Hydroxychloroquine azithromycin combined with zinc sulfate can effectively treat COVID-19.
According to American medical experts, hydroxychloroquine+Azithromycin+Zinc Sulfate can treat patients with mild COVID-19 infection.
Interpretation of popular science:
On March 28th, 2020, Dr. Vladimir Zelenko from new york published the clinical application: 350 patients with coronavirus pneumonia-19 were successfully cured by the combined application of hydroxychloroquine, azithromycin and zinc sulfate, and the success rate was 100%. At one time, there was a constant debate about the curative effect of hydroxychloroquine, azithromycin and zinc sulfate on coronavirus pneumonia-19. So can the combination of hydroxychloroquine, azithromycin and zinc sulfate effectively treat patients with mild COVID-19?
1, hydroxychloroquine
Speaking of hydroxychloroquine, we need to talk about chloroquine first. Chloroquine is widely used in anti-malaria and autoimmune diseases, and has broad-spectrum antiviral effect. By changing the intracellular PH value, it inhibits virus replication that depends on pH value, thus playing a direct antiviral role. In addition, chloroquine can effectively block the infection of SARS-CoV in cell lines. The National Health and Wellness Committee recommended chloroquine phosphate to treat patients with coronavirus pneumonia-19 in the novel coronavirus Diagnosis and Treatment Plan (Trial 6th Edition), and updated its application method in the 7th edition of the diagnosis and treatment plan.
Hydroxychloroquine sulfate adds a hydroxyl group to chloroquine, which has the same curative effect as chloroquine and lower toxicity. It is one of the drugs with potential curative effect on coronavirus pneumonia-19 at present. Zhang et al. included 20 patients in the "hydroxychloroquine+basic treatment group" and found that the clinical symptoms of patients were obviously improved 1-2 days after hydroxychloroquine treatment. The results of this clinical trial preliminarily confirm that hydroxychloroquine has short-term efficacy in relieving symptoms, reversing the severity rate and shortening the course of COVID-19. Dr. Chen Jun and others collected 30 patients with common coronavirus pneumonia-19, and conducted a single-center, prospective, random and open study. It was found that patients with common coronavirus pneumonia-19 had a better prognosis after using hydroxychloroquine. However, it is difficult to compare the efficacy of the drugs in the study with the virus negative rate and severe rate as the main end points. Follow-up research needs to determine a more suitable population and endpoint, and fully consider the sample size.
It is worth noting that studies have shown that long-term and large-scale use of hydroxychloroquine will lead to severe retinopathy and potential cardiotoxicity. In addition, hydroxychloroquine's indication is immune system diseases, and its inhibitory effect on the immune system should be fully considered when treating COVID-19 patients.
Although the US FDA issued an emergency authorization on March 29th, 2020, allowing hydroxychloroquine to be used in the treatment of coronavirus pneumonia-19, authorities such as the US FDA, the US CDC (Center for Disease Control and Prevention) and WHO all think that the effect of hydroxychloroquine on COVID-19 needs further study, and the drug has the risk of serious side effects, so it should not be used as a specific drug, and it is not recommended to use it alone. On April 10, the French Medical Safety Bureau also issued a warning on the side effects of taking hydroxychloroquine to treat COVID-19, especially hydroxychloroquine's adverse reaction to the heart. Therefore, the use of hydroxychloroquine in the treatment of COVID-19 should be very cautious.
2. Azithromycin
Azithromycin is a second-generation macrolide antibiotic, which mainly inhibits the directed protein synthesis dependent on ribonucleic acid (RNA), thus hindering the process of bacterial peptide transfer and achieving antibacterial effect. Studies have shown that azithromycin also has anti-inflammatory and immunomodulatory effects, and can be used for adjuvant treatment of some infectious or non-infectious diseases. Therefore, azithromycin can play a certain role in treatment and adjuvant therapy when the immunity of infected people in COVID-19 is low or there are many infections such as Gram-positive cocci, mycoplasma, chlamydia and Legionella pneumophila.
Other studies show that azithromycin has antiviral activity in vitro and can resist novel coronavirus, but its mechanism is not clear, which may be related to the fact that azithromycin can change the pH value of ribosomes or lysosomes and inhibit virus replication dependent on pH value. This mechanism is similar to that of hydroxychloroquine, so azithromycin combined with hydroxychloroquine may have complementary antiviral effects. However, more research is needed to verify it.
3. Zinc sulfate
Zinc participates in the synthesis and activation of many enzymes, and plays an important physiological role in protein, nucleic acid synthesis, absorption and digestion of intestinal protein. Zinc sulfate is mainly used for various diseases caused by zinc deficiency. Early studies showed that zinc ions had antiviral effects in vitro and in vivo, which could inhibit the replication of human rhinovirus, respiratory syncytial virus and HIV- 1, while other studies showed that chloroquine could promote the transport of zinc ions into cells, so hydroxychloroquine probably had the same effect. Whether azithromycin has a similar effect remains to be studied.
Therefore, when azithromycin, hydroxychloroquine and zinc sulfate are combined to treat COVID-19 patients, there may be a combined antiviral effect. However, this effect needs more in-depth research to confirm.
On March 20th, 2020, Didier, a French scientist, published a paper in the International Journal of Antimicrobial Drugs, demonstrating the effect of hydroxychloroquine and Azithromycin in the treatment of coronavirus pneumonia-19. However, on April 3, the International Association of Antibacterial Biochemistry said that the results of non-randomized clinical trials of hydroxychloroquine and Azithromycin in the treatment of COVID-19 did not meet the industry standards, and the relevant papers were revoked.
In a word, there is no specific medicine in COVID-19 at present. The efficacy and safety of hydroxychloroquine, azithromycin and zinc sulfate in the treatment of coronavirus pneumonia-19 need more large-scale randomized controlled clinical trials and scientific experimental design to confirm.
Rumor expert: Wang Yu, pharmacist in charge of Qilu Children's Hospital of Shandong University.
Expert: Wu Xuexin, Chief Pharmacist of Qilu Children's Hospital of Shandong University.
References:
1, Chen Jun, Liu Danping, Xu Qingnian, Ling Yun, Song Shuli, Qian Zhiping, Shen, Lu Hongzhou. Preliminary study on the treatment of common coronavirus disease (coronavirus pneumonia-19) with hydroxychloroquine sulfate.
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2. Zhang Sailong, Miao. Pharmacological characteristics of chloroquine and hydroxychloroquine and therapeutic application of novel coronavirus (coronavirus pneumonia-19) [J/OL]. China Journal of Pharmacology and Toxicology.
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4. Clinical pharmacological viewpoint of azithromycin antiviral activity and its application in coronavirus pneumonia-19. Damle B 1，Vourvahis M 1，Wang E2，Leaney，B4。 Clinical pharmacological treatment in April 2020 65438 +07. doi: 10. 1002/CPT . 1857。 [Epub before printing]
5. Qiu Min. Study on the mechanism of zinc ionophore against herpes simplex virus and preliminary discussion on the relationship between ubiquitin proteasome pathway and virus replication [D]. Nanjing University, 20 14.