Covid-19 living Data

Pharmacologic treatments for covid-19 patients

Azithromycin vs Standard care/Placebo

This comparison will not be updated. Last search date 28 Feb, 2022.

Outpatients

Forest plots
(last update: 2022-04-29)

Summary of findings
(last update: 2022-05-10)

Patient or population: COVID-19 patients
Setting: Worldwide
Intervention: Azithromycin
Comparison: Standard care/Placebo

Outcome	Relative effect (95% CI)	Absolute effect (95% CI)¹		Certainty of the Evidence (GRADE)
Clinical improvement D28	Outcome not yet measured or reported
Clinical improvement D60	Outcome not yet measured or reported
Hospitalisation or death	RR: 0.83 (0.54 - 1.29)	9 fewer per 1000 (from 24 fewer to 15 more)		Very low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level: some concerns or high riak regarding missing data, and selection of the reported results Inconsistency: Not serious Indirectness: Not serious Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
3 trials Oldenburg CE, 2021; Hinks T, 2021; Butler C, 2021 1687 participants		Azithromycin 43 per 1,000 (28 - 67)	Standard care/Placebo 52 per 1,000
WHO progression score (level 7 or above) D28	RR: 0.67 (0.19 - 2.35)	3 fewer per 1000 (from 7 fewer to 12 more)		Very low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level: some concerns or high risk regarding deviation from intended intervention and missing data Inconsistency: Not serious Indirectness: Serious studies from a single country, therefore results in this population might not be generalizable to other settings. Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
2 trials Hinks T, 2021; Butler C, 2021 1424 participants		Azithromycin 6 per 1,000 (2 - 21)	Standard care/Placebo 9 per 1,000
WHO progression score (level 7 or above) D60	Outcome not yet measured or reported
All-cause mortality D28	RR: 1.01 (0.06 - 15.95)	0 fewer per 1000 (from 1 fewer to 17 more)		Low certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Not serious Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
3 trials Hinks T, 2021; Butler C, 2021; Oldenburg CE, 2021 1687 participants		Azithromycin 1 per 1,000 (0 - 18)	Standard care/Placebo 1 per 1,000
All-cause mortality D60	Outcome not yet measured or reported
Viral negative conversion D7	Outcome not yet measured or reported
Adverse events	RR: 2.32 (1.51 - 3.57)	273 more per 1000 (from 105 more to 531 more)		Moderate certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Not serious We presume that the adverse event rates and the corresponding relative risks, are similar across diverse settings, therefore not downgraded for indirectness Imprecision: Serious due to low number of participants/events
1 trials Oldenburg CE, 2021 263 participants		Azithromycin 479 per 1,000 (312 - 737)	Standard care/Placebo 207 per 1,000
Serious adverse events	RR: ( - )	Zero events in both groups		Low certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Not serious We presume that the adverse event rates and the corresponding relative risks, are similar across diverse settings, therefore not downgraded for indirectness Imprecision: Very serious no events in both groups and low number of participants
2 trials Hinks T, 2021; Oldenburg CE, 2021 558 participants		Azithromycin 0 per 1,000 ( - )	Standard care/Placebo 0 per 1,000

¹The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)

CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

Hospitalized patients

Forest plots
(last update: 2021-05-27)

Summary of findings
(last update: 2021-06-04)

Patient or population: COVID-19 patients
Setting: Worldwide
Intervention: Azithromycin
Comparison: Standard care/Placebo

