Early hydroxychloroquine and azithromycin as combined therapy for COVID-19: a case series


Siswanto Siswanto(1), Oktaviarum S. Utama(2), Agit S. Adisetiadi(3), Maria E. Pranasakti(4), Mohamad Saifudin Hakim(5*)

(1) Department of Pulmonology and Respiratory Medicine, Academic Hospital, Department of Physiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta
(2) Department of Pulmonology and Respiratory Medicine, Academic Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta
(3) Department of Internal Medicine, Academic Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta
(4) Department of Internal Medicine, Academic Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta
(5) Department of Microbiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta
(*) Corresponding Author


Coronavirus disease 2019 (COVID-19) is a worldwide outbreak caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The World Health Organization (WHO) has declared it as a public health emergency of international concern (PHEIC) and eventually a pandemic. Many clinical trials have been conducted to investigate potential and effective therapies for COVID-19. Here we reported the outcome of three COVID-19 cases treated early with the combination of hydroxychloroquine and azithromycin. Early treatments of suspected or confirmed positive COVID-19 cases with this combination therapy is to avoid disease progressions into a more severe and irreversible state. In these cases, clinical, radiological, and laboratory features were followed up. No complications were observed. The COVID-19 patients treated with this early combination therapy showed good clinical and virological responses.


azithromycin; COVID-19; hydroxychloroquine; SARS-CoV-2; therapy;

Full Text:



  1. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020; 382(8):727-733. https://doi.org/10.1056/NEJMoa1211721
  2. Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature 2020; 579(7798):270-273. https://doi.org/10.1038/s41586-020-2012-7
  3. Coronaviridae Study Group of the International Committee on Taxonomy of Viruses. The species severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol 2020; 5(4):536-44. https://doi.org/10.1038/s41564-020-0695-z
  4. World Health Organization. Coronavirus disease (COVID-19) situation reports. [cited May 29, 2020]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports
  5. Sanders JM, Monogue ML, Jodlowski TZ, Cutrell JB. Pharmacologic treatments for coronavirus disease 2019 (COVID-19): a review. JAMA 2020; https://doi.org/10.1001/jama.2020.6019
  6. Zhai P, Ding Y, Wu X, Long J, Zhong Y, Li Y. The epidemiology, diagnosis, and treatment of COVID-19. Int J Antimicrob Agents 2020; 55(5):105955 https://doi.org/10.1016/j.ijantimicag.2020.105955
  7. Wan S, Xiang Y, Fang W, Zheng Y, Li B , Hu Y, et al. Clinical features and treatment of COVID-19 patients in northeast Chongqing. J Med Virol 2020; https://doi.org/10.1002/jmv.25783
  8. Gautret P, Lagier JC, Parola P, Hoang VT, Meddeb L, Mailhe M, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents 2020; 105949. https://doi.org/10.1016/j.ijantimicag.2020.105949
  9. Yao X, Ye F, Zhang M, Cui C, Huang B, Niu P, et al. In vitro antiviral activity and projection of optimized dosing design of hydroxychloroquine for the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Clin Infect Dis 2020; ciaa237. https://doi.org/10.1093/cid/ciaa237
  10. Retallack H, Di Lullo E, Arias C, Knopp KA, Laurie MT, Sandoval-Espinosa C, et al. Zika virus cell tropism in the developing human brain and inhibition by azithromycin. Proc Natl Acad Sci USA 2016; 113(50):14408-14413. https://doi.org/10.1073/pnas.1618029113
  11. Bacharier LB, Guilbert TW, Mauger DT, et al. Early administration of azithromycin and prevention of severe lower respiratory tract illnesses in preschool children with a history of such illnesses: a randomized clinical trial. JAMA 2015; 314(19):2034-2044. https://doi.org/10.1001/jama.2015.13896
  12. Gautret P, Lagier JC, Parola P, Boehmer S, Beigelman A, Fitzpatrick AM, et al. Clinical and microbiological effect of a combination of hydroxychloroquine and azithromycin in 80 COVID-19 patients with at least a six-day follow up: a pilot observational study. Travel Med Infect Dis 2020; 34:101663. https://doi.org/10.1016/j.tmaid.2020.101663
  13. Protokol Tatalaksana COVID-19. First Edition, April 2020. Available from: http://www.inaheart.org/perki/upload/files/Protokol%20Tatalaksana%20COVID-19%205OP%20FINAL(4).pdf (accessed on 9 June 2020)
  14. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395(10229):1054-62. https://doi.org/10.1016/S0140-6736(20)30566-3
  15. To KK, Tsang OT, Leung WS, Tam AR, Wu TC, Lung DC, et al. Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study. Lancet Infect Dis 2020; 20(5):565-574. https://doi.org/10.1016/S1473-3099(20)30196-1
  16. Liu Y, Yan LM, Wan L, Xang TX, Le A, Liu JM, et al. Viral dynamics in mild and severe cases of COVID-19. Lancet Infect Dis 2020; 20(6):656-7. https://doi.org/10.1016/S1473-3099(20)30232-2
  17. Xiao AT, Tong YX, Gao C, Zhu L, Zhang YJ, Zhang S. Dynamic profile of RT-PCR findings from 301 COVID-19 patients in Wuhan, China: a descriptive study. J Clin Virol 2020; 127:104346. https://doi.org/10.1016/j.jcv.2020.104346
  18. Bullard J, Dust K, Funk D, Xiang TX, Le A, Liu JM, Strong JE, Alexander D, Garnett L, et al. Predicting infectious SARS-CoV-2 from diagnostic samples. Clin Infect Dis 2020; ciaa638. https://doi.org/10.1093/cid/ciaa638
  19. Sinha N, Balayla G. Hydroxychloroquine and Covid-19. Postgrad Med J 2020; https://doi.org/10.1136/postgradmedj-2020-137785
  20. Chatre C, Roubille F, Vernhet H, Jorgensen C, Pers YM. Cardiac complications attributed to chloroquine and hydroxychloroquine: a systematic review of the literature. Drug Saf 2018; 41(10):919-31. https://doi.org/10.1007/s40264-018-0689-4
  21. Hicks LA, Taylor TH, Jr, Hunkler RJ. U.S. outpatient antibiotic prescribing, 2010. N Engl J Med 2013; 368(15):1461-2. https://doi.org/10.1056/NEJMc1212055

DOI: https://doi.org/10.19106/JMedSciSI005203202016

Article Metrics

Abstract views : 3451 | views : 4044

Copyright (c) 2020 Siswanto Siswanto, Oktaviarum S. Utama, Agit S. Adisetiadi, Maria E. Pranasakti, Mohamad Saifudin Hakim

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

View My Stats


Creative Commons License
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) by  Universitas Gadjah Mada is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Based on a work at http://jurnal.ugm.ac.id/bik/.