All Studies Meta Analysis Recent:

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

Hong et al., PLOS ONE, doi:10.1371/journal.pone.0267645

May 2022

Post
Facebook

Source PDF All Meta

HCQ for COVID-19

1st treatment shown to reduce risk in March 2020

^*, now known with p < 0.00000000001 from 422 studies, recognized in 42 countries.

Lower risk for mortality, hospitalization, recovery, cases, and viral clearance.

No treatment is 100% effective. Protocols combine complementary and synergistic treatments. ^* >10% efficacy in meta analysis with ≥3 clinical studies.

4,100+ studies for 60+ treatments. c19hcq.org

Retrospective 25 hospitalized patients treated with cephalosporin, azithromycin, and HCQ, and 217 SOC patients in South Korea, reporting no significant differences. 5 patients receiving lopinavir/ritonavir and HCQ >5 days were excluded for unknown reasons. HCQ was typically initiated based on progression or side effects from another treatment. Conflicting results are reported. Table 2 indicates 15 CA/HCQ patients after matching, while Table S2 shows 25, and the Table 3 count is blank. S2 appears to incorrectly show before matching results, and the after matching results are missing in Table 3. 200mg HCQ bid.

Viral load measured by PCR may not accurately reflect infectious virus measured by viral culture. Porter show that viral load early in infection was correlated with infectious virus, but viral load late in infection could be high even with low or undetectable infectious virus. Assessing viral load later in infection may underestimate reductions in infectious virus with treatment.

1. Porter et al., The ratio between SARS-CoV-2 RNA viral load and culturable viral titer differs depending on stage of infection, medRxiv, doi:10.1101/2023.07.06.23292300.medrxiv.org, doi.org.

Important missing comments or errors? Let us know.

recovery time, 24.9% lower, HR 0.75, p = 0.45, treatment 15, control 15, inverted to make HR<1 favor treatment, propensity score matching.

hospitalization time, 12.7% higher, HR 1.13, p = 0.75, treatment 15, control 15, inverted to make HR<1 favor treatment, propensity score matching.

viral clearance time, 0.5% lower, HR 1.00, p = 0.99, treatment 15, control 15, inverted to make HR<1 favor treatment, propensity score matching.

Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates

Hong et al., 4 May 2022, retrospective, South Korea, peer-reviewed, 11 authors, study period 28 February, 2020 - 28 April, 2020. Contact: kmedicsoon@pusan.ac.kr, thhwang@pusan.ac.kr, wsabf@naver.com.

This Paper HCQ All

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

Wooyoung Hong, Yu-Kyung Park, Bong-Ok Kim, Sung Kyu Park, Jiin Shin, Soon-Pyo Jang, Hea-Woon Park, Wonjong Yang, Joonyoung Jang, Soon-Woo Jang, Tae-Ho Hwang

PLOS ONE, doi:10.1371/journal.pone.0267645

Objectives 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. Methods 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. Results 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

Supporting information S1 Author Contributions Conceptualization: Wooyoung Hong, Soon-Woo Jang. Data curation: Sung Kyu Park, Soon-Woo Jang. Formal analysis: Wooyoung Hong. Funding acquisition: Tae-Ho Hwang. Investigation: Yu-Kyung Park, Bong-Ok Kim, Sung Kyu Park, Hea-Woon Park, Wonjong Yang, Joonyoung Jang, Soon-Woo Jang. Methodology: Wooyoung Hong. Project administration: Soon-Woo Jang, Tae-Ho Hwang. Resources: Yu-Kyung Park, Bong-Ok Kim, Sung Kyu Park, Hea-Woon Park, Wonjong Yang, Joonyoung Jang. Software: Wooyoung Hong. Supervision: Soon-Woo Jang, Tae-Ho Hwang. Validation: Wooyoung Hong, Soon-Woo Jang. Visualization: Soon-Pyo Jang. Writing -original draft: Wooyoung Hong, Soon-Woo Jang. Writing -review & editing: Wooyoung Hong, Jiin Shin.

