5 ms·

Azithromycin is a common antibiotic, not an anti-viral drug. This is an important distinction. Also hydroxychloroquine is an anti-malarial drug, which is also n

Azithromycin is a common antibiotic, not an anti-viral drug. This is an important distinction. Also hydroxychloroquine is an anti-malarial drug, which is also not an anti-viral.

LinuxBender 6y ago
Hydroxychloroquine is a zinc ionophore which helps zinc get into the cells in your lungs and slows the viral replication. It was not designed to be used this way, it just happens to work. This is mostly useful before your viral load is high. Same goes for Quercetin, also a zinc ionophore. They are good proactive measures to slow down the viral transcription before you reach a critical stage. It won't help everyone, especially if given late in their infection and especially if their immune system is compromised or otherwise dysfunctional.
- jogundas 6y ago
  Wiki says that "Hydroxychloroquine is being studied to prevent and treat coronavirus disease 2019 (COVID‑19), but all clinical trials conducted during 2020 found it is ineffective and may cause dangerous side effects." https://en.wikipedia.org/wiki/Hydroxychloroquine https://en.wikipedia.org/wiki/Hydroxychloroquine
  - LinuxBender 6y ago
    That is mostly correct based on the studies I have been following. In most cases, by the time people are admitted to the hospital, the viral load is too high and their immune system has not been able to keep up. There is a whole lot more going on, all the way from interactions with ACE to VWF to clotting, that administering zinc ionophores late in the game may be a bit too late.
  - viggity 6y ago
    millions of people take HCQ on a daily basis for their lupus. Ask any rheumatologist, the danger of Torsades de Points is only a concern for HCQ if the patient already has a serious heart condition, or if the patient has been taking HCQ for years. Millions more take HCQ as a malaria treatment. It is generally recognized as safe, if you do not have a heart condition (and even then a short course is unlikely to yield adverse outcomes).
    - outworlder 6y ago
      > It is generally recognized as safe There are no safe drugs for a patient admitted to intensive care. We should not start administering anything in large scale just because most healthy people can tolerate it well.
    - aden1ne 6y ago
      Covid has severe effects on the cardiovascular system, with myocardial injury being a frequent occurrence of those covid patients admitted to hospital.
    - deelowe 6y ago
      The dosages are different (much higher) for Covid-19.
    - Filligree 6y ago
      > Millions more take HCQ as a malaria treatment. It is generally recognized as safe, if you do not have a heart condition (and even then a short course is unlikely to yield adverse outcomes). COVID-19 can infect the heart and damage it. As safe as HCQ might be on its own, here it's adding extra load to a system that's already under stress.
  - notadoc 6y ago
    Wikipedia is not a reliable source for anything, let alone medical information or studies
    - burfog 6y ago
      It's pretty good for purely non-political things. Sadly, this is political.
  - koboll 6y ago
    Here's a good rundown from Science on why hydroxychloroquine has failed large RCTs: https://www.sciencemag.org/news/2020/06/three-big-studies-dim-hopes-hydroxychloroquine-can-treat-or-prevent-covid-19 https://www.sciencemag.org/news/2020/06/three-big-studies-di...
  - narrator 6y ago
    In the interest of free speech, here's a PDF with all the positive trials for HCQ: https://drive.google.com/file/d/1l6y3L_KGb1ilMW0FaP4VZsd7WvX2IU3z/view https://drive.google.com/file/d/1l6y3L_KGb1ilMW0FaP4VZsd7WvX...
    - chowells 6y ago
      I mean, I guess quackery is free speech. But it's awfully irresponsible to pretend it's good for society to spread it. Not everyone has the scientific knowledge necessary to understand p-values and what they mean for research like this. It's a lot to ask that everyone know the standard for publishing in medicine is a p-value < 0.05, which corresponds to a 5% chance of the study's results being wrong. It's a lot to ask that everyone be aware that there were 130 different studies on hydroxychloroquine and to do the math from there to determine that we'd expect 6 or 7 of them to be wrong. It's much better to say "just because it's not illegal doesn't mean it's a good idea" and just not share such thoroughly bad information.
  - burfog 6y ago
    Wikipedia is pretty reliable for math, old computer hardware, and other dry technical subjects. This is not one. This is a political subject. Wikipedia is a complete disaster for anything that even remotely touches upon modern politics. There are teams of people paid to impose an opinion on Wikipedia, relentlessly wearing down any neutral editor with 24x7 edits and every kind of bureaucratic fight. The people who edit for free are also pulled from a highly-biased population, with strong overrepresentation by unemployed single people with non-STEM degrees. Simply put, "ineffective and may cause dangerous side effects" is a purely political attack on the US president. Last year, the drug was handed out freely, with very little worry, to anybody claiming that they would visit a country with malaria. In many places it is non-prescription. Clearly, the "dangerous side effects" aren't such a big deal. You can get deadly "dangerous side effects" from aspirin (Reye syndrome) and from Tylenol/paracetamol/acetaminophen (complete liver failure).
    - learc83 6y ago
