Vian Namanya* and Kalema Bashir Amza
Introduction: Worldwide the efficacy and safety of Azithromycin and 4-Aminoquinoline regimen in the treatment of COVID-19 has remained uncertain in both pregnant and other mothers. Pregnancy complications studies are still lacking, although a high preterm birth rate due to the combination of this regimen has been reported which is mostly caused by iatrogenic preterm birth owing to the diagnosis of COVID-19 principally preterm cesarean deliveries and perinatal transmission may occur but seems rare. There is lack of evidence reporting an increase in the incidence of congenital abnormalities, an increase in stillbirth or neonatal death (miscarriages), Fetal Growth Restriction (FGR) among pregnant mothers with COVID-19.
Aim: This study aimed at systematically reviewing studies regarding the use of Azithromycin and 4-Aminoquinoline based regimens in COVID-19 positive pregnant mothers.
Methods: This was asystematic literature review. A systemic search of articles was done on PubMed, TRIP, EPPI COVID Living Map, Web of Science, and medRxiv databases until 2020 using the keywords “COVID-19”, “SARS-CoV-2”, “coronavirus”, “hydroxychloroquine”, and “mortality”. Relevant articles were chosen for further evaluation based on a review of their titles and abstracts. In vivo and in vitro studies were included assessing the safety and effectiveness of Azithromycin and 4-aminoquinline for treatment of COVID-19 pregnant mothers.
Results: A total of 438 articles were screened and 12 eligible clinical studies (seven peer-reviewed and published studies and five non-peer-reviewed studies from pre-print servers were included) selected. A number of studies have established very good virological and clinical outcomes with 4-Aminoquinoline in particular HCQ therapy alone or in combination with Azithromycin among COVID-19 pregnant mothers. However, some studies have shown negative results with combination of HCQ treatment and Azithromycin among COVID-19 pregnant mothers.
Conclusion: In this systematic review, we have found that the results of effectiveness and safety of Azithromycin and 4-aminoquinoline combination in COVID-19 pregnant mothers as obtained from 12 eligible clinical studies, is not satisfactory, although many of these studies had major methodological limitations. Stronger evidence from well-designed robust randomized clinical trials is required before conclusively determining the role of Azithromycin and 4-aminoquinoline combination regimen in the treatment of COVID-19. Clinical prudence is required to advocate of Azithromycin and 4-aminoquinoline combination regimen as an unmitigated therapeutic armamentarium in pregnant mothers with COVID-19. Also, the potential of HCQ as a chemo-prophylactic agent against COVID-19 needs to be explored.
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