References

Adler, Ball, Fisher, Mortimer, Vardhan, Low rate of bacterial co-infection in patients with COVID-19, The Lancet Microbe, doi:10.1016/S2666-5247%2820%2930036-7

Austin, An Introduction to Propensity Score Methods for Reducing the Effects of Confounding in Observational Studies, Multivariate Behav Res, doi:10.1080/00273171.2011.568786

Biot, Daher, Chavain, Fandeur, Khalife et al., Design and synthesis of hydroxyferroquine derivatives with antimalarial and antiviral activities, Journal of medicinal chemistry, doi:10.1021/jm0601856

Borba, Val, Sampaio, Alexandre, Melo et al., Effect of high vs low doses of chloroquine diphosphate as adjunctive therapy for patients hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection: a randomized clinical trial, JAMA network open, doi:10.1001/jamanetworkopen.2020.8857

Bosseboeuf, Aubry, Nhan, Pina, Rolain et al., Azithromycin inhibits the replication of Zika virus, J Antivirals Antiretrovirals

Campbell, Marrie, Anstey, Dickinson, Ackroyd-Stolarz et al., The contribution of blood cultures to the clinical management of adult patients admitted to the hospital with communityacquired pneumonia: a prospective observational study, Chest, doi:10.1378/chest.123.4.1142

Cao, Wang, Wen, Liu, Wang et al., A trial of lopinavir-ritonavir in adults hospitalized with severe Covid-19, New England Journal of Medicine, doi:10.1056/NEJMoa2001282

Cavalcanti, Zampieri, Rosa, Azevedo, Veiga et al., Hydroxychloroquine with or without azithromycin in mild-to-moderate Covid-19, New England Journal of Medicine

Chen, Chan, Jiang, Kao, Lu et al., In vitro susceptibility of 10 clinical isolates of SARS coronavirus to selected antiviral compounds, Journal of Clinical Virology, doi:10.1016/j.jcv.2004.03.003

Chen, Zhou, Dong, Qu, Gong et al., Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study, The lancet, doi:10.1016/S0140-6736%2820%2930211-7

Choi, Kang, Shin, Noh, Cheong et al., Comparison of antiviral effect for mildto-moderate COVID-19 cases between lopinavir/ritonavir versus hydroxychloroquine: A nationwide propensity score-matched cohort study, International Journal of Infectious Diseases, doi:10.1016/j.ijid.2020.10.062

Choi, Kim, Kim, Nam, Sohn, Community treatment centers for isolation of asymptomatic and mildly symptomatic patients with coronavirus disease, South Korea, Emerging infectious diseases, doi:10.3201/eid2610.201539

Choy, Wong, Kaewpreedee, Sia, Hui, Remdesivir, lopinavir, emetine, and homoharringtonine inhibit SARS-CoV-2 replication in vitro, Antiviral research, doi:10.1016/j.antiviral.2020.104786

Colson, Rolain, Lagier, Brouqui, Raoult, Chloroquine and hydroxychloroquine as available weapons to fight COVID-19, Int J Antimicrob Agents, doi:10.1016/j.ijantimicag.2020.105932

Corman, Bleicker, Bru ¨nink S, Drosten, Zambon, Organization, Diagnostic detection of Wuhan coronavirus 2019 by real-time RT-PCR

Fernandes, Silva, Martins, Oliveira, QTc interval prolongation in critically ill patients: Prevalence, risk factors and associated medications, PLoS One, doi:10.1371/journal.pone.0199028

Furst, Lindsley, Baethge, Botstein, Caldwell et al., Dose-loading with hydroxychloroquine improves the rate of response in early, active rheumatoid arthritis: a randomized, doubleblind six-week trial with eighteen-week extension. Arthritis & Rheumatism: Official Journal of the American, College of Rheumatology, doi:10.1002/1529-0131%28199902%2942%3A2%26lt%3B357%3A%3AAID-ANR19%26gt%3B3.0.CO%3B2-J

Gautret, Lagier, Parola, Hoang, Meddeb et al., 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, Travel Med Infect Dis, doi:10.1016/j.tmaid.2020.101663

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, International Journal of Antimicrobial Agents, doi:10.1016/j.ijantimicag.2020.105949

Govind, Freitas, Pritchard, Hayes, Maccabe, Clozapine treatment and risk of COVID-19 infection: retrospective cohort study, The British journal of psychiatry, doi:10.1192/bjp.2020.151

Guaraldi, Meschiari, Cozzi-Lepri, Milic, Tonelli et al., Tocilizumab in patients with severe COVID-19: a retrospective cohort study, The Lancet Rheumatology, doi:10.1016/S2665-9913%2820%2930173-9

Han Yc, Jh, Diagnosis and treatment of bacterial pneumonia in Korea, Respirology, doi:10.1111/j.1440-1843.1996.tb00019.x

Hong, Lee, Kim, Huh, Lee et al., Guidelines for laboratory diagnosis of coronavirus disease 2019 (COVID-19) in Korea, Annals of laboratory medicine, doi:10.3343/alm.2020.40.5.351