      >"ineffective and may cause dangerous side effects" Dangerous on an individual level, not really. But at a population level if hundreds of millions of people start taking it, you're going to have high absolute numbers of bad side effects. > is a purely political attack on the US president. As for ineffective, there isn't one single national health agency that recommends taking it for covid. Surely the entire globe isn't killing scores of their citizens by preventing the use of an effective treatment just to make the US President look bad. Since it's ineffective in this case, there's no benefit to outweigh the downsides of "dangerous side effects" like their is with aspirin or Tylenol.
      - gridlockd 6y ago
        > As for ineffective, there isn't one single national health agency that recommends taking it for covid. Surely the entire globe isn't killing scores of their citizens by preventing the use of an effective treatment just to make the US President look bad. Not true: https://www.mohfw.gov.in/pdf/AdvisoryontheuseofHydroxychloroquinasprophylaxisforSARSCoV2infection.pdf https://www.mohfw.gov.in/pdf/AdvisoryontheuseofHydroxychloro... Of course, it's controversial because the WHO recommended against it and most health agencies just follow suit. Also, American politics don't end at the border. There are countries that favor Trump, India being one of them.
- ReflectedImage 6y ago
  The issue is it stops viral transcription at levels that also happen to be lethal to humans :p
  - amluto 6y ago
    My recollection is that it stops viral replication in vitro in monkey cells but does not stop viral replication in vitro in human cells.
    - acqq 6y ago
      Yes, it just stops replication "within the glass" (that's the meaning of "in vitro") with the cell culture, not in living human patients, and even "within the glass" only when using the "the Vero E6 cell line which is derived from kidney cells of green monkeys." https://www.infectioncontroltoday.com/view/new-study-hydroxychloroquine-works-in-monkeys-not-humans https://www.infectioncontroltoday.com/view/new-study-hydroxy... "The mechanism of action of hydroxychloroquine is to block entry of the virus into cells. Viral entry requires a helper enzyme. In the Vero E6 cell line, this enzyme is cathepsin L which hydroxychloroquine blocks. However, in the human lung cell line, the helping enzyme is TMPRSS2. Hydroxychloroquine does not effectively block this enzyme and cellular entry of the virus occurs." So, inspired by the reports of the experiments with wrong cells a French doctor made some false claims about his success when treating patients, which were then promoted by one person wanting to be reelected, and then the followers... the results can be seen in the comments here.
gojomo 6y ago
While neither azithromycin nor hydroxychloroquine are primarily thought of as anti-virals, both are hypothesized by some to have some anti-viral effect, and it's still unclear whether any potential effects they have on Covid-19 are via such anti-viral effects, or other effects.
- azinman2 6y ago
  Just because something helps with issues created by a virus doesn’t make it an anti-viral. For example it seems to be now that steroids are aiding those in the ICU with covid, but I don’t think anyone could plausibly call a steroid an anti-viral, as much as a bandaid can’t be called an antibiotic even if it helps heal a cut and prevent additional bacterial infection.
  - gojomo 6y ago
    True, but if you look in the literature, you will find both of these compounds referred to as having some anti-viral effects, and their hypothesized mechanism(s) against Covid-19 may involve those effects. For example, in <https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(20)30293-7/fulltext> https://www.clinicalmicrobiologyandinfection.com/article/S11..., even though the study concludes other anti-virals are better, we see the footnoted, uncontroversial claim: "The antiviral properties of CQ were first explored against viral hepatitis as far back as 1963 [1]. Since then many observations from in vitro and animal experiments have suggested a beneficial role of HCQ and CQ in viral infections [2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13]." There are of course hundreds more such authoritative references to observed anti-viral activity. Or regarding Azithromycin (AZM) in <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7290142/> https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7290142/>, we see: "It has been shown that AZM has significant antiviral properties. In contrast with CQ or HCQ, its antiviral activity has been shown in vitro and/or in vivo on a large panel of viruses: Ebola, Zika, respiratory syncytial virus, influenzae H1N1 virus, enterovirus, and rhinovirus [4–13]. Its activity against respiratory syncytial virus has been demonstrated in a randomized study in infants [10]. Azithromycin exhibited a synergistic antiviral effect against SARS-CoV-2 when combined with HCQ both in vitro [11] and in a clinical setting [13]." That HCQ is mainly known as an antimalarial doesn't refute that it has, and is often tried for, antiviral effects. That AZM is mainly known as an antibiotic doesn't refute that it has shown broad antiviral effects as well. (If you're stuck on 'antiviral' as some binary category, or mutually-exclusive with other categories, you're going to miss all the interesting incremental effects in real chemistry/biology. That sort of "sharply-bounded categories" thinking has killed a lot of people recently, as with those insistent on 'droplets vs aerosols' instead of a continuum including every size/variant of both.)

