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International Journal of Antimicrobial Agents Available online 26 October 2020, 106214

COVID-19 outpatients – early risk-stratified treatment with zinc plus low dose hydroxychloroquine and azithromycin: a retrospective case series study

AUTHORS: Roland Derwand[1], Martin Scholz[2], Vladimir Zelenko[3]

[1] * Alexion Pharma Germany GmbH, 80687 Munich, Germany
[2] * Heinrich-Heine-University, Düsseldorf, 40225 Düsseldorf, Germany
[3] * Practice, 10950 Monroe, New York, USA

Highlights

•: First COVID-19 outpatient study based on risk stratification and early antiviral treatment at the beginning of the disease
•: Hydroxychloroquine at low dose in combination with zinc and azithromycin proved to be an effective therapeutic approach against COVID-19
•: Significantly reduced hospitalization rates in the treatment group
•: Reduced mortality rates in the treatment group

ABSTRACT

Objective

To describe outcomes of patients with coronavirus disease 2019 (COVID-19) in the outpatient setting after early treatment with zinc, low dose hydroxychloroquine, and azithromycin (triple therapy) dependent on risk stratification.

Design

Retrospective case series study.

Setting

General practice.

Participants

141 COVID-19 patients with laboratory confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in the year 2020.

Main outcome measures

Risk-stratified treatment decision, rate of hospitalization and all-cause death.

Results

After 4 days (median, IQR 3-6, available for N=66/141) of onset of symptoms, 141 patients (median age 58 years, IQR 40-67; 73% male) received a prescription for the triple therapy for 5 days. Independent public reference data from 377 confirmed COVID-19 patients of the same community were used as untreated control. 4 of 141 treated patients (2.8%) were hospitalized, which was significantly less (p<0.001) compared with 58 of 377 untreated patients (15.4%) (odds ratio 0.16, 95% CI 0.06-0.5). One patient (0.7%) died in the treatment group versus 13 patients (3.5%) in the untreated group (odds ratio 0.2, 95% CI 0.03-1.5; p=0.12). There were no cardiac side effects.

Conclusions

Risk stratification-based treatment of COVID-19 outpatients as early as possible after symptom onset with the used triple therapy, including the combination of zinc with low dose hydroxychloroquine, was associated with significantly fewer hospitalizations.

Keywords

SARS-CoV-2

COVID-19

outpatients

zinc

hydroxychloroquine

azithromycin

^#: Derwand R and Scholz M contributed equally to the article.

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