1.Diverse effects of clarithromycin and proposal of its clinical application for treating COVID-19 as a repurposing drug
Takemori, N. ; Ooi, H.K. ; Imai, G. ; Saio, M.
Tropical Biomedicine 2021;38(No.3):343-352
Outbreak of SARS-CoV-2 has been declared a pandemic, which is a serious threat to human
health. The disease was named coronavirus disease 2019 (COVID-19). Until now, several
vaccines and a few drugs have been approved for the prevention and treatment for COVID-19.
Recently, the effect of some macrolides including clarithromycin (CAM) on COVID-19 has
attracted attention. CAM is known to have diverse effects including immunomodulatory and
immunosuppressive effects, autophagy inhibition, steroid sparing effect, reversibility of
drug resistance, antineoplastic effect, antiviral effect as well as bacteriostatic/bactericidal
effect. Many patients with COVID-19 died due to an overwhelming response of their own
immune system characterized by the uncontrolled release of circulating inflammatory
cytokines (cytokine release syndrome [CRS]). This CRS plays a major role in progressing
pneumonia to acute respiratory distress syndrome (ARDS) in COVID-19 patients. It is
noteworthy that CAM can suppress inflammatory cytokines responsible for CRS and also has
anti-SARS-CoV-2 effect. Considering the rapidly progressive global disease burden of COVID-
19, the application of CAM for treating COVID-19 needs to be urgently evaluated. Recently, an
open-labeled non-randomized trial using CAM for treating COVID-19 (ACHIEVE) was initiated
in Greece in May, 2020. Its results, though preprint, indicated that CAM treatment of patients
with moderate COVID-19 was associated with early clinical improvement and containment
of viral load. Thus, treatment with CAM as a single agent or combined with other anti-SARSCoV-
2 drugs should be tried for treating COVID-19. In this article, we discussed the significance
and usefulness of CAM in treating COVID-19.