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Doxycycline for COVID-19

Rapid Response:

Doxycycline for COVID-19 Prophylaxis in NHS Frontline Workers

Dear Editor, 

To Whom it May Concern, 

I would like to propose that frontline NHS healthcare workers take the antibiotic Doxycycline (1) prophylactically to prevent COVID-19 infections in hospital and GP settings nationwide. For example, they could take 100-mg of Doxycycline per day. 

Doxycycline is widely and readily available in the United Kingdom and world-wide. The cost would be minimal, less than 10 pence a day per person. Since it is already MHRA-approved for bacterial infections, it can also be prescribed legally by consultants and GPs, in an off-licence fashion. 

Doxycycline has previously been shown to inhibit the replication of other viruses, such as the Dengue virus (2), among others, because it is an inhibitor of protein synthesis. It also inhibits the production of inflammatory cytokines, such as IL-6 (3), that are activated in COVID-19 patients. 

Doxycycline is a very safe drug, which was first FDA-approved in 1967, over 50 years ago. It is already used for the prevention of acne and malaria, as well as many other bacterial infections. Bacterial super-infection is a major complication of viral infections and was the major cause of mortality during the influenza pandemic of 1918 (4, 5). 

Also, NICE has already designated Doxycycline as the treatment of choice for community acquired pneumonia, during the COVID-19 pandemic:
https://www.nice.org.uk/guidance/ng165/chapter/4-Managing-suspected-or-c…

Thank you for considering this inexpensive approach to preventing ongoing viral transmission during the COVID-19 pandemic, using Doxycycline prophylaxis. 

Best wishes, 

Professor Michael P. Lisanti, MD-PhD, FRSA, FRSB
Chair, Translational Medicine
University of Salford

Supporting Evidence

1. COVID-19 and Chronological Aging: Senolytics and Other Anti-Aging Drugs for the Treatment or Prevention of Corona Virus Infection?
https://pubmed.ncbi.nlm.nih.gov/32229706/

2. Inhibitory Effect of Doxycycline Against Dengue Virus Replication in Vitro
https://pubmed.ncbi.nlm.nih.gov/24142271/

3. Dengue Patients Treated with Doxycycline Showed Lower Mortality Associated to a Reduction in IL-6 and TNF Levels.
https://pubmed.ncbi.nlm.nih.gov/25858261/

4. Predominant role of bacterial pneumonia as a cause of death in pandemic influenza: implications for pandemic influenza preparedness.
https://www.ncbi.nlm.nih.gov/pubmed/18710327/

5. Bacterial Pneumonia Caused Most Deaths in 1918 Influenza Pandemic (Press Release from NIH by Dr. Anthony Fauci in 2008)
https://www.nih.gov/news-events/news-releases/bacterial-pneumonia-caused…

Competing interests: No competing interests24 April 2020Michael P Lisanti, MD-PhD, FRSA, FRSB Professor and Chair, Translational Medicine University of Salford 43 Crescent, School of Science, Engineering and Environment, Greater Manchester, M5 4WT @LisantiMichael

Are antibiotics being investigated as treatment options?

Azithromycin is an antibiotic that researchers are currently investigating as a potential treatment option for COVID-19. Azithromycin has anti-inflammatory effects, which may help reduce an overactive immune response to COVID-19.

Research has also found azithromycin to have positive effects against Zika and Ebola viruses in test tube experiments. 

Azithromycin is also effective in preventing severe bacterial respiratory tract infections in children with viral infections.

Researchers are looking into the effects of the combination of hydroxychloroquine, an anti-malarial drug, and azithromycin. 

Research has found hydroxychloroquine to have anti-SARS-CoV activity in test tube experiments.

One small scale study looked at the effects of hydroxychloroquine and azithromycin on people receiving hospital treatment for COVID-19 in France.

The results showed hydroxychloroquine significantly reduced the viral load or eliminated the coronavirus. The addition of azithromycin increased the effectiveness of hydroxychloroquine.

However, another study from the American College of Cardiology found that treatment with hydroxychloroquine and azithromycin did not improve outcomes, and increased the risk of cardiac arrest. The study looked at 1,438 people receiving hospital treatment for COVID-19 in New York. All participants had similar age, race, and time of starting treatment. 

Since then, the FDA has revoked the emergency use authorization for hydroxycholoroquine, so people and doctors should not use it to treat COVID-19 anymore. 

Why do doctors prescribe antibiotics to those with COVID-19?

The new coronavirus causes a respiratory infection that can weaken the immune system. This impact can increase the risk of getting a bacterial infection, which the individual may find harder to fight off.

Doctors may prescribe antibiotics to people with COVID-19 to prevent or treat secondary bacterial infections, such as bacterial pneumonia. Doctors may then use antibiotics as part of the treatment to fight the infection.

What are the treatment options available?

The Food and Drug Administration (FDA) has not approved any drugs for the specific treatment of COVID-19.

Current treatments depend on the severity of each case and focus on treating symptoms and complications of COVID-19.

For mild symptoms, people may be able to treat COVID-19 with home remedies. These can include:

  • getting plenty of rest
  • drinking plenty of fluids to stay well hydrated
  • fever and pain relief medication, such as acetaminophen
  • monitor symptoms, and contacting a doctor straight away if they worsen

Current treatment options for people hospitalized with COVID-19 can include:

  • intravenous fluids to prevent dehydration
  • oxygen supply if people have difficulty breathing
  • treating any complications, such as pneumonia
  • antiviral drug remdesivir for emergency cases of COVID-19

Researchers are also looking into a range of existing drugs as potential treatments. These medications include:

  • anti-malarial drugs
  • drugs for autoimmune conditions
  • antiviral drugs that are effective for other viruses
  • convalescent plasma, using antibodies from people who have recovered from COVID-19
  • high doses of intravenous vitamin C

Further tests and trials will help to determine whether any of these options could be potential treatment options for COVID-19.

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