20 IN T E R N A L m E d Ic IN E ISSN 2413-6077. IJmmR 2021 Vol. 7 Issue 1 DOI 10.11603/ijmmr.2413-6077.2021.1.11814 CLINICAL OUTCOMES AND ADVERSE DRUG REACTIONS IN COVID-19 PATIENTS TREATED WITH HYDROXYCHLOROQUINE AND AZITHROMYCIN ALONE OR COMBINED *H. Rathi1, P. Rathi2, M. Biyani3 1 – RAJASTHAN UNIVERSITY OF HEALTH SCIENCES COLLEGE OF MEDICAL SCIENCES, JAIPUR (RAJASTHAN), INDIA 2 – MAHATMA GANDHI MEDICAL COLLEGE, JAIPUR (RAJASTHAN), INDIA 3 – SAWAI MAN SINGH MEDICAL COLLEGE, JAIPUR (RAJASTHAN), INDIA Background. Use of Hydroxychloroquine with or without Azithromycin is repurposed in SARS-CoV-2 in the absence of definitive treatment. Objective. To evaluate the association between the use of Hydroxychloroquine and Azithromycin when given alone or in combination on clinical outcomes and adverse drug reactions among lab confirmed SARS CoV-2 positive patients admitted in a COVID tertiary care hospital of a University Medical college. Methods. a retrospective observational comparative study was conducted. COVID-19 positive patients admitted in study hospital for management of COVID-19 were enrolled into the study. The patients were categorized into 4 treatment groups based on having received the following treatment during hospitalization: (A) Hydroxychloroquine with Azithromycin, (B) Hydroxychloroquine without Azithromycin (Hydroxychloroquine alone), (C) Azithromycin alone, and (D) Neither drug, defined as no receipt of either Hydroxychloroquine or Azithromycin in the record; other medications may have been dispensed. Results. 800 patients were enrolled. Mean±Standard deviation of duration of hospital stay (in days) for study Group A was 11.37±7.11, for Group B was 8.37±4.77, for Group C was 18.22 ± 5.69 and for Group D was 6.12±2.97. Mortality in Group A was 29.74%, Group B – 33.16%, Group C – 0% and in Group D – 1.32%. Conclusion. Among hospitalized patients with COVID-19 treatment, Group C was associated with good clinical outcome. However, the interpretation of these findings may be limited by the observational design. KEYWORDS: COVID-19; hydroxychloroquine; azithromycin; SARS CoV-2 International Journal of Medicine and Medical Research 2021, Volume 7, Issue 1, p. 20-27 copyright © 2021, TNMU, All Rights Reserved *Corresponding author: Heena Rathi, B.D.S, MSc. (med-phar- macology) 3rd year, RUHS College of Medical Sciences, Jaipur (Rajasthan), 302033, India. E-mail: drheenarathi@gmail.com Introduction In December 2019, several cases of pneu- monia like disease were reported in the Wuhan city of China [1, 2]. The World Health Organisation (WHO) named this disease COVID-19. The causative agent for COVID-19 is the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV2). SARS-CoV-2 is the newest of the family and is currently the cause of COVID-19 across the world [3]. Within months after its onset in China, this virus had spread involving most of the countries of the world. In March 2020, WHO declared it as a pandemic [4]. According to the recent available data by the end of December 2020, approximately 95 million populations worldwide and 10 million individuals in India have been diagnosed as COVID-19 positive. Until December 2020, the recovery rate in In- dian population was 95.77% while the mortality rate was 1.45 %. The sources of infection of SARS-CoV-2 are reported to be infected animal hosts and infected humans. Bats [7] are considered to be initial hosts of this virus strain [5]. Main modes of transmission for interhuman spread of SARS CoV-2 are respiratory droplets and contact transmission. Patients of COVID-19 commonly present with symptoms like fatigue, cough, fever, myalgia, and diarrhoea. Most of the people infected with the virus experience mild-to-moderate respiratory illness and recover without requiring any special treatment. However, elderly and those with underlying medical problems or diseases are more likely to develop serious illness. Research published till date has shown evidence that COVID-19 cause cytokine storm [6]. Some reports