Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan.
Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan.
Respir Med. 2024 Nov-Dec;234:107834. doi: 10.1016/j.rmed.2024.107834. Epub 2024 Oct 10.
Azithromycin has favorable effects on critical respiratory diseases owing to its antimicrobial and anti-inflammatory properties. During the early stages of the coronavirus disease 2019 (COVID-19) pandemic, azithromycin was frequently administered before specific treatments were developed. However, the efficacy of this treatment has not been verified. We retrospectively investigated the effects of its intravenous (IV) administration in patients with severe/critical COVID-19 using the National Administrative Database of Japan during the first wave (February-April 2020).
Patients were categorized based on whether they received IV azithromycin within three days of hospitalization. An overlap weighting method with estimated propensity scores was used to reduce bias.
Among the 830 patients with severe/critical COVID-19, 148 (17.8 %) received azithromycin, and 682 (82.2 %) did not. After adjustment, the use of azithromycin was associated with a shorter duration of intensive care unit (ICU) management (-3.48 days, 95 % confidence interval [CI]: 4.59 to -2.38). However, other endpoints, including mortality rate, duration of mechanical ventilation, and duration of hospital stay, did not suggest any associations. Furthermore, of the 115 ICU patients, 27 (23.5 %) were treated with IV azithromycin and 88 (76.5 %) were not. After adjustment, azithromycin was associated with favorable outcomes, including reduced in-hospital mortality (odds ratio [OR], 0.45, 95 % CI: 0.22 to 0.92), 30-day mortality (OR, 0.46, 95 % CI: 0.22 to 0.94), and a shorter duration of ICU management (-2.94 days, 95 % CI: 5.15 to -0.73).
We verified that IV azithromycin was associated with favorable impact in patients with COVID-19 requiring ICU management.
阿奇霉素具有抗菌和抗炎特性，因此对严重呼吸道疾病有良好的疗效。在 2019 年冠状病毒病（COVID-19）大流行的早期阶段，在开发出特定疗法之前，经常使用阿奇霉素进行治疗。但是，这种治疗的疗效尚未得到验证。我们使用日本国家行政数据库在第一波（2020 年 2 月至 4 月）期间回顾性研究了静脉注射（IV）阿奇霉素治疗严重/危重症 COVID-19 患者的效果。
根据患者住院后三天内是否接受 IV 阿奇霉素治疗，将患者进行分类。采用估计倾向评分的重叠加权法来减少偏倚。
在 830 例严重/危重症 COVID-19 患者中，148 例（17.8％）接受了阿奇霉素治疗，682 例（82.2％）未接受阿奇霉素治疗。调整后，使用阿奇霉素与 ICU 管理时间缩短有关（-3.48 天，95％置信区间[CI]：4.59 至-2.38）。但是，其他终点，包括死亡率，机械通气时间和住院时间，均未提示任何关联。此外，在 115 例 ICU 患者中，27 例（23.5％）接受了 IV 阿奇霉素治疗，88 例（76.5％）未接受 IV 阿奇霉素治疗。调整后，阿奇霉素与有利的结局相关，包括降低院内死亡率（比值比[OR]，0.45，95％CI：0.22 至 0.92），30 天死亡率（OR，0.46，95％CI：0.22 至 0.94）和 ICU 管理时间缩短（-2.94 天，95％CI：5.15 至-0.73）。
我们证实静脉注射阿奇霉素可改善需要 ICU 管理的 COVID-19 患者的预后。
