Papel da azitromicina no transcorrer clínico em pacientes acometidos com Sars-Cov2: revisão bibliográfica
DOI:
https://doi.org/10.34117/bjdv9n7-120Keywords:
azitromicina, SARS-COV2, terapiaAbstract
A pandemia mundial do novo Corona Vírus- SARS-COV2 e seus elevados números de óbitos, trouxe a emergente necessidade de intervenção terapêutica para tratamento dos indivíduos infectados, além das medidas sanitárias e de medicina preventiva na transmissibilidade do vírus. Após de elucidados o ciclo de replicação e os fenômenos fisiopatológicos do desfecho fatal da infecção, diferentes esquemas terapêuticos foram considerados em toda comunidade de saúde dentre os quais, está o macrolídeo azitromicina. Já existem evidências de efeitos antivirais e imunomoduladores dessa droga. Com objetivo de revisar o papel da azitromicina no transcorrer clínico dos indivíduos infectados pelo SARS-COV2, foi realizada revisão integrativa nas plataformas PubMed, Scielo e Google Acadêmico com os indexadores “SARS-COV2”, “azithromycin”, “COVID” gerando 37 produções elegíveis de acordo com critérios. Até o momento não foi observado diferença significativa do emprego da azitromicina no desfecho clínico de paciente nos diferentes ensaios clínicos randomizados já realizados. Embora exista evidência in vitro do potenciais benefícios da azitromicina mediante infecção viral e profilaxia de pneumonia bactéria em vigência de SARS-COV2, não existem evidências sólidas que alicercem o seu implemento em diretrizes terapêuticas para controle de status clínico ou impedir sua evolução desfavorável.
References
ALBERT, R.K.; CONNETT, J.; BAILEY, W.C., et al. Azithromycin for prevention of exacerbations of COPD. New England Journal of Medicine. V.366 n.8, p. 689-698, 2021.
CAVALCANTI, A. B. et al. Hydroxychloroquine with or without Azithromycin in Mild-to-Moderate Covid-19. New England Journal of Medicine, v. 383, n. 21, p. 2041–2052, 2020.
FURTADO, R. H. M. et al. Azithromycin in addition to standard of care versus standard of care alone in the treatment of patients admitted to the hospital with severe COVID-19 in Brazil (COALITION II): a randomised clinical trial. The Lancet, v. 396, n. 10256, p. 959–967, 2020
GAUTRET, Philippe et al, Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial, International Journal of Antimicrobial Agents, v. 56, n. 1, p. 105949, 2020.
HINKS, T. S. C. et al. Azithromycin versus standard care in patients with mild-to-moderate COVID-19 (ATOMIC2): an open-label, randomised trial. The Lancet Respiratory Medicine, v. 9, n. 10, p. 1130–1140, 2021.
JOHNSTON, C. et al. Hydroxychloroquine with or without azithromycin for treatment of early SARS-CoV-2 infection among high-risk outpatient adults: A randomized clinical trial. EClinicalMedicine, v. 33, p. 100773, 2021.
LAMBACK, E. B. et al. Hydroxychloroquine with azithromycin in patients hospitalized for mild and moderate COVID-19. Brazilian Journal of Infectious Diseases , v. 25, n. 2, 2021.
OLDENBURG, C. E. et al. Effect of Oral Azithromycin vs Placebo on COVID-19 Symptoms in Outpatients With SARS-CoV-2 Infection. JAMA, v. 326, n. 6, p. 490, 2021.
OMRANI, A. S. et al. Randomized double-blinded placebo-controlled trial of hydroxychloroquine with or without azithromycin for virologic cure of non-severe Covid-19. EClinicalMedicine, v.29, p. 100645, 2020.
TOURET, F. et al. In vitro screening of a FDA approved chemical library reveals potential inhibitors of SARS-CoV-2 replication. bioRxiv, 2020. Doi: 101101/20200403023846, 2020.04.03).
LAGIER, J.C et al. Outcomes of 3,737 COVID-19 patients treated with hydroxychloroquine/azithromycin and other regimens in Marseille, France: A retrospective analysis. Travel medicine and infectious disease, v. 36, p. 101791, 2020.
SIVAPALAN, P. et al. Azithromycin and hydroxychloroquine in hospitalised patients with confirmed COVID-19: a randomised double-blinded placebo-controlled trial. The European respiratory journal, v. 59, n. 1, p. 2100752, 2022. doi:10.1183/13993003.00752-2021
AKRAM, J. et al. Pakistan Randomized and Observational Trial to Evaluate Coronavirus Treatment (PROTECT) of Hydroxychloroquine, Oseltamivir and Azithromycin to treat newly diagnosed patients with COVID-19 infection who have no comorbidities like diabetes mellitus: A structured summary of a study protocol for a randomized controlled trial.” Trials, v. 21, n. 1, p. 702,2020.
CHEN, F.; CHAN, K.H.; JIANG, Y. In vitro susceptibility of 10 clinical isolates of SARS coronavirus to selected antiviral compounds. J Clin Virol, v.31, n.1, p. 69–75, 2004.
RECOVERY Collaborative Group. “Lopinavir-ritonavir in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial”. Lancet, v. 396, n. 10259, p. 1345–1352, 2020.
RECOVERY Collaborative Group. Azithromycin in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial. Lancet, v. 397, n. 10274, p. 605–612, 2021.
ABBAS, H. M. et al. Assessment of COVID-19 Treatment containing both Hydroxychloroquine and Azithromycin: A natural clinical trial. International journal of clinical practice, v. 75,n.4, p. e13856, 2021.
PRINCIPLE Trial Collaborative Group. Azithromycin for community treatment of suspected COVID-19 in people at increased risk of an adverse clinical course in the UK (PRINCIPLE): a randomised, controlled, open-label, adaptive platform trial. Lancet v. 397,n. 10279, p.1063-1074, 2021.
SEKHAVATI, E. et al. Safety and effectiveness of azithromycin in patients with COVID-19: An open-label randomised trial. International journal of antimicrobial agents , v.56, n. 4, p. 106143, 2020.
RODRIGUES, C. et al. Hydroxychloroquine plus azithromycin early treatment of mild COVID-19 in an outpatient setting: a randomized, double-blinded, placebo-controlled clinical trial evaluating viral clearance. International journal of antimicrobial agentes, v. 5an. 5, p. 106428, 2021.
RASHAD, A. et al. “Therapeutic efficacy of macrolides in management of patients with mild COVID-19.” Scientific reports, v. 11, n.1, p.16361, 2021.
SHEPSHELOVICH, D. et al. “Concordance between the results of randomized and non-randomized interventional clinical trials assessing the efficacy of drugs for COVID-19: a cross-sectional study. The Journal of antimicrobial chemotherapy, v. 76, n. 9, p. 2415-2418, 2021.
