What antibiotics kill Covid-19 (coronavirus)?
There are no antibiotics that kill the SARS-CoV-2 virus, the virus which causes COVID-19. Antibiotics work on bacteria to kill or slow their growth. COVID-19 is caused by a virus so you need an antiviral medicine to slow the virus's development.
Click here for information on COVID-19: Treatments and Vaccines
Azithromcyin and COVID-19
Azithromycin (Zithromax) is a macrolide antibiotic that was being investigated in clinical trials as a potential treatment for people with COVID-19, at the beginning of the COVID-19 pandemic. It was often trialed in conjunction with hydroxychloroquine. Hydroxychloroquine is not recommended for treatment of COVID-19 by the National Institutes of Health (NIH).
Scientists started studying Azithromycin, even though it was an antibiotic, as it was thought to also have antiviral effects, anti-inflammatory activity, be able to change the immune response and may work well with other antiviral treatments. In in vitro laboratory studies azithromycin has demonstrated antiviral activity against Zika virus and against rhinoviruses, which cause the common cold.
Results of many clinical trials show that azithromycin did not improve patients' health, when compared to standard COVID-19 treatments.
- The results of both the COALITION II Trial (NCT04321278) and the RECOVERY Trial (NCT04381936) showed that when treating hospitalized COVID-19 patients the addition of using azithromycin was not any better than just using standard care alone.
- The PRINCIPLE clinical trial, studied treating non hospitalized COVID-19 patients (outpatients) with azithromycin and results showed that azithromycin did not provide benefits in terms of reducing time to recovery or risk of hospitalization, when compared to standard COVID-19 treatment.
The NIH recommends against the use of antibacterial therapy (e.g., azithromycin, doxycycline) for non hospitalized COVID-19 patients unless there is another medical reason to prescribe an antibiotic.
The World Health Organisation (WHO) does not recommend azithromycin or other antibiotics to be used for COVID-19 in the 'Guideline Therapeutics and COVID-19: living guideline'.
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COVID-19 Pneumonia and Antibiotics
Part of the COVID-19 illness is viral lung infection (viral pneumonia). A small number of viral pneumonias can also develop a bacterial infection within the lung.
- The addition of the bacterial infection on top of the viral infection is called a secondary bacterial infection.
- If there is a secondary bacterial infection it may need to be treated with an antibiotic.
- If there is no bacterial infection, then antibiotics are not needed.
If treatment is required for a secondary bacterial infection then a range of antibiotics can be used such as:
- penicillins (ampicillin plus sulbactam [Unasyn],
- piperacillin plus tazobactam [Zosyn]),
- cephalosporins (ceftriaxone [Rocephin]Cefepime [Maxipime]),
- aminoglycosides (tobramycin)
- glycopeptides (vancomycin [Vancocin HCL])
Often a combination of two different antibiotics is used.
Bottom Line:
- Antibiotics do not kill the SARS-CoV-2 virus, the virus causes COVID-19.
- Antibiotics are used to treat bacterial infections.
- Azithromycin and other antibiotics are not recommended to treat COVID-19, unless they are being prescribed an antibiotic for a bacterial infection the patient currently has as well as COVID-19.
References
- World Health Organisation: Clinical management of COVID-19 patients: living guideline,23 November 2021 [Accessed December 1, 2021] https://app.magicapp.org/#/guideline/j1WBYn
- AHFS Assessment of Evidence for COVID-19-Related Treatments [Accessed December 1, 2021] https://www.ashp.org/-/media/assets/pharmacy-practice/resource-centers/Coronavirus/docs/ASHP-COVID-19-Evidence-Table.ashx
- Co-infections, secondary infections, and antimicrobial use in patients hospitalised with COVID-19 during the first pandemic wave from the ISARIC WHO CCP-UK study: a multicentre, prospective cohort study.[Accessed December 1, 2021] https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(21)00090-2/fulltext
- World Health Organization (WHO). Coronavirus disease (COVID-19) advice for the public: Myth busters. [Accessed December 1, 2021]. Available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters
- Michigan Medicine University of Michigan. Inpatient guidance for treatment of COVID-19 in adults and children. [Accessed December 1, 2021]. Available online at: http://www.med.umich.edu/asp/pdf/adult_guidelines/COVID-19-treatment.pdf
- Michigan Medicine University of Michigan. Treatment pathway for adult patients with pneumonia. [Accessed December 1, 2021]. Available online at: http://www.med.umich.edu/asp/pdf/adult_guidelines/Pneumonia_ADULT.pdf
- Iannetta M, Ippolito G, Nicastri E. 2017. Azithromycin shows anti-Zika virus activity in human glial cells. Antimicrob Agents Chemother 61:e01152-17. https://doi.org/10.1128/AAC.01152-17
- Gielen V, Johnston SL, Edwards MR. Azithromycin induces anti-viral responses in bronchial epithelial cells. European Respiratory Journal 2010 36: 646-654; DOI: 10.1183/09031936.00095809
- Schogler A, Kopf BS, Edwards MR et al. Novel antiviral properties of azithromycin in cystic fibrosis airway epithelial cells. European Respiratory Journal 2015 45: 428-439; DOI: 10.1183/09031936.00102014
- Gautret P, Lagier J-C, Parola P et al. (2020) Hydroxychloroquine and azithromycin as a treatment of COVID‐19: results of an open‐label non‐randomized clinical trial. International Journal of Antimicrobial Agents – In Press 17 March 2020 – DOI : 10.1016/j.ijantimicag.2020.105949
- Jun C, Danping L, Li L, et al. A pilot study of hydroxychloroquine in treatment of patients with common coronavirus disease-19 (COVID-19). Journal of Zhejiang University. [Accessed March 27, 2020]. DOI : 10.3785/j.issn.1008-9292.2020.03.03
- Effect of Hydroxychloroquine in Hospitalized Patients with Covid-19 [Accessed December 1, 2021] https://www.nejm.org/doi/full/10.1056/NEJMoa2022926
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