Coronavirus antimalarial and antibiotic?
During any viral epidemic, the media, the popularizers of evidence-based medicine and simply literate people do not tire of repeating that antibiotics do not work on viruses and are useless in viral infections. And sometimes not only useless, but also frankly harmful, because, taken without prescription and without need, contribute to the development of drug resistance in different inhabitants of our microbiota.
In the meantime, if you follow the public reaction to the current coronavirus epidemic, you may have noticed, for example, that some Italian citizens complained in social networks about doctors prescribing antibiotics to infected people. But "everyone knows that antibiotics for viral infection are useless." What is it? Don't doctors know what almost every journalist or Facebook user knows? The point is that, on the one hand, everything is true, antibiotics, as a rule, do not affect viruses, but, on the other hand, the rules have exceptions, clarifications and additions.
We have already mentioned hydroxychloroquine (trade name "Placquenil"), an antimalarial drug whose effectiveness against COVID-19 has been shown in a trial of 24 patients in Marseille. Interestingly, however, the best results according to this study are combined with the antibiotic azithromycin. Yes, exactly with the antibiotic.
Of course, during the pandemic, the news of a study with only 24 patients may not seem very convincing. So let us look at the context and try to understand the situation better.
* * * It is difficult to say whether an article about the study has been officially published. It is available as a pdf on the website of the Institut hospitalo-universitaire Méditerranée Infection (IHU Méditerranée Infection), Marseille, France, and at Google Docks. Under the publication is the DOI and please quote it as published on March 17, 2020 in the International Journal of Antimicrobial Agents. It is not yet on the website of the magazine itself. But a pandemic, that's the thing. Explaining why azithromycin, one of the scientists who conducted the test, Didier Raoult, Professor of Medicine at the IHU, was chosen for the test, said:
"We, like other doctors, have long advised to give antibiotics for viral respiratory infections, because the latter are often complicated by pneumonia. Therefore, we gave azithromycin to all patients who had clinical signs that the disease may progress to a complication in the form of bacterial pneumonia. One scientific publication reported that it reduces the risk in people with viral infections. Another reason is that a laboratory study has shown that azithromycin, although an antibiotic, is effective against a large number of viruses. So in choosing an antibiotic, we preferred one that is effective against viruses. And when we look at the test results after the combination of hydroxychloroquine and azithromycin, we see a very sharp decrease in the number of positive results.
A little bit about the antiviral activity of azithromycin. In 2016, PNAS published an article on a study that showed in testing 2177 compounds that azithromycin in human nerve cell culture inhibits the growth of Zeke virus virions and reduces the pathological effects of the virus.
A year later, the magazine Antimicrobial Agents and Chemotherapy published a letter from a group of Italian scientists who also write about the ability of azithromycin to destroy the Zeke virus in glial cells and in the culture of induced pluripotent cells in humans.
An article published in 2019 in The Journal of Antibiotics of Japan by a large team of authors argues that azithromycin is also effective against the pandemic influenza virus H1N1 - prevents the latter from entering the cell, as well as reducing its intracellular activity. According to the authors, a single intra-uterine application of azithromycin (i.e., in the form of spray or nose drops) successfully reduced viral load in the lungs and relieved hypothermia caused by the infection.
Given the known activity of azithromycin against other viruses and the fact that it is still quite often prescribed for viral infections (for the treatment and prevention of bacterial complications, in particular, in the recent Chinese report on the treatment of already COVID-19 mentioned that of 138 patients in the report 25 people received azithromycin), it would be logical to check its activity against the new coronavirus. Even if it was combined with another drug.
So, why did you choose azithromycin, I see. And why hydroxychloroquine? Where are the plasmodics it's designed to fight, and where are the viruses? Maybe it's because Dr. Raul has been doing hydroxychloroquine for a long time. Back in 2014, he was one of the authors of a paper on how prolonged treatment