Azithromycin is a common antibiotic, not an anti-viral drug. This is an important distinction. Also hydroxychloroquine is an anti-malarial drug, which is also not an anti-viral.

LinuxBender 6y ago

Hydroxychloroquine is a zinc ionophore which helps zinc get into the cells in your lungs and slows the viral replication. It was not designed to be used this way, it just happens to work. This is mostly useful before your viral load is high. Same goes for Quercetin, also a zinc ionophore. They are good proactive measures to slow down the viral transcription before you reach a critical stage. It won't help everyone, especially if given late in their infection and especially if their immune system is compromised or otherwise dysfunctional.

jogundas 6y ago
Wiki says that "Hydroxychloroquine is being studied to prevent and treat coronavirus disease 2019 (COVID‑19), but all clinical trials conducted during 2020 found it is ineffective and may cause dangerous side effects." https://en.wikipedia.org/wiki/Hydroxychloroquine https://en.wikipedia.org/wiki/Hydroxychloroquine
- LinuxBender 6y ago
  That is mostly correct based on the studies I have been following. In most cases, by the time people are admitted to the hospital, the viral load is too high and their immune system has not been able to keep up. There is a whole lot more going on, all the way from interactions with ACE to VWF to clotting, that administering zinc ionophores late in the game may be a bit too late.
- viggity 6y ago
  millions of people take HCQ on a daily basis for their lupus. Ask any rheumatologist, the danger of Torsades de Points is only a concern for HCQ if the patient already has a serious heart condition, or if the patient has been taking HCQ for years. Millions more take HCQ as a malaria treatment. It is generally recognized as safe, if you do not have a heart condition (and even then a short course is unlikely to yield adverse outcomes).
  - outworlder 6y ago
    > It is generally recognized as safe There are no safe drugs for a patient admitted to intensive care. We should not start administering anything in large scale just because most healthy people can tolerate it well.
  - aden1ne 6y ago
    Covid has severe effects on the cardiovascular system, with myocardial injury being a frequent occurrence of those covid patients admitted to hospital.
  - deelowe 6y ago
    The dosages are different (much higher) for Covid-19.
  - Filligree 6y ago
    > Millions more take HCQ as a malaria treatment. It is generally recognized as safe, if you do not have a heart condition (and even then a short course is unlikely to yield adverse outcomes). COVID-19 can infect the heart and damage it. As safe as HCQ might be on its own, here it's adding extra load to a system that's already under stress.
- notadoc 6y ago
  Wikipedia is not a reliable source for anything, let alone medical information or studies
  - burfog 6y ago
    It's pretty good for purely non-political things. Sadly, this is political.
- koboll 6y ago
  Here's a good rundown from Science on why hydroxychloroquine has failed large RCTs: https://www.sciencemag.org/news/2020/06/three-big-studies-dim-hopes-hydroxychloroquine-can-treat-or-prevent-covid-19 https://www.sciencemag.org/news/2020/06/three-big-studies-di...
- narrator 6y ago
  In the interest of free speech, here's a PDF with all the positive trials for HCQ: https://drive.google.com/file/d/1l6y3L_KGb1ilMW0FaP4VZsd7WvX2IU3z/view https://drive.google.com/file/d/1l6y3L_KGb1ilMW0FaP4VZsd7WvX...
  - chowells 6y ago
    I mean, I guess quackery is free speech. But it's awfully irresponsible to pretend it's good for society to spread it. Not everyone has the scientific knowledge necessary to understand p-values and what they mean for research like this. It's a lot to ask that everyone know the standard for publishing in medicine is a p-value < 0.05, which corresponds to a 5% chance of the study's results being wrong. It's a lot to ask that everyone be aware that there were 130 different studies on hydroxychloroquine and to do the math from there to determine that we'd expect 6 or 7 of them to be wrong. It's much better to say "just because it's not illegal doesn't mean it's a good idea" and just not share such thoroughly bad information.