Huang, Ran, Lv, Feng, Ran et al., Chronological changes of viral shedding in adult inpatients with COVID-19 in Wuhan, China, Clinical Infectious Diseases, doi:10.1093/cid/ciaa631

Izmirly, Costedoat-Chalumeau, Pisoni, Khamashta, Kim et al., Maternal use of hydroxychloroquine is associated with a reduced risk of recurrent anti-SSA/Ro-antibody-associated cardiac manifestations of neonatal lupus, Circulation, doi:10.1161/CIRCULATIONAHA.111.089268

Jefferson, Dalton, Escobar, Allison, Transportation delay and the microbiological quality of clinical specimens, American journal of clinical pathology, doi:10.1093/ajcp/64.5.689

Ji, Huh, Kang, Hong, Bae et al., Effect of underlying comorbidities on the infection and severity of COVID-19 in Korea: a nationwide case-control study, Journal of Korean medical science, doi:10.3346/jkms.2020.35.e237

Karolyi, Pawelka, Mader, Omid, Kelani et al., Hydroxychloroquine versus lopinavir/ritonavir in severe COVID-19 patients, Wiener Klinische Wochenschrift, doi:10.1007/s00508-020-01720-y

Kcfdca, Management guidelines for coronavirus disease-19

Kim, An, -K, Bitton, Gawande, How South Korea responded to the COVID-19 outbreak in Daegu, NEJM Catalyst Innovations in Care Delivery

Kim, Huh, Heo, Joo, Kim et al., Interim guidelines on antiviral therapy for COVID-19, Infection & chemotherapy, doi:10.3947/ic.2020.52.2.281

Kim, Roslin, Wang, Kane, Hirsch et al., BMI as a risk factor for clinical outcomes in patients hospitalized with COVID-19 in New York, Obesity, doi:10.1002/oby.23076

Kim, Sung, Kim, Kim, Clinical Relevance of Positive NOW™ Legionella Urinary Antigen Test in a Tertiary-Care Hospital in Korea, The Korean journal of laboratory medicine, doi:10.3343/kjlm.2006.26.2.93

Kumar, Kumar, Lee, A computational drug repurposing approach in identifying the cephalosporin antibiotic and anti-hepatitis C drug derivatives for COVID-19 treatment, Computers in biology and medicine, doi:10.1016/j.compbiomed.2020.104186

Li, Xie, Lin, Cai, Wen et al., Efficacy and safety of lopinavir/ritonavir or arbidol in adult patients with mild/moderate COVID-19: an exploratory randomized controlled trial, Med, doi:10.1016/j.medj.2020.04.001

Lin, Zhao, -S, Zhou, -X, Zhou F-C et al., Coronavirus disease 2019 (COVID-19): cytokine storms, hyper-inflammatory phenotypes, and acute respiratory distress syndrome, Genes & Diseases

Lofgren, Nicol, Bangdiwala, Pastick, Okafor et al., Safety of hydroxychloroquine among outpatient clinical trial participants for COVID-19

Mahe ´vas, Tran, Roumier, Chabrol, Paule et al., Clinical efficacy of hydroxychloroquine in patients with covid-19 pneumonia who require oxygen: observational comparative study using routine care data, Bmj, doi:10.1136/bmj.m1844

Manohar, Loh, Nachimuthu, Hua, Welburn et al., Secondary bacterial infections in patients with viral pneumonia, Frontiers in medicine, doi:10.3389/fmed.2020.00420

Matsunaga, Hayakawa, Terada, Ohtsu, Asai et al., Clinical Epidemiology of Hospitalized Patients With Coronavirus Disease

Min, Jang, Macrolide therapy in respiratory viral infections, Mediators of inflammation, doi:10.1155/2012/649570

Nio, Coronavirus disease 2019 (COVID-19) treatment guidelines

Park, Yu, Kim, Kim, Kim et al., Antiviral Efficacies of FDA-Approved Drugs against SARS-CoV-2 Infection in Ferrets, Mbio, doi:10.1128/mBio.01114-20

Petrilli, Jones, Yang, Rajagopalan, Donnell et al., Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study, Bmj, doi:10.1136/bmj.m1966

Rawson, Moore, Zhu, Ranganathan, Skolimowska et al., Bacterial and fungal coinfection in individuals with coronavirus: a rapid review to support COVID-19 antimicrobial prescribing, Clinical Infectious Diseases, doi:10.1093/cid/ciaa530

