The Use of Azithromycin and Lopinavir-Ritonavir in the Treatment of COVID-19

Coronavirus disease 2019 (COVID-19) is a new type of disease first identified in 2019 which is caused by the Sars-CoV-2 virus that can cause illness with mild-to-severe symptoms. A common symptom of COVID-19-infected individuals is that of acute respiratory distress, such as fever, cough, and shortness of breath. COVID-19 causes pneumonia, acute respiratory syndrome, renal failure, and even, in severe cases, death. Clinical symptoms reported as presented by patients with this condition include fever, breathing difficulties, and double pneumonia affecting both lungs as confirmed by a patient’s X-ray results. Curative therapy can be administered using antiviral agents such as those drugs prescribed during the MERS and SARS pandemics, one being a combination of lopinavir/ritonavir. An antibiotic such as azithromycin is additionally utilized. The combination of these drugs has been studied through both in vitro and clinical trials; the results of which have confirmed its potential application as part of COVID-19 treatment therapy. In vitro tests conducted on Vero cells indicated that a combination of lopinavir/ritonavir and azithromycin is highly effective in inhibiting viral replication of the SARS-CoV-2 virus previously isolated from patients at Universitas Airlangga Hospital, Indonesia. In vitro studies of mesenchymal cells have confirmed the low cytotoxicity of this drug combination. Moreover, molecular docking studies have shown the effectiveness of the combination of lopinavir/ritonavir and azithromycin at several stages of the viral infection cycle. Clinical trials involving COVID-19 patients confirmed an accelerated improvement in their clinical symptoms and virus clearance with high levels of safety within kidney and liver function parameters. The combination of these drugs has also been shown to reduce the effect of IL-6 and TNF-α as pro-inflammatory markers, as well as an enhanced anti-inflammatory response characterized by an increase in IL-10 cytokines. The combination of lopinavir/ritonavir and azithromycin represents an effective drug combination for managing the COVID-19 virus or future viral pandemic outbreaks.