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All-cause mortality among patients treated with repurposed antivirals and antibiotics for COVID-19 in Mexico City: A real-world observational study.
EXCLI J. 2021; 20:199-222.EJ

Abstract

The aim of our study was to evaluate all-cause mortality risk in patients with laboratory-confirmed COVID-19 in Mexico City treated with repurposed antivirals and antibiotics. This real-world retrospective cohort study contemplated 395,343 patients evaluated for suspected COVID-19 between February 24 and September 14, 2020 in 688 primary-to-tertiary medical units in Mexico City. Patients were included with a positive RT-PCR for SARS-CoV-2; those receiving unspecified antivirals, excluded; and groups of antivirals prescribed in < 30 patients, eliminated. Survival and mortality risks were determined for patients receiving antivirals, antibiotics, both, or none. We assessed the effect of early (<2 days) versus late (>2 days) use of antivirals on mortality in a sub-cohort of patients. Multivariable adjustment, propensity score matching, generalized estimating equations, and calculation of E-values were performed to limit confounding. 136,855 patients were analyzed; mean age 44.2 (SD:16.8) years; 51.3 % were men. 16.6 % received antivirals (3 %), antibiotics (10 %), or both (3.6 %). Antivirals studied were Oseltamivir (n=8414), Amantadine (n=319), Lopinavir-Ritonavir (n=100), Rimantadine (n=61), Zanamivir (n=39), and Acyclovir (n=36). Survival with antivirals (73.7 %, p<0.0001) and antibiotics (85.8 %, p<0.0001) was lower than no antiviral/antibiotic (93.6 %). After multivariable adjustment, increased risk of death occurred with antivirals (HR=1.72, 95 % CI: 1.61-1.84) in ambulatory (HR=4.7, 95 % CI: 3.94-5.62) and non-critical (HR=2.03, 95 % CI: 1.86-2.21) patients. Oseltamivir increased mortality risk in the general population (HR=1.72, 95 % CI: 1.61-1.84), ambulatory (HR=4.79, 95 % CI: 4.01-5.75), non-critical (HR=2.05, 95 % CI: 1.88-2.23), and pregnancy (HR=8.35, 95 % CI: 1.77-39.30); as well as hospitalized (HR=1.13, 95 % CI: 1.01-1.26) and critical patients (HR=1.22, 95 % CI: 1.05-1.43) after propensity score-matching. Early versus late oseltamivir did not modify the risk. Antibiotics were a risk factor in general population (HR=1.13, 95 % CI: 1.08-1.19) and pediatrics (HR=4.22, 95 % CI: 2.01-8.86), but a protective factor in hospitalized (HR=0.81, 95 % CI: 0.77-0.86) and critical patients (HR=0.67, 95 % CI: 0.63-0.72). No significant benefit for repurposed antivirals was observed; oseltamivir was associated with increased mortality. Antibiotics increased mortality risk in the general population but may increase survival in hospitalized and critical patients.

Authors+Show Affiliations

Unidad de Investigación UNAM-INC, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico. Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico.Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico. Departamento de Posgrado y Educación Médica Continua, Instituto Nacional de Cancerología, Mexico City, Mexico. Departamento de Infectología, Fundación Clínica Médica Sur, Mexico City, Mexico.Departamento de Infectología, Instituto Nacional de Pediatría, Mexico City, Mexico.Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico. Departamento de Posgrado y Educación Médica Continua, Instituto Nacional de Cancerología, Mexico City, Mexico.Departamento de Atención Institucional Continua y Urgencias, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico.Departamento de Atención Institucional Continua y Urgencias, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33628159

Citation

Mancilla-Galindo, Javier, et al. "All-cause Mortality Among Patients Treated With Repurposed Antivirals and Antibiotics for COVID-19 in Mexico City: a Real-world Observational Study." EXCLI Journal, vol. 20, 2021, pp. 199-222.
Mancilla-Galindo J, García-Méndez JÓ, Márquez-Sánchez J, et al. All-cause mortality among patients treated with repurposed antivirals and antibiotics for COVID-19 in Mexico City: A real-world observational study. EXCLI J. 2021;20:199-222.
Mancilla-Galindo, J., García-Méndez, J. Ó., Márquez-Sánchez, J., Reyes-Casarrubias, R. E., Aguirre-Aguilar, E., Rocha-González, H. I., & Kammar-García, A. (2021). All-cause mortality among patients treated with repurposed antivirals and antibiotics for COVID-19 in Mexico City: A real-world observational study. EXCLI Journal, 20, 199-222. https://doi.org/10.17179/excli2021-3413
Mancilla-Galindo J, et al. All-cause Mortality Among Patients Treated With Repurposed Antivirals and Antibiotics for COVID-19 in Mexico City: a Real-world Observational Study. EXCLI J. 2021;20:199-222. PubMed PMID: 33628159.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - All-cause mortality among patients treated with repurposed antivirals and antibiotics for COVID-19 in Mexico City: A real-world observational study. AU - Mancilla-Galindo,Javier, AU - García-Méndez,Jorge Óscar, AU - Márquez-Sánchez,Jessica, AU - Reyes-Casarrubias,Rodrigo