also revealed that patients of COVID-19 are associated with hyper inflammation and increased production of cytokines such as inter- leukin (IL)-1, 2, 6, 8, 10, and 17 [4, 7]. This may be the reason of tissue damage in the lungs of moderate to severely infected patients. Reports have also suggested that cytokine storm may H. Rathi et al. 21 IN T E R N A L m E d Ic IN E ISSN 2413-6077. IJmmR 2021 Vol. 7 Issue 1 cause cellular demise and tissue injury in cardiac system which may lead to cardiovascular arrest [5]. Conditions like ARDS and cardiac arrest require an emergent medical attention in an intensive care unit. Since no drug therapy has been specifically and conclusively established for the prevention, control, and cure at the time of its onset. So, several drugs have been repurposed to manage the rapidly deteriorating public health situation. Many initial researches published during the early months of 2020 had suggested that Hydroxychloroquine is highly effective in both prophylaxis and treatment of COVID-19 positive patients. In vitro studies have demonstrated that Chloroquine and Hydroxychloroquine can inhibit viral replication at multiple points in the initial phase of viral infection [8]. It is postulated to exert a direct antiviral activity by increasing intracellular pH resulting in decreased pha- golysosome fusion, impairing viral receptor glycosylation [9]. Various other studies showed the potential role of Azithromycin in treatment of COVID-19 patients. Azithromycin is a potent immuno- modulator with significant antiviral properties. Azithromycin, a macrolide antibiotic, has in- vitro antiviral properties such as decreased viral replication, blocking entrance into host cells, and a potential immunomodulating effect [10]. According to other researches, combination of both the drugs may be more effective in curing the disease but some have also contra- dicted this line of treatment and several studies have even supported the statement that combination of both is harmful to the patient because the combination may add or increase the severity of their adverse effects. All the above reasons led us to carry out this pilot study including drugs Hydroxychloroquine and Azithromycin. The aim of this study was to evaluate clinical outcome and adverse drug reactions among hospitalised laboratory confirmed COVID-19 positive patients treated with Hydroxychloroquine and Azithromycin either given alone or in combination. Methods This study received ethical approval from institutional ethics committee. Study design: A retrospective, observational, comparative study. Study population: All laboratory confirmed COVID-19 positive patients admitted in study hospital from March 2020 to July 2020. Sample size: COVID-19 positive patients have been admitted in study hospital for management of COVID-19. Out of these, all those patients, who matched the inclusion and exclusion criteria, were enrolled in the study. Inclusion and Exclusion criteria Inclusion criteria: 1. All laboratory confirmed COVID-19 posi- tive patients admitted in RUHS-HMS between March-July 2020. 2. Patients of both genders and above the age of 12 years old. Exclusion criteria: 1. Patients whose hospital stay was less than 5 days (due to any reason). 2. Incomplete case files. Study Groups: Patients were categorized into 4 treatment Groups based on having received the following treatment during hospitalization: (A) Hydroxychloroquine with Azithromycin, (B) Hydroxychloroquine without Azithro- mycin (Hydroxychloroquine alone), (C) Azithromycin alone, and (D) Neither drug, defined as no receipt of either Hydroxychloroquine or Azithromycin in the record; other medications may have been dispensed. Results A total of 800 case records of lab confirmed COVID-19 positive patients admitted to RUHS Hospital of Medical Sciences from March to July were reviewed and enrolled in the study. All the study Groups were compared via ANOVA test. This comparison included the parameters such as age, systolic blood pressure, diastolic blood pressure, SPO2, and duration of hospital stay. Mean±standard deviation of each parameter of all groups were calculated. The obtained results of ANOVA test for all the study groups has p value less than 0.05, which re- presents a higher significance for the study. Observations and results of this test is shown in Table 1. 