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World J Exp Med. May 20, 2022; 12(3): 44-52
Published online May 20, 2022. doi: 10.5493/wjem.v12.i3.44
Use of hydroxychloroquine and azithromycin combination to treat the COVID-19 infection
Jyoti Bajpai, Akshyaya Pradhan, Ajay Kumar Verma, Surya Kant
Jyoti Bajpai, Ajay Kumar Verma, Department of Respiratory Medicine, King George's Medical University, Lukcnow, Lucknow 226003, Uttar Pradesh, India
Akshyaya Pradhan, Department of Cardiology, King George's Medical University, Lukcnow, Lucknow 226003, Uttar Pradesh, India
Surya Kant, Department of Respiratory Medicine, King George Medical University, Lucknow 226003, Uttar Pradesh, India
Author contributions: Bajpai J and Verma AK conceptualized the article design; Bajpai J, Pradhan A, and Verma AK searched the literature; Bajpai J and Pradhan A drafted the manuscript; A critical revision was done by Kant S, Verma AK, Pradhan A, and Bajpai J.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Surya Kant, FCCP, Professor, Department of Respiratory Medicine, King George Medical University, Lucknow 226003, Uttar Pradesh, India.
Received: November 21, 2021
Peer-review started: November 21, 2021
First decision: January 12, 2022
Revised: January 24, 2022
Accepted: April 21, 2022
Article in press: April 21, 2022
Published online: May 20, 2022

Coronavirus disease 2019 (COVID-19) infection is unequivocally the worst crisis in recent decades, which is caused by a severe acute respiratory virus 2. Currently, there is no effective therapy for the COVID-19 infection. Different countries have different guidelines for treating COVID-19 in the absence of an approved therapy for COVID-19. Therefore, there is an imminent need to identify effective treatments, and several clinical trials have been conducted worldwide. Both hydroxychloroquine [HCQS], chloroquine, and azithromycin (AZ) have been widely used for management based on in vitro studies favoring antiviral effects against the COVID-19 virus. However, there is evidence both in favor and against the use of hydroxychloroquine and azithromycin (HCQS+AZ) combination therapy to manage the COVID-19 infection. The combination of hydroxychloroquine and azithromycin was significantly associated with increased adverse events. However, the inference of these findings was from observational studies. Therefore, large randomized trials are imperative to show the future path for the use of HCQS+AZ combination therapy. However, owing to the ban on HCQS use in COVID-19, this may no longer be essential. This review is on the pharmacology, trials, regimens, and side effects of hydroxychloroquine and azithromycin combination therapy.

Keywords: Hydroxychloroquine, Azithromycin, Antiviral effects, QT interval, Randomized controlled trial

Core Tip: The coronavirus disease 2019 (COVID-19) pandemic has raged across the globe imposing a huge burden on the health systems. In absence of definitive treatment or vaccines, many drugs with antiviral properties were repurposed for use against COVID-19 infection. Based on the results of preliminary success in observational studies, Hydroxychloroquine (HCQS) and azithromycin were used extensively in the initial part of pandemic in he management of COVID-19 pandemic. Subsequently, reports of QT prolongation emerged with HCQS and its combination therapy with azithromycin. Later on HCQS was discontinued by major guidelines including World Health Organization. The review traces the emergence and downfall of the combination therapy in management of COVID-19.