Use of combined treatment of 3rd-generation cephalosporin, azithromycin and antiviral agents on moderate SARs-CoV-2 patients in South Korea: A retrospective cohort study

{ 'indexed': {'date-parts': [[2022, 5, 5]], 'date-time': '2022-05-05T11:41:36Z', 'timestamp': 1651750896392}, 'reference-count': 69, 'publisher': 'Public Library of Science (PLoS)', 'issue': '5', 'license': [ { 'start': { 'date-parts': [[2022, 5, 4]], 'date-time': '2022-05-04T00:00:00Z', 'timestamp': 1651622400000}, 'content-version': 'vor', 'delay-in-days': 0, 'URL': 'http://creativecommons.org/licenses/by/4.0/'}], 'funder': [ { 'DOI': '10.13039/501100002543', 'name': 'Pusan National University', 'doi-asserted-by': 'publisher', 'award': ['201914420004']}], 'content-domain': {'domain': ['www.plosone.org'], 'crossmark-restriction': False}, 'abstract': '<jats:sec id="sec001">\n' '<jats:title>Objectives</jats:title>\n' '<jats:p>To assess efficacy and safety of the combined treatment of antibiotics ' '(3rd-generation cephalosporin and azithromycin) and antiviral agents (lopinavir/ritonavir or ' 'hydroxychloroquine) on moderate COVID-19 patients in South Korea.</jats:p>\n' '</jats:sec>\n' '<jats:sec id="sec002">\n' '<jats:title>Methods</jats:title>\n' '<jats:p>A retrospective cohort study of the 358 laboratory-confirmed SARS-CoV-2 (COVID-19) ' 'patients was conducted. 299 patients met inclusion criteria for analysis. Propensity score ' 'matching (PSM) and Cox regression method were used to control and adjust for confounding ' 'factors. Mild to moderate COVID-19 patients were managed with either CA/LoP (cephalosporin, ' 'azithromycin, and lopinavir/ritonavir) (n = 57), CA/HQ (cephalosporin, azithromycin, and ' 'hydroxychloroquine) (n = 25) or standard supportive care (n = 217). We analyzed the ' 'association between treatment group and standard supportive group in terms of three ' 'endpoints: time to symptom resolution, time to viral clearance, and hospital stay duration. ' 'Using propensity-score matching analysis, three rounds of propensity-matching analysis were ' 'performed to balance baseline characteristics among three cohorts.</jats:p>\n' '</jats:sec>\n' '<jats:sec id="sec003">\n' '<jats:title>Results</jats:title>\n' '<jats:p>Kaplan-Meier curves fitted using propensity score-matched data revealed no ' 'significant differences on time to symptom resolution, time to viral clearance, hospital stay ' 'duration among the three treatment arms (CA/LoP vs Standard, log-rank p-value = 0.2, 0.58, ' 'and 0.74 respectively for the three endpoints) (CA/HQ vs Standard, log-rank p-value = 0.46, ' '0.99, and 0.75 respectively). Similarly, Cox regression analysis on matched cohorts of CA/LoP ' 'and standard supportive group showed that hazard ratios of time to symptom resolution (HR: ' '1.447 [95%-CI: 0.813–2.577]), time to viral clearance(HR: 0.861, [95%-CI: 0.485–1.527]), and ' 'hospital stay duration (HR: 0.902, [95%-CI: 0.510–1.595]) were not significant. For CA/HQ and ' 'standard supportive group, hazard ratios of the three endpoints all showed no statistical ' 'significance (HR: 1.331 [95%-CI:0.631–2.809], 1.005 [95%-CI:0.480–2.105], and 0.887, ' '[95%-CI:0.422–1.862] respectively). No severe adverse event or death was observed in all ' 'groups.</jats:p>\n' '</jats:sec>\n' '<jats:sec id="sec004">\n' '<jats:title>Conclusions</jats:title>\n' '<jats:p>Combined treatment of 3rd cephalosporin, azithromycin and either low-dose ' 'lopinavir/ritonavir or hydroxychloroquine was not associated with better clinical outcomes in ' 'terms of time to symptom resolution, time to viral clearance, and hospital stay duration ' 'compared to standard supportive treatment alone. Microbiological evidence should be closely ' 'monitored when treating SARS-CoV-2 patients with antibiotics to prevent indiscreet ' 'administration of empirical antimicrobial treatments.</jats:p>\n' '</jats:sec>', 'DOI': '10.1371/journal.pone.0267645', 'type': 'journal-article', 'created': {'date-parts': [[2022, 5, 4]], 'date-time': '2022-05-04T17:33:47Z', 'timestamp': 1651685627000}, 'page': 'e0267645', 'update-policy': 'http://dx.doi.org/10.1371/journal.pone.corrections_policy', 'source': 'Crossref', 'is-referenced-by-count': 0, 'title': 'Use of combined treatment of 3rd-generation cephalosporin, azithromycin and antiviral agents on ' 'moderate SARs-CoV-2 patients in South Korea: A retrospective cohort study', 'prefix': '10.1371', 'volume': '17', 'author': [ {'given': 'Wooyoung', 'family': 'Hong', 'sequence': 'first', 'affiliation': []}, {'given': 'Yu-Kyung', 'family': 'Park', 'sequence': 'additional', 'affiliation': []}, {'given': 'Bong-Ok', 'family': 'Kim', 'sequence': 'additional', 'affiliation': []}, {'given': 'Sung Kyu', 'family': 'Park', 'sequence': 'additional', 'affiliation': []}, {'given': 'Jiin', 'family': 'Shin', 'sequence': 'additional', 'affiliation': []}, {'given': 'Soon-Pyo', 'family': 'Jang', 'sequence': 'additional', 'affiliation': []}, {'given': 'Hea-Woon', 'family': 'Park', 'sequence': 'additional', 'affiliation': []}, {'given': 'Wonjong', 'family': 'Yang', 'sequence': 'additional', 'affiliation': []}, {'given': 'Joonyoung', 'family': 'Jang', 'sequence': 'additional', 'affiliation': []}, { 'ORCID': 'http://orcid.org/0000-0003-2303-7124', 'authenticated-orcid': True, 'given': 'Soon-Woo', 'family': 'Jang', 'sequence': 'additional', 'affiliation': []}, {'given': 'Tae-Ho', 'family': 'Hwang', 'sequence': 'additional', 'affiliation': []}], 'member': '340', 'published-online': {'date-parts': [[2022, 5, 4]]}, 'reference': [ { 'key': 'pone.0267645.ref001', 'author': 'WHO', 'year': '2020', 'journal-title': 'World Health Organization, Coronavirus disease (COVID-19) Situation ' 'Report– 135'}, { 'issue': '1', 'key': 'pone.0267645.ref002', 'article-title': 'Potential treatments for COVID-19; a narrative literature review', 'volume': '8', 'author': 'A. 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