Azithromycin, an antibiotic with potential antiviral and anti-inflammatory properties, has been used to treat COVID-19, but evidence from community randomised trials is lacking.
Azithromycin might increase the pH of the Golgi network and recycling endosome, which could in turn interfere with intracellular SARS-CoV-2 activity and replication. The drug might also reduce levels of the enzyme furin;4 this could interfere with the ability of SARS-CoV-2 to enter cells, as the virus is believed to have a furin-like cleavage site in the spike protein.5 The ability of azithromycin to reduce the levels of proinflammatory cytokines, such as IL-6,6 could reduce the ability of SARS-CoV-2 infection to trigger a cytokine storm, along with associated tissue damage. Furthermore, some patients with viral respiratory illness might develop a secondary bacterial infection or present with a bacterial co-infection, which azithromycin could effectively treat. Azithromycin use in primary care has increased during the COVID-19 pandemic, which could contribute to antimicrobial resistance.
Source: Lancet