- burfog 6y ago
  Wikipedia is pretty reliable for math, old computer hardware, and other dry technical subjects. This is not one. This is a political subject. Wikipedia is a complete disaster for anything that even remotely touches upon modern politics. There are teams of people paid to impose an opinion on Wikipedia, relentlessly wearing down any neutral editor with 24x7 edits and every kind of bureaucratic fight. The people who edit for free are also pulled from a highly-biased population, with strong overrepresentation by unemployed single people with non-STEM degrees. Simply put, "ineffective and may cause dangerous side effects" is a purely political attack on the US president. Last year, the drug was handed out freely, with very little worry, to anybody claiming that they would visit a country with malaria. In many places it is non-prescription. Clearly, the "dangerous side effects" aren't such a big deal. You can get deadly "dangerous side effects" from aspirin (Reye syndrome) and from Tylenol/paracetamol/acetaminophen (complete liver failure).
  - learc83 6y ago
    >"ineffective and may cause dangerous side effects" Dangerous on an individual level, not really. But at a population level if hundreds of millions of people start taking it, you're going to have high absolute numbers of bad side effects. > is a purely political attack on the US president. As for ineffective, there isn't one single national health agency that recommends taking it for covid. Surely the entire globe isn't killing scores of their citizens by preventing the use of an effective treatment just to make the US President look bad. Since it's ineffective in this case, there's no benefit to outweigh the downsides of "dangerous side effects" like their is with aspirin or Tylenol.
    - gridlockd 6y ago
      > As for ineffective, there isn't one single national health agency that recommends taking it for covid. Surely the entire globe isn't killing scores of their citizens by preventing the use of an effective treatment just to make the US President look bad. Not true: https://www.mohfw.gov.in/pdf/AdvisoryontheuseofHydroxychloroquinasprophylaxisforSARSCoV2infection.pdf https://www.mohfw.gov.in/pdf/AdvisoryontheuseofHydroxychloro... Of course, it's controversial because the WHO recommended against it and most health agencies just follow suit. Also, American politics don't end at the border. There are countries that favor Trump, India being one of them.
ReflectedImage 6y ago
The issue is it stops viral transcription at levels that also happen to be lethal to humans :p
- amluto 6y ago
  My recollection is that it stops viral replication in vitro in monkey cells but does not stop viral replication in vitro in human cells.
  - acqq 6y ago
    Yes, it just stops replication "within the glass" (that's the meaning of "in vitro") with the cell culture, not in living human patients, and even "within the glass" only when using the "the Vero E6 cell line which is derived from kidney cells of green monkeys." https://www.infectioncontroltoday.com/view/new-study-hydroxychloroquine-works-in-monkeys-not-humans https://www.infectioncontroltoday.com/view/new-study-hydroxy... "The mechanism of action of hydroxychloroquine is to block entry of the virus into cells. Viral entry requires a helper enzyme. In the Vero E6 cell line, this enzyme is cathepsin L which hydroxychloroquine blocks. However, in the human lung cell line, the helping enzyme is TMPRSS2. Hydroxychloroquine does not effectively block this enzyme and cellular entry of the virus occurs." So, inspired by the reports of the experiments with wrong cells a French doctor made some false claims about his success when treating patients, which were then promoted by one person wanting to be reelected, and then the followers... the results can be seen in the comments here.