1. Gender distribution of patients as per groups Results and observations obtained are presented in Fig. 1. 2. SPO2 distribution as per group Mean±Standard deviation of SPO2 for study Group A was 89.6±7.1, for Group B was 90.24±7.44, for Group C was 91.63±5.34 and for Group D was 96.12±3.62. Results and obser- vations obtained are presented in Fig. 2. H. Rathi et al. 22 IN T E R N A L m E d Ic IN E ISSN 2413-6077. IJmmR 2021 Vol. 7 Issue 1 3. Duration of Hospital stay distribution as per group Mean±Standard deviation of duration of hospital stay (in days) for the study Group A was 11.37±7.11, for Group B – 8.37±4.77, for Group C – 18.22±5.69 and for Group D – 6.12±2.97. Results and observations obtained are presented in Fig. 3. 4. Severity of illness in study population Severity of illness in study population in the study is classified as: Asymptomatic – flu-like symptoms, patients are not hospitalized, and recover at home. Mild symptoms – runny nose, sore throat, congestion, and dry cough. Moderate symptoms – high fever, tiredness and fatigue, and chest pain. Patients with severe symptoms – respiratory distress syndrome (shortness of breath, in- creased blood pressure, and decreased oxygen saturation). Patients in the critical stage – Severe Acute Respiratory Syndrome (SARS) (high fever, chest pain, and breathlessness). Patients with mild-moderate symptoms were categorized in one group and patients with severe symptoms and patients with critical stage were categorized in another group. Chi-square test was applied for evaluation which was 72.73, and p value for this was Table 1. ANOVA of the groups (N=800) Parameters ANOVA Significance Age 12.46 0.000001 Systolic BP 3.07 0.0271 Diastolic BP 3.01 0.02971 SPO2 (in %) 19.01 0.000001 Hospital Stay 103.03 0.000001 Fig. 1. Gender distribution of patients as per groups (N=800). Results and observations obtained are presented in Fig. 1. Fig. 1. Gender distribution of patients as per groups (N=800). 2. SPO2 distribution as per group Mean ± Standard deviation of SPO2 for study Group A was 89.6 ± 7.1, for Group B was 90.24 ±7.44, for Group C was 91.63 ± 5.34 and for Group D was 96.12 ± 3.62. Results and observations obtained are presented in Fig. 2. Fig. 2. Mean and SD of SPO2 (in %). 3. Duration of Hospital stay distribution as per group 69,0% 70,2% 56,6% 63,2% 31,0% 29,8% 43,4% 36,8% 0,0% 10,0% 20,0% 30,0% 40,0% 50,0% 60,0% 70,0% 80,0% Group A Group B Group C Group D Male Female Fig. 2. Mean and SD of SPO2 (in %). Results and observations obtained are presented in Fig. 1. Fig. 1. Gender distribution of patients as per groups (N=800). 2. SPO2 distribution as per group Mean ± Standard deviation of SPO2 for study Group A was 89.6 ± 7.1, for Group B was 90.24 ±7.44, for Group C was 91.63 ± 5.34 and for Group D was 96.12 ± 3.62. Results and observations obtained are presented in Fig. 2. Fig. 2. Mean and SD of SPO2 (in %). 3. Duration of Hospital stay distribution as per group 69,0% 70,2% 56,6% 63,2% 31,0% 29,8% 43,4% 36,8% 0,0% 10,0% 20,0% 30,0% 40,0% 50,0% 60,0% 70,0% 80,0% Group A Group B Group C Group D Male Female H. Rathi et al. 23 IN T E R N A L m E d Ic IN E ISSN 2413-6077. IJmmR 2021 Vol. 7 Issue 1 0.0000001, which was highly significant for our study. Severity of illness was highly significant with p-value 0.000001 (chi-square=72.73). Results and observations obtained are pre- sented in Fig. 4. 5. Comparison of the clinical outcome of all the groups on the basis of illness severity and presence or absences of co-morbidity (Table 2). 