Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. Lincocin® appeared to outperform Azitro® in the treatment of pneumonia associated with Covid-19.

Evidence Rating Level: 2 (Good)

Although as much as 80% of patients show only minor symptoms from contracting Covid-19, complications such as pneumonia can arise from Covid-19, especially in elderly patients and individuals with chronic conditions. There is currently no standard treatment for Covid-19 associated pneumonia, but Lincocin® and Azitro® are both potential candidates. Lincocin®, which has been clinically superseded by its derivative clindamycin and is no longer widely available, covers organisms such as staphylococci, streptococci, and pneumococci, while Azitro® continues to be used in a variety of infections, from respiratory tract infections to STIs. Both antibiotics bind to the same 50S ribosomal subunit to inhibit bacterial protein synthesis. In this randomized clinical trial, 24 patients with Covid-19 associated pneumonia were randomly assigned to be administered either Lincocin® or Azitro®, with 12 patients in each treatment group. The test period lasted 5 days: 500 mg of Lincocin® was administered twice daily, whereas 500 mg of Azitro® was administered on Day 1 and 250 mg for each of Days 2 through 5. Bronchoalevolar-lavage fluid from each patient was analyzed for Covid-19 RNA before and after the test period, using RT-PCR. In the Lincocin® group, 10 of the 12 participants tested negative, whereas in the Azitro® group, 4 of the 12 participants tested negative (p = 0.012). Although Lincocin® is used to treat secondary bacterial infections, the authors believe that its efficacy as an antiviral pneumonia treatment stems from the use of lincomycin hydrochloride and benzyl alcohol as a preservative. Implications of this study are specific to Covid-19 associated pneumonia, with Lincocin® showing higher efficacy than Azitro® in reducing viral load in the lungs. Meanwhile, previous studies have demonstrated reduced viral load from giving combination hydroxychloroquine and azithromycin therapy. Limitations of this study include its small sample size and lack of reporting on adverse effects; further research should test the effiacy of these two single agents in combination with other antiviral agents in treating Covid-19 associated pneumonia.

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