Efficacy and safety of azithromycin compared to standard care/placebo

The information presented in the summary of findings table below comes from a living network meta-analysis that combines all the available evidence on drug therapies for COVID-19. This statistical approach allows us to obtain estimates of effect for all potential comparisons, even those that have not been compared head-to-head in trials. We present the most trustworthy estimates of effect, based on the GRADE approach.

Comparison of azithromycin to standard care/placebo:

Summary of Findings Table

Population: Patients with COVID-19 at any severity

Export to PDF
OutcomeN studies / participants with direct evidenceRelative effect estimatesAbsolute effect estimatesCertainty of the EvidencePlain language summarySource of highest certainty estimate
Mortality (closest to 90 days)8 RCTs;
10146 patients		Odds Ratio: 0.98
(95% CI 0.78 - 1.25)		Difference: 1 more per 1000
(95% CI 1 more to 1 more)		LOWDue to serious risk of bias, serious imprecision,Azithromycin may have little or no impact on mortality compared to standard care/placeboNMA
Mechanical ventilation (closest to 90 days)5 RCTs;
9282 patients		Odds Ratio: 0.93
(95% CI 0.67 - 1.27)		Difference: 1 more per 1000
(95% CI 1 more to 1 more)		LOWDue to serious risk of bias, serious imprecision,Azithromycin may have little or no impact on mechanical ventilation compared to standard care/placeboNMA
AE leading to discontinuation (within 28 days)1 RCTs;
111 patients		N/AN/ALOWDue to serious risk of bias, serious imprecision,Azithromycin may have little or no impact on adverse events compared to standard care/placeboNMA
Viral clearance closest to 7 days (± 3 days)0 RCTs; 0 patientsOdds Ratio: 0.02
(95% CI 0 - 0.12)		Difference: 0 fewer per 1000
(95% CI 0 fewer to 0 fewer)		VERY LOWDue to extremely serious imprecisionWe are very uncertain about the effect of azithromycin on viral cleareance compared to standard care/placebo

NMA1
Duration of mechanical ventilation (in days)
No data were reported for this outcome.
Length of hospital stay (in days)4 RCTs;
8178 patients		N/ADifference: 0 fewer days
(95% CI 4 fewer to 4 more)		LOWDue to serious risk of bias, serious imprecision,Azithromycin may have little or no impact on duration of hospitalization compared to standard care/placeboNMA
Time to symptom resolution2 RCTs;
1335 patients		Ratio of Means: 0.57
(95% CI 0.45 - 0.74)		Difference: 1 more days
(95% CI 0 fewer to 1 more)		LOWDue to serious risk of bias, serious inconsistencyAzithromycin may reduce time to symptom resolution compared to standard care/placeboNMA
Time to viral clearance (in days)1 RCTs;
206 patients		Ratio of Means: 0.66
(95% CI 0.45 - 0.96)		Difference: 1 more days
(95% CI 0 fewer to 1 more)		MODERATEDue to serious risk of biasAzithromycin probably reduces time to viral cleareance compared to standard care/placeboNMA
Length of intensive care unit stay (in days)
No data were reported for this outcome.
Admission to hospital (within 28 days)3 RCTs;
1618 patients		Odds Ratio: 1.08
(95% CI 0.57 - 2.29)		Difference: 1 more per 1000
(95% CI 1 more to 2 more)		VERY LOWDue to serious risk of bias, very serious imprecision,We are very uncertain about the effect of azithromycin on admission to hospital compared to standard care/placeboNMA
Mechanical ventilation-free days (within 28 days; in days)1 RCTs;
225 patients		N/ADifference: 2 fewer days
(95% CI 5 fewer to 0 fewer)		LOWDue to serious risk of bias, serious imprecisionAzithromycin may reduce ventilation-free days compared to standard care/placeboNMA

Abbreviations: AE, adverse events; 95% CI, 95% credible interval; NMA, network meta-analysis; N/A, not applicable; RCT, randomized control trial

GRADE Working Group grades of evidence

High certainty: We are very confident that the true effect lies close to that of the estimate of the effect.

Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.

Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect.

Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.

Footnotes:

  1. The guideline development group did not consider viral clearance, time to viral clearance, length of ICU stay, or mechanical ventilator-free days critical for decision-making. Therefore, we did not include these outcomes in the current update of our NMA. Evidence for these outcomes based on the previous iteration of the NMA can be viewed in this summary of findings table.

Questions or comments about the data you see on this page?

©2021 by COVID-19 Living Network Meta-Analysis Terms of Service