6. Adverse events observed during study Total numbers of adverse events observed in this study were 3. Two patients experienced itching over the body and they were associated to Group A and 1 patient of Group B experienced diarrhoea. Observations and results are shown in Table 3. Discussion For the evaluation of the treatment efficacy in our study two variables were examined. The first was the duration of hospital stay and the second was outcome (discharged or death). In the present study, duration of hospital stay for Group A was 8 days (IQR: 5-16), Group B – 7 days (IQR: 5-9), Group C – 18 days (IQR: 15-20), and Group D – 5 days (IQR: 5-6). The Mean±SD for Group A, B, C, D was 11.37±7.11, 8.37±4.77, 18.22±5.69, and 6.12±2.97 respectively. p value was 0.000001 and was highly significant. Group D had the shortest duration of hospital stay. Possible reasons for this could be that in Group D, 98.68% were mild-moderately ill. Also, SPO2 which was an important clinical feature in COVID-19 was maximum for Group D (median 97.5, IQR: 95-99, and mean±SD 96.12±3.62) with a p value of 0.000001. Therefore, we can infer that milder disease severity and least deranged clinical features in Group D may have resulted in faster recovery and a shorter duration of hospital stay. Another reason can be that in Group D only 14.47% patients were having underlying comorbidities. This could also be important factor since presence of co-mor- bidities is now known to adversely affect the course of illness. Fig. 3. Mean and SD of hospital stay (in days). Mean ± Standard deviation of duration of hospital stay (in days) for the study Group A was 11.37 ± 7.11, for Group B – 8.37 ± 4.77, for Group C – 18.22 ± 5.69 and for Group D – 6.12 ± 2.97. Results and observations obtained are presented in Fig. 3. Fig. 3. Mean and SD of hospital stay (in days). 4. Severity of illness in study population Severity of illness in study population in the study is classified as: Asymptomatic – flu-like symptoms, patients are not hospitalized, and recover at home. Mild symptoms – runny nose, sore throat, congestion, and dry cough. Moderate symptoms – high fever, tiredness and fatigue, and chest pain. Patients with severe symptoms – respiratory distress syndrome (shortness of breath, increased blood pressure, and decreased oxygen saturation). Patients in the critical stage – Severe Acute Respiratory Syndrome (SARS) (high fever, chest pain, and breathlessness). Patients with mild-moderate symptoms were categorized in one group and patients with severe symptoms and patients with critical stage were categorized in another group. Fig. 4. Distribution of illness severity (N=800). Chi-square test was applied for evaluation which was 72.73, and p value for this was 0.0000001, which was highly significant for our study. Severity of illness was highly significant with p-value 0.000001 (chi-square = 72.73). Results and observations obtained are presented in Fig. 4. Fig. 4. Distribution of illness severity (N=800). 5. Comparison of the clinical outcome of all the groups on the basis of illness severity and presence or absences of co-morbidity: Table 2. Comparison of clinical outcome among all groups A B C D Hosp ital stay Reco very Dea th Hosp ital stay Reco very Dea th Hosp ital stay Reco very De ath Hosp ital stay Reco very De ath Mild- moder ate comorb id patient s 16.1 27.03 % (N=30 ) 0% (N= 0) 8.3 13.67 % (N=29 ) 0% (N= 0) 18.94 88.46 % (N=69 ) 0% (N= 0) 6.9 13.33 % (N=10 ) 0% (N= 0) 111 212 78 75 121 174 28 1 0 50 100 150 200 250 Group A Group B Group C Group D Mild-moderate Severe H. Rathi et al. 24 IN T E R N A L m E d Ic IN E ISSN 2413-6077. IJmmR 2021 Vol. 7 Issue 1 Table 2. Comparison of clinical outcome among all groups A B C D H os pi ta l st ay Re co ve ry D ea th H os pi ta l st ay Re co ve ry D ea th H os pi ta l st ay Re co ve ry D ea th H os pi ta l st ay Re co ve ry D ea th Mild-mode- rate comorbid patients 16.1 27.03% (N=30) 0% (N=0) 8.3 13.67% (N=29) 0% (N=0) 18.94 88.46% (N=69) 0% (N=0) 6.9 13.33% (N=10) 0% (N=0) Mild-mode- rate patients without comorbidity 10.6 72.97% (N= 81) 0% (N=0) 8.4 86.32% (N=183) 0% (N=0) 8.25 11.53% (N=9) 