Abstract
Background
Drug repurposing otherwise known as drug repositioning or drug re-profiling is a time-tested approach in drug discovery through which new medical uses are being established for already known drugs. Antibiotics are among the pharmacological agents being investigated for potential anti-SARS-COV-2 activities. The antibiotics are used either to resolve bacterial infections co-existing with COVID-19 infections or exploitation of their potential antiviral activities. Herein, we aimed to review the various antibiotics that have been repositioned for the management of COVID-19.
Methods
This literature review was conducted from a methodical search on PubMed and Web of Science regarding antibiotics used in patients with COVID-19 up to July 5, 2020.
Results
Macrolide and specifically azithromycin is the most common antibiotic used in the clinical management of COVID-19. The other antibiotics used in COVID-19 includes teicoplanin, clarithromycin, doxycycline, tetracyclines, levofloxacin, moxifloxacin, ciprofloxacin, and cefuroxime. In patients with COVID-19, antibiotics are used for their immune-modulating, anti-inflammatory, and antiviral properties. The precise antiviral mechanism of most of these antibiotics has not been determined. Moreover, the use of some of these antibiotics against SARS-CoV-2 infection remains highly controversial and not widely accepted.
Conclusion
The heavy use of antibiotics during the COVID-19 pandemic would likely worsen antibiotic resistance crisis. Consequently, antibiotic stewardship should be strengthened in order to prevent the impacts of COVID-19 on the antibiotic resistance crisis.
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Introduction
In December 2019, a pneumonia like disease of unknown cause emerged in Wuhan, an emerging business hub located in the Hubei province of China [1]. The disease was caused by a highly transmissible, hitherto undescribed beta-coronavirus, the SARS-coronavirus-2 (SARS-CoV-2) [2, 3]. The disease rapidly spread globally prompting the World Health Organisation (WHO) to declare it a global pandemic in March, 2020 [4]. As of 24th November 2020, 59,175,309 laboratory-confirmed COVID-19 cases were reported worldwide, with 1,396,403 deaths [5].
The rising biological, clinical, and socio-economic impacts of this COVID-19 diseases underscore the urgent need for effective resolution of this crisis [6, 7]. Currently, there is no specific vaccine or an approved antiviral for its effective treatment, several strategies are however being explored [3]. Drug repurposing offers a quick and cost-effective strategy to achieve this [8]. Drug repurposing otherwise known as drug repositioning or drug re-profiling is a time-tested approach in drug discovery through which new medical uses are being established for already known drugs, including approved, discontinued, shelved and experimental drugs [8]. This approach offers considerable advantage over the search for novel molecules. The advantages of drug repurposing have been summarised in a published review article on drug repurposing [8]. This approach has been successful used to brought back several drugs to the market [9]. Zidovudine for example, a well-known antiviral drug active against human immunodeficiency virus (HIV) has been shown to demonstrate in-vitro activity against colistin-resistant and carbapenem-resistant isolates [10]. Similarly, some anti-cancer drugs have been successfully repurposed for treatment of resistant bacterial infections [11]. Other successful examples abound in the literature.
Currently, various pharmacological agents are being investigated for potential use in the clinical management of coronavirus diseases [12,13,14,81]. However, no in-vitro or human clinical trial has been conducted to establish the proprieties of this finding.
Conclusion
Antibiotic repurposing is one of the therapeutic strategies being employed in the clinical management of COVID-19. This is aimed at either the resolution of any bacterial infections co-existing with the COVID-19 infections or exploitation of its potential antiviral properties. Though some of these antibiotics have shown promising results, their use remains highly controversial and not widely accepted. Moreover, the precise antiviral mechanism of most of these antibiotics has not yet been determined. Considering the positive association between heavy antibiotic use and worsening of antibiotic resistance crisis, efforts should be made to strengthen antibiotic stewardship at both national and sub-national levels so as to reduce the long and short impact of antibiotic use in COVID-19 on the antibiotic resistance crisis. Also, data are needed to increase the body of evidence and the clinicians’ confidence in the use of antibiotics for COVID-19 diseases.
Availability of data and materials
All relevant data are available within the paper. https://doi.org/10.6084/m9.figshare.12690077.v1.
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Yacouba, A., Olowo-okere, A. & Yunusa, I. Repurposing of antibiotics for clinical management of COVID-19: a narrative review. Ann Clin Microbiol Antimicrob 20, 37 (2021). https://doi.org/10.1186/s12941-021-00444-9
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DOI: https://doi.org/10.1186/s12941-021-00444-9