gojomo 6y ago

While neither azithromycin nor hydroxychloroquine are primarily thought of as anti-virals, both are hypothesized by some to have some anti-viral effect, and it's still unclear whether any potential effects they have on Covid-19 are via such anti-viral effects, or other effects.

azinman2 6y ago
Just because something helps with issues created by a virus doesn’t make it an anti-viral. For example it seems to be now that steroids are aiding those in the ICU with covid, but I don’t think anyone could plausibly call a steroid an anti-viral, as much as a bandaid can’t be called an antibiotic even if it helps heal a cut and prevent additional bacterial infection.
- gojomo 6y ago
  True, but if you look in the literature, you will find both of these compounds referred to as having some anti-viral effects, and their hypothesized mechanism(s) against Covid-19 may involve those effects. For example, in <https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(20)30293-7/fulltext> https://www.clinicalmicrobiologyandinfection.com/article/S11..., even though the study concludes other anti-virals are better, we see the footnoted, uncontroversial claim: "The antiviral properties of CQ were first explored against viral hepatitis as far back as 1963 [1]. Since then many observations from in vitro and animal experiments have suggested a beneficial role of HCQ and CQ in viral infections [2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13]." There are of course hundreds more such authoritative references to observed anti-viral activity. Or regarding Azithromycin (AZM) in <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7290142/> https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7290142/>, we see: "It has been shown that AZM has significant antiviral properties. In contrast with CQ or HCQ, its antiviral activity has been shown in vitro and/or in vivo on a large panel of viruses: Ebola, Zika, respiratory syncytial virus, influenzae H1N1 virus, enterovirus, and rhinovirus [4–13]. Its activity against respiratory syncytial virus has been demonstrated in a randomized study in infants [10]. Azithromycin exhibited a synergistic antiviral effect against SARS-CoV-2 when combined with HCQ both in vitro [11] and in a clinical setting [13]." That HCQ is mainly known as an antimalarial doesn't refute that it has, and is often tried for, antiviral effects. That AZM is mainly known as an antibiotic doesn't refute that it has shown broad antiviral effects as well. (If you're stuck on 'antiviral' as some binary category, or mutually-exclusive with other categories, you're going to miss all the interesting incremental effects in real chemistry/biology. That sort of "sharply-bounded categories" thinking has killed a lot of people recently, as with those insistent on 'droplets vs aerosols' instead of a continuum including every size/variant of both.)