0% (N=0) 6.3 86.66% (N=65) 0% (N=0) Severe comorbid patients 11.97 33.88% (N=41) 42.14% (N=51) 7.7 16.66% (N=29) 56.32% (N=98) 21.04 100% (N=28) 0% (N=0) 14 0% (N=0) 100% (N=1) Severe patients without comorbidity 7.9 9.09% (N=11) 14.8% (N=18) 8.2 9.77% (N=17) 17.24% (N=80) 0 0% (N=0) 0% (N=0) 0 0% (N=0) 0% (N=0) Table 3. Adverse events observed during study ADR Group A Group B Group C Group D Diarrhoea 0 1 0 0 Itching 2 0 0 0 NIL 230 385 106 76 Total 232 386 106 76 The longest duration of hospital stay was in Group C which was having Median 18, IQR: 15-20 and mean±SD for 18.22±5.69. Despite of having borderline SPO2 (Median 92, IQR:88-96 and mean±SD 91.63 ±5.34) with 73.58% patients of this Group being mild-moderately ill, still this Group had the longest duration of hospital stay. Possible reasons could be that 92.45% patients of this group were having underlying comor- bidities. Second variable which was observed in our study was clinical outcome. Two possible clinical outcomes were considered; recovered and discharged – meaning a good clinical outcome, and death -denoting a poor clinical outcome. Samia Arshad et. al [9] found in a retro spec- tive observational study that overall mortality was 18.1%, 20.1% by treatment with the com- bination of Hydroxychloroquine with Azith- romycin, 13.5% with Hydroxychloroquine alone, 22.4% with Azithromycin alone and 26.4% with neither drug. According to their results Hydroxychloroquine provided 66% hazard ratio reduction and Hydroxychloroquine with Azith- romycin 71% compared to neither treatment (p<0.001). In the present study good clinical outcome was observed in Group C. In Group C 100% of the patients were discharged whether in Group A only 66.37% were discharged. Various factors could cause this. Chi square test was applied to measure the significance of illness severity in the population. Results of this test showed p=0.000001, it means severity of illness was highly significant. In Group C 98.68% patients were mild moderately ill and only 1.34% were severely ill. Another reason could be that SPO2 as SPO2 was 91.63±5.34 (p value 0.000001), which showed high significance. It may have led to decreased mortality in this Group. To validate this overall result sub-Group analysis was performed. Thus it was established that in the patients, who were mild to moderately ill with comorbidities, maximum recovery or good clinical outcome were observed in Group C (88.46%). Similarly, when severely ill comorbid patients were evaluated again maximum re- covery or good clinical outcome were observed in Group C (100%). It was also observed that in both groups of comorbidities (mild-moderate and severe) the longest duration of hospital stay was in Group C. In Group C the mean of H. Rathi et al. 25 IN T E R N A L m E d Ic IN E ISSN 2413-6077. IJmmR 2021 Vol. 7 Issue 1 hospital stay for mild-moderate comorbid patients was 18.24 and for severely ill co-morbid patients it was 21.04. It proved that in our study effective treatment in the co-morbid patients was observed in Group C among all patients but it took more time to recover comparatively to other groups. However, in patients without co-morbidities maximum recovery was evidenced in Group B. For Group B patients, who were mild-moderately ill with no co-morbidities, recovery was 86.32% and for severely ill without co-morbidity, re- covery was 9.77%. In Group D recovery in mild- moderate non-co-morbid patients was 86.6%, which was slightly higher than in Group B, but for severely ill non-comorbid patients, recovery rate was higher in Group B. So, the overall recovery for non-comorbid patients was higher in Group B. The duration of hospital stay for mild-moderately ill Group B patients with comorbidities was 8.3 and for patients without comorbidities it was 8.4. For severely ill Group B patients with comorbidities it was 7.7 and for patients without comorbidities – 8.2. This data also revealed that patients of Group B without comorbidities had longer duration of hospital stay than the non-co-morbid patients. Poor clinical outcome was measured by number of deaths. The highest mortality was observed in Group B with 33.16% death. Factors which influenced this result could be that 70.2% of patients of this Group were males. Males were more prone to lung infection due to their habits like smoking. Smoking habit is associated with males in Indians comparative to females. Therefore, this could be a reason for a greater number of deaths. In this Group 45.07% patient were severely ill. So, risk was higher for them compare to mild-to-moderate ill patients. 