Rismanbaf, Potential treatments for COVID-19; a narrative literature review, Archives of Academic Emergency Medicine

Ritchie, Beltekian, Daily confirmed deaths: are we bending the curve

Rosenberg, Dufort, Udo, Wilberschied, Kumar et al., Association of treatment with hydroxychloroquine or azithromycin with in-hospital mortality in patients with COVID-19 in New York State, Jama, doi:10.1001/jama.2020.8630

Roso ´n, ´ndez-Sabe, Carratala, Verdaguer, Dorca et al., Contribution of a urinary antigen assay (Binax NOW) to the early diagnosis of pneumococcal pneumonia, Clinical Infectious Diseases, doi:10.1086/380639

Rubin, Multiple imputation for nonresponse in surveys

Schrezenmeier, Do ¨rner T, Mechanisms of action of hydroxychloroquine and chloroquine: implications for rheumatology, Nature Reviews Rheumatology, doi:10.1038/s41584-020-0372-x

Sharma, Singh, Banerjee, Antibacterial agents used in COVID-19: A systematic review and metaanalysis, Environmental Sustainability, doi:10.4103/ijp.ijp%5F839%5F21

Tang, Cao, Han, Wang, Chen et al., Hydroxychloroquine in patients with mainly mild to moderate coronavirus disease 2019: open label, randomised controlled trial, doi:10.1136/bmj.m1849

Tang, Godfrey, Stawell, Nikpour, Hydroxychloroquine in lupus: emerging evidence supporting multiple beneficial effects, Internal medicine journal, doi:10.1111/j.1445-5994.2012.02886.x

Townsend, Hughes, Kerr, Kelly, Connor et al., Bacterial pneumonia coinfection and antimicrobial therapy duration in SARS-CoV-2 (COVID-19) infection. JAC-Antimicrobial Resistance, doi:10.1093/jacamr/dlaa071

Tran, Sugamata, Hirose, Suzuki, Noguchi et al., Azithromycin, a 15-membered macrolide antibiotic, inhibits influenza A (H1N1) pdm09 virus infection by interfering with virus internalization process, The Journal of antibiotics, doi:10.1038/s41429-019-0204-x

Van Der Eerden, Vlaspolder, Graaff, Groot, Jansen et al., Value of intensive diagnostic microbiological investigation in low-and high-risk patients with community-acquired pneumonia, European Journal of Clinical Microbiology and Infectious Diseases, doi:10.1007/s10096-005-1316-8

Wang, Yang, Li, Wen, Zhang, Clinical features of 69 cases with coronavirus disease 2019 in Wuhan, China, Clinical infectious diseases, doi:10.1093/cid/ciaa272

Who, World Health Organization

Wu, Mcgoogan, Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention, Jama, doi:10.1001/jama.2020.2648

Yang, Yu, Xu, Shu, Liu et al., Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study, The Lancet Respiratory Medicine, doi:10.1016/S2213-2600%2820%2930079-5

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), Clinical Infectious Diseases

Ye, Luo, Xia, Sun, Ding et al., Clinical efficacy of lopinavir/ritonavir in the treatment of Coronavirus disease 2019, Eur Rev Med Pharmacol Sci, doi:10.26355/eurrev%5F202003%5F20706

Yeon Lee, Hong, Hyun, Park, Lee et al., Epidemiological and clinical characteristics of coronavirus disease 2019 in Daegu, South Korea, International Journal of Infectious Diseases, doi:10.1016/j.ijid.2020.07.017

You, Wu, -H, Fu, -N et al., The use of methylprednisolone in COVID-19 patients: A propensity score matched retrospective cohort study, PloS one, doi:10.1371/journal.pone.0244128

Yu, Sun, Shi, Wang, Zhao et al., SARS-CoV-2 viral load in sputum correlates with risk of COVID-19 progression, Critical care, doi:10.1186/s13054-019-2683-3

Zhao, He, Tang, Xie, Tang et al., The relationship between chest imaging findings and the viral load of COVID-19, Frontiers in Medicine, doi:10.3389/fmed.2020.558539

Zheng, Yu, Feng, Lou, Zou, Viral load dynamics and disease severity in patients infected with SARS-CoV-2 in Zhejiang province, doi:10.1136/bmj.m1443

Late treatment
is less effective

Please send us corrections, updates, or comments. c19early involves the extraction of 100,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. FLCCC and WCH provide treatment protocols.

Submit

Post

@CovidAnalysis

FAQ

Public domain CC0 1.0