Efficacy and safety of azithromycin in Covid-19 patients: A systematic review and meta-analysis of randomized clinical trials

Abstract
Azithromycin (AZM) is commonly used in Covid-19 patients based on low-quality evidence, increasing the risk of developing adverse events and antimicrobial resistance. The current systematic review and meta-analysis investigated the safety and efficacy of AZM in treating Covid-19 patients using published randomized controlled trials. Google Scholar, PubMed, Scopus, Cochrane Library, Clinical Trials.gov, MEDLINE, bioRxiv and medRxiv were searched for relevant studies. The random-effects model was used to pool estimates using the Paule-Mandel estimate for heterogeneity. The odds ratio and raw difference in medians were used for dichotomous and continuous outcomes, respectively. The analysis included seven studies with 8822 patients (median age, 55.8 years; 61% males). The risk of bias was assessed as ‘low’ for five of the seven mortality results and as ‘some concerns’ and ‘high’ in one trial each. There were 657/3100 (21.2%) and 1244/5654 (22%) deaths among patients randomized to AZM and standard of care, respectively. The use of AZM was not associated with mortality in Covid-19 patients (OR = 0.96, 95% CI 0.88-1.05, p = 0.317 based on the random-effect meta-analysis). The use of AZM was not associated with need for invasive mechanical ventilation (OR = 0.96, 95% CI 0.49-1.87, p = 0.85) and length of stay (Δ = 1.11, 95% CI -2.08 to 4.31, p = 0.49). The results show that using AZM as routine therapy in Covid-19 patients is not justified due to lack of efficacy and potential risk of bacterial resistance that is not met by an increased clinical benefit.
Keywords: Covid-19; azithromycin; efficacy; meta-analysis; mortality; safety; systematic review.

All Keywords
【저자키워드】 COVID-19, Meta-analysis, Efficacy, Azithromycin, Mortality, Safety, systematic review, 【초록키워드】 Meta-analysis, therapy, Randomized controlled trials, Azithromycin, Trial, systematic review, risk, antimicrobial resistance, heterogeneity, adverse events, outcomes, controlled trials, clinical, adverse event, Patient, death, estimate, COVID-19 patients, Bacterial, Evidence, Invasive mechanical ventilation, Analysis, Odds ratio, Google Scholar, Standard of care, 95% CI, median age, medians, potential risk, clinical benefit, Cochrane Library, medRxiv, random-effects model, bioRxiv, FIVE, males, Seven, was used, lack, investigated, median, were used, searched, patients randomized, risk of bia, 【제목키워드】 randomized clinical trial, Azithromycin,

{{{ 추상적인 }}} 아지스로마이신(AZM)은 낮은 품질의 근거에 근거하여 코로나19 환자에게 일반적으로 사용되어 부작용 및 항균제 내성 발생 위험을 높입니다. 현재의 체계적인 검토 및 메타 분석은 공개된 무작위 대조 시험을 사용하여 Covid-19 환자를 치료할 때 AZM의 안전성과 효능을 조사했습니다. Google Scholar, PubMed, Scopus, Cochrane Library, Clinical Trials.gov, MEDLINE, bioRxiv 및 medRxiv에서 관련 연구를 검색했습니다. 랜덤 효과 모델은 이질성에 대한 Paule-Mandel 추정치를 사용하여 추정치를 합산하는 데 사용되었습니다. 중간값의 승산비와 원시 차이는 각각 이분법 및 연속 결과에 사용되었습니다. 분석에는 8,822명의 환자를 대상으로 한 7건의 연구가 포함되었습니다(중앙 연령, 55.8세, 남성 61%). 비뚤림 위험은 7개의 사망률 결과 중 5개에 대해 '낮음'으로 평가되었고 각각 1건의 시험에서 '약간의 우려' 및 '높음'으로 평가되었습니다. AZM 및 표준 치료에 무작위 배정된 환자 중 각각 657/3100명(21.2%) 및 1244/5654명(22%)이 사망했습니다. AZM의 사용은 Covid-19 환자의 사망률과 관련이 없었습니다(OR = 0.96, 95% CI 0.88-1.05, p = 0.317, 무작위 효과 메타 분석 기반). AZM의 사용은 침습적 기계 환기의 필요성(OR = 0.96, 95% CI 0.49-1.87, p = 0.85) 및 재원 기간(Δ = 1.11, 95% CI -2.08~4.31, p = 0.49)과 관련이 없었습니다. . 결과는 코로나19 환자에서 AZM을 일상적인 요법으로 사용하는 것은 증가된 임상적 이점으로 충족되지 않는 박테리아 내성의 잠재적 위험과 효능 부족으로 인해 정당화되지 않는다는 것을 보여줍니다. {{ 키워드: }} 코비드-19; 아지트로마이신; 효능; 메타분석; 인류; 안전; 체계적인 검토.