Doxycycline vs Hydroxychloroquine + Azithromycin in the Management of COVID-19 Patients: An Open-Label Randomized Clinical Trial in Sub-Saharan Africa (DOXYCOV)

• Published in: Curēus (Palo Alto, CA) Vol. 15; no. 9; p. e45619
• Main Authors: Sobngwi, Eugene, Zemsi, Sylvain, Guewo, Magellan, Katte, Jean-Claude, Kouanfack, Charles, Mfeukeu, Liliane, Zemsi, Armel, Wasnyo, Yves, Ntsama Assiga, Antoinette, Ndi Manga, Arnaud, Sobngwi-Tambekou, Joelle, Ngatchou, William, Moussi Omgba, Charlotte, Mbanya, Jean-Claude, Ongolo Zogo, Pierre, Fouda, Pierre Joseph
• Format: Journal Article
• Language: English
• Published: United States Cureus Inc 20.09.2023; Cureus
• Subjects: Ambulatory care; Antibiotics; Asymptomatic; Blood tests; Clinical outcomes; Clinical trials; COVID-19; Hospitals; Infectious Disease; Patients; Public Health; Severe acute respiratory syndrome coronavirus 2; Therapeutics; Cameroon; azithromycin; hydroxychloroquine; doxycycline; mild covid-19; sub-saharan africa
• ISSN: 2168-8184; 2168-8184
• DOI: 10.7759/cureus.45619

Objective We aimed to compare the safety and efficacy of a doxycycline-based regimen against Cameroon National Standard Guidelines (hydroxychloroquine plus azithromycin) for the treatment of mild symptomatic COVID-19. Methods We conducted an open-label, randomized, non-inferiority trial in Cameroon comparing doxycycline 100 mg, twice daily for seven days versus hydroxychloroquine 400 mg daily for five days and azithromycin 500 mg at day 1 and 250 mg from day 2 through 5 in mild COVID-19 patients. Clinical recovery, biological parameters, and adverse events were assessed. The primary outcome was the proportion of clinical recovery on days 3, 10, and 30. Non-inferiority was determined by the clinical recovery rate between protocols with a 20-percentage points margin. Results One hundred and ninety-four participants underwent randomization and were treated either with doxycycline (n = 97) or hydroxychloroquine-azithromycin (n = 97). On day 3, 74/92 (80.4%) participants on doxycycline versus 77/95 (81.1%) on hydroxychloroquine-azithromycin-based protocols were asymptomatic (p = 0.91). On day 10, 88/92 (95.7%) participants on doxycycline versus 93/95 (97.9%) on hydroxychloroquine-azithromycin were asymptomatic (p = 0.44). On day 30, all participants were asymptomatic. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) polymerase chain reaction (PCR) test was negative on day 10 in 60/92 (65.2%) participants who were assigned to doxycycline and in 63/95 (66.3%) participants who were assigned to hydroxychloroquine-azithromycin. None of the participants were admitted for worsening of the disease after treatment initiation. Conclusion Doxycycline 100 mg twice daily for seven days proved to be safe and non-inferior in terms of efficacy when compared to hydroxychloroquine-azithromycin for preventing clinical worsening of mild symptomatic or asymptomatic COVID-19 and achieving virological suppression.