Outcome	Relative effect (95% CI)	Absolute effect (95% CI)¹		Certainty of the Evidence (GRADE)
Clinical improvement D28	RR: 1.02 (0.99 - 1.05)	14 more per 1000 (from 7 fewer to 34 more)		Moderate certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Serious Indirectness downgraded by 1 level: despite a multicentre design this is a single study from a single country, therefore results in this population might not be generalizable to other settings. Imprecision: Not serious
1 trials Horby P, RECOVERY, 2020 7763 participants		Azithromycin 694 per 1,000 (674 - 714)	Standard care/Placebo 680 per 1,000
Clinical improvement D60	Outcome not yet measured or reported
WHO progression score (level 7 or above) D28	RR: 0.11 (0.01 - 1.98)	65 fewer per 1000 (from 72 fewer to 71 more)		Very low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level: some concerns regarding adequate randomization, deviation from intended intervention and selection of reported results Inconsistency: Not serious Indirectness: Serious single study from a single institution therefore results in this population might not be generalizable to other settings Imprecision: Very serious Imprecision downgraded by 2 level: due to wide confidence interval consistent with the possibility for benefit and the possibility for harm and very low number of participants and events
1 trials Sekhavati E, 2020 111 participants		Azithromycin 8 per 1,000 (1 - 144)	Standard care/Placebo 73 per 1,000
WHO progression score (level 7 or above) D60	Outcome not yet measured or reported
All-cause mortality D28	RR: 0.97 (0.89 - 1.06)	7 fewer per 1000 (from 24 fewer to 13 more)		High certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Not serious Imprecision: Not serious
2 trials Horby P, RECOVERY, 2020; Sekhavati E, 2020 7874 participants		Azithromycin 215 per 1,000 (198 - 235)	Standard care/Placebo 222 per 1,000
All-cause mortality D60	Outcome not yet measured or reported
Viral negative conversion D7	Outcome not yet measured or reported
Adverse events	Outcome not yet measured or reported
Serious adverse events	Outcome not yet measured or reported

¹The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)

CI: Confidence interval; RR: Risk ratio

To access all information :

click here for Outpatients
click here for Hospitalized patients

You can print it as a pdf. You can also click on each forest plot with your right mouse button and download.

Permanent URL for this comparison: https://covid-nma.com/living_data/index.php?comparison=31

Back to your research

Trial	Funding	Comparisons		Design	Participants	Sample size	Overall risk of bias Highest assessment	Full description
		Treatment 1	Treatment 2
NCT04332107 Oldenburg CE, JAMA, 2021 Full text Commentary Commentary	Mixed	Azithromycin	Placebo	RCT	Outpatients with confirmed COVID-19 (mild, asymptomatic and symptomatic) enrolled in the community in the USA.	N=263	Some concerns Details	Full description
NCT04381962 ATOMIC2 Hinks T, Lancet Respir Med, 2021 Full text 00263-0/fulltext Commentary Commentary	Mixed	Azithromycin	Standard care	RCT	Outpatients with suspected or confirmed COVID-19 (mild) treated at 19 centers in the UK.	N=295	Some concerns Details	Full description
ISRCTN86534580 ; EudraCT 2020-001209-22 PRINCIPLE Butler C, Lancet , 2021 Full text Commentary	Public/non profit	Azithromycin	Standard care	RCT	Outpatients with suspected or confirmed COVID-19 (mild) recruited in the community in the UK	N=1129	High Details	Full description
NCT04622891 Rashad A, Scientific Reports, 2021 Full text Full text Commentary Commentary	Public/non profit	Azithromycin Clarithromycin Azithromycin	Standard care Standard care Clarithromycin	RCT	Patients with confirmed COVID-19 (mild outpatients) treated at a single center in Egypt	N=305	N/A	Full description
NCT04381936 ; ISRCTN (50189673) RECOVERY (AZM) Horby P, Lancet, 2021 Full text Commentary Commentary	Mixed	Azithromycin	Standard care	RCT	Patients with suspected or confirmed COVID-19 (mild to critical) admitted to 176 centers in the UK	N=7763	Some concerns Details	Full description
IRCT20200415047092N1 Sekhavati E, Int J Antimicrob Age, 2020 Full text Commentary	Public/non profit	Azithromycin	Standard care	RCT	Patients with COVID-19 confirmed (moderate-severe) admitted to a single center in Iran	N=111	Some concerns Details	Full description