharged from IDU with a mean length of stay of five days.
Conclusion: We believe there is urgency to evaluate the effectiveness of this potentially-life saving therapeutic strategy at a larger scale, both to treat and cure patients at an early stage before irreversible severe respiratory complications take hold and to decrease duration of carriage and avoid the spread of the disease. Furthermore, the cost of treatment is negligible.
Appendix A. Supplementary data Supplementary data to this article can be found online at https:// doi.org/10.1016/j.tmaid.2020.101663.
References
Amrane, Tissot-Dupont, Doudier, Eldin, Hocquart et al., Rapid viral diagnosis and ambulatory management of suspected COVID-19 cases presenting at the infections diseases referral hospital in Marseille, France, -January 31st to March 1st, 2020: a respiratory virus snapshot, Trav Med Infect Dis
Chatre, Roubille, Vernhet, Jorgensen, Pers, Cardiac complications attributed to chloroquine and hydroxychloroquine: a systematic review of the literature, Drug Saf
Chen, Hu, Zo, Jiang, Han et al., Efficacy of hydroxychloroquine in patients with COVID-19: results of a randomized clinical trial, MedRxiv,
doi:10.1101/2020.03.22.20040758Chen, Liu, Liu, Liu, Xu et al., A pilot study of hydroxychloroquine in treatment of patients with common coronavirus disease-19 (COVID-19
Colson, Rolain, Lagier, Brouqui, Raoult, Chloroquine and hydroxychloroquine as available weapons to fight COVID-19, Int J Antimicrob Agents
Colson, Rolain, Raoult, Chloroquine for the 2019 novel coronavirus SARS-CoV-2, Int J Antimicrob Agents
Corman, Landt, Kaiser, Molenkamp, Meijer et al., Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR, Euro Surveill
Gao, Tian, Yang, Breakthrough: chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies, Biosci Trends
Gautret, Lagier, Parola, Hoang, Meddeb et al., Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial, Int J Antimicrob Agents
Hicks, Th, Hunkler, outpatient antibiotic prescribing, 2010, N Engl J Med
Lai, Shih, Ko, Tang, Hsueh, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): the epidemic and the challenges, Int J Antimicrob Agents
Liao, Wang, Kang, Novel coronavirus infection during the 2019-2020 epidemic: preparing intensive care units-the experience in Sichuan Province, China, Intensive Care Med
Liu, Cao, Xu, Wang, Zhang et al., Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro, Cell Discov
Liu, Yan, Wan, Xiang, Le et al., Viral dynamics in mild and severe cases of COVID-19, Lancet Infect Dis
Mitja, Clotet, Use of antiviral drugs to reduce COVID-19 transmission, Lancet Glob Health
Mo, Yuan, Tao, Peng, Wang, Time kinetics of viral clearance and resolution of symptoms in novel coronavirus infection, Am J Respir Crit Care Med
Nabirothckin, Peluffo, Bouaziz, Cohen, Focusing on the unfolded protein response and autophagy related pathways to reposition common approved drugs against COVID-19, Preprints,
doi:10.20944/preprints202003.0302.v1To, Tsang, Leung, Tam, Wu et al., Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study, Lancet
Wang, Cao, Zhang, Yang, Liu et al., Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro, Cell Res
Wu, Mcgoogan, Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72314 cases from the Chinese center for disease control and prevention, J Am Med Assoc
Yao, Ye, Zhang, Cui, Huang et al., In vitro antiviral activity and projection of optimized dosing design of hydroxychloroquine for the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Clin Infect Dis
Zhou, Dai, Tong, COVID-19: a recommendation to examine the effect of hydroxychloroquine in preventing infection and progression, J Antimicrob Chemother
Zhou, Yu, Du, Fan, Liu et al., Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study, Lancet
Zhu, Zhang, Li, Yang, Song, A novel coronavirus from patients with pneumonia in China, 2019, N Engl J Med