40.9% patients with underlying comorbidities were present in this Group which can have led to poor clinical outcome. Sub-Group analysis revealed that there were no deaths in mild-moderately ill patients in both co-morbid and non-co-morbid groups. All the deaths were associated with severely ill patients. The highest mortality among all severely co-morbid patients was associated with Group D, which was 100%. There were no patients in Group D with non-co-morbidity. After that, the maximum deaths of non-co- comorbid patients were seen in Group B (17.24%). Results of our study revealed that Group C treatment in comorbid patients were more effective and similar treatment in Group D was not safe. Recovery ratein mild-moderately ill comorbid patients was higher (27.03%) in the Group A compare to Group B (13.67%). However, in mild-moderately ill non-co-morbid patients, higher recovery was observed in Group B (86.32%) compared to Group A (72.97%). In severely ill co-morbid patients decreased mortality (42.14%) and increased recovery (33.88%) was seen in Group A compare to Group B, where mortality was 56.32% and recovery was 16.66%. In non-co-morbid severely ill patients, recovery in both groups (A – 9.09% and B – 9.77%) was almost the same but mortality was lesser in Group A (14.80%) compare to Group B (17.24%). These findings revealed that on the whole Group C treatment was the best among all and among groups A and B, Group A was better than B. Similar results have been shown in the study by Matthieu Million et. al [11]. They also conducted a retrospective analysis of early treatment of COVID-19 patients with Hydro- xychloroquine and Azithromycin. A poor clinical outcome was observed in 4.3%. They concluded that this combination was safe and associated with low fatality rate in patients. Adverse events distribution in the study In the present study safety of the treatment was also observed by adverse events. Very few adverse events were reported and they were mild which were associated with Group A and B. Reason for this is because of retrospective study, we are unable to analyse all those events which were not mentioned in case record files. Conclusion The present study concluded that no deaths were observed in mild-moderately ill patients with or without comorbidity. Among four groups, treatment in Group C (Azithromycin- 500 mg OD for 5 days) had better results. Between groups A (Hydroxychloroquine with Azithromycin) and B (alone Hydroxychloroquine 400 mg BD on day 1 followed by 200 mg BD on day 2 to 5), treatment in Group A had better outcome. The duration of hospital stay was longer for comorbid patients compare to patients with no comorbidity. Limitations Though, we did our best to make this study without any blemish but several limitations make the scope for future study. It was a retrospective observational study. Therefore, regarding the data we had to rely on the case records and the mentioned records. There might be a few findings which were not H. Rathi et al. 26 IN T E R N A L m E d Ic IN E ISSN 2413-6077. IJmmR 2021 Vol. 7 Issue 1 mentioned in the records but may have been present in the patients. We could not note them. Time constraint was the major limitation. So, we were unable to analyse the data on the basis of each sub-group. The data were incomplete for some patients because services were overwhelmed. CT scans, ECG and potential cofounders such as inflammatory