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Authors: Gautret et al

Link to paper: https://www.sciencedirect.com/science/article/pii/S1477893920301319?via%3Dihub

Journal/ Pre-Print: Travel Medicine and Infectious Disease

Key Words: hydroxychloroquine; azithromycin; clinical study

Research Highlights 

1. The authors treated 80 patients with hydroxychloroquine and azithromycin, 78 of which recovered

2. Viral shedding is reduced following co-treatment when compared to other studies

Summary 

The authors set out to observe the effect of hydroxychloroquine and azithromycin co-treatment on patients admitted to hospital for COVID-19. The study included individuals of all age groups and with pre-existing conditions in some cases. Co-treatment led to 93% of patients having undetectable levels of the virus on day 8. 78 of 80 patients recovered, with one patient still in ICU and one death reported in the cohort. The investigators argue that hydroxychloroquine and azithromycin co-treatment can reduce viral shedding, hindering viral transmission, and facilitating recovery. However, future controlled studies will be needed to highlight the suggested positive impact of co-treatment.

Impact for SARS-CoV2/COVID19 research efforts

Clinical symptoms and pathogenesis of SARS-Cov2/COVID19: the authors note the clinical symptoms and pre-existing conditions of their 80-person COVID-19 cohort.

Inhibit of SARS-CoV2/COVID19 transmission: the study suggests that hydroxychloroquine and azithromycin co-treatment reduces viral shedding when compared with other studies.

Treatment of SARS-CoV2/COVID19 positive individuals: the investigators suggest that hydroxychloroquine and azithromycin co-treatment can expedite and have a positive impact on recovery.

Study Type

· Clinical Cohort study (e.g. drug trials)

· Patient Case study

Strengths and limitations of the paper

Novelty: The authors observe reduced viral shedding and increased recovery rates compared to what is reported in the literature following treatment with hydroxychloroquine and azithromycin.

Standing in the field: Compared to other studies, viral shedding was reduced with the use of hydroxychloroquine and azithromycin in this cohort. However, a different study (Molina, Medecine et Maladies Infectieuses, 2020) of 11 patients did not conclude a benefit with co-administration. A randomized, controlled, and ideally double-blinded study will be required to draw conclusions about the efficacy of the combination of hydroxychloroquine and azithromycin in COVID-19 patients.

Appropriate statistics: Yes

Viral model used: N/A

Translatability: The findings are translatable, the authors recommend the combination of hydroxychloroquine and azithromycin to treat COVID-19 patients.

Main limitations:

1. While the authors compare their cohort findings to literature, they have no controls.

2. The criteria for inclusion in the study are not stated.

3. The authors do not expand on which patients had adverse events (death or ICU) or took longer to recover with respect to pre-existing conditions. It would also be interesting to note the drugs patients were already on for their pre-existing conditions.

4. Lack of follow-up after discharge and criteria for discharge changed during the study to deal with increasing hospital admissions.

5. Rather arbitrary rubric for assessing clinical improvement of patients; does not facilitate contextualisation of patients with respect to presenting condition.