markers associated with severity of the disease were not frequently measured/recorded. Mortality was limited to in-hospital death and patients, who were discharged or referred, were assumed to still be alive during study period. Because of retrospective analysis, we were not able to record all adverse events. Therefore, the evaluation of the safety was not adequate. For this, prospective randomized controlled trials may have been conducted at that time. Conflict of interest Authors declare no conflict of interest. Acknowledgment There had been no funding supports for this research. The total cost of completing the research work was carried by authors own finance. Author’s contribution Heena Rathi, Priyanka Rathi – concep- tualization, methodology, formal analysis, writing – original draft; Heena Rathi, Mohit Biyani – data curation, investigation; Heena Rathi, Priyanka Rathi, Mohit Biyani – writing, reviewing and editing. НАСЛІДКИ ТА ПОБІЧНІ РЕАКЦІЇ ПРИ ЛІКУВАННІ ПАЦІєНТІВ З COVID-19 ГІДРОКСИХЛОРОХІНОМ ТА АЗИТРОМІЦИНОМ ОКРЕМО ТА В КОМБІНАЦІЇ *H. Rathi1, P. Rathi2, M. Biyani3 1 – RAJASTHAN UNIVERSITY OF HEALTH SCIENCES COLLEGE OF MEDICAL SCIENCES, JAIPUR (RAJASTHAN), INDIA 2 – MAHATMA GANDHI MEDICAL COLLEGE, JAIPUR (RAJASTHAN), INDIA 3 – SAWAI MAN SINGH MEDICAL COLLEGE, JAIPUR (RAJASTHAN), INDIA Вступ. Застосування гідроксихлорохіну самостійно або у комбінації з азитроміцином – одна з опцій терапії SARS-CoV-2 за відсутності чітко визначеного лікування. Мета. Оцінити вплив застосування гідроксихлорохіну та азитроміцину у якості монотерапії чи у комбінації на клінічні результати та частоту розвитку побічних реакцій серед пацієнтів з лабораторно підтвердженої інфекцією SARS-CoV-2, які були госпіталізовані до спеціалізованої COVID-лікарні при медичному коледжі університету. Методи. Було проведене ретроспективне спостережне порівняльне дослідження. У дослідженні брали участь госпіталізовані пацієнти з лабораторно підтвердженим діагнозом COVID-19. Пацієнти були розділені на 4 групи, базуючись на лікуванні яке вони отримували під час госпіталізації: (A) гідроксихлорохін з азитроміцином, (B) гідроксихлорохін без азитроміцину (лише гідроксихлорохін), (C) лише азитроміцин та (D) жоден з препаратів не призначався; могли застосовуватися інші ліки. Результати. Було залучено 800 пацієнтів. Середнє значення±стандартне відхилення тривалості перебування в лікарні (у днях) для досліджуваної групи А становило 11,37±7,11, для групи В – 8,37±4,77, для групи С – 18,22±5,69 та для групи D – 6,12±2,97. Смертність у групі A становила 29,74%, групі B – 33,16%, групі C – 0%, а групі D – 1,32%. Висновок. Серед госпіталізованих пацієнтів з COVID-19 лікування у групі С (лише азитроміцин) було пов'язане з позитивними клінічними результатами. Однак інтерпретувати висновки остаточно неможливо через обмеження і рамки проведеного дослідження. КЛЮЧОВІ СЛОВА: COVID-19; гідроксихлорохін; азитроміцин; SARS-CoV-2. Information about the authors Heena Rathi, B.D.S, MSc. (med-pharmacology) 3rd year, Rajasthan University of Health Sciences College of Medical Sciences, Jaipur, India ORCID 0000-0002-8056-8768, e-mail: drheenarathi@gmail.com Priyanka Rathi, Associate Professor, Mahatma Gandhi Medical College and Hospital, Jaipur, India ORCID 0000-0002-6400-6888, e-mail: drpriyankarathi@gmail.com Mohit Biyani, M.B.B.S, M.D (Anaesthesia) 3rd year, Swai Man Singh Medical College, Jaipur, India ORCID 0000-0002-5543-6480, e-mail: mohit2.ncity@gmail.com H. Rathi et al. 27 IN T E R N A L m E d Ic IN E ISSN 2413-6077. IJmmR 2021 Vol. 7 Issue 1 References 1. Lai CC, Shih TP, Ko WC, Tang HJ, Hsueh PR. Severe acute respiratory syndrome coronavirus 2 ( S A R S - C o V - 2 ) a n d c o ro n a v i r u s d i s e a s e - 2 0 1 9 (COVID-19): The epidemic and the challenges. Int J Antimicrob Agents 2020 Feb 17:105924. DOI: 10.1016/j.ijantimicag.2020.105924. 2. Wang LS, Wang YR, Ye DW, Liu QQ. A review of the 2019 Novel Coronavirus (COVID-19) based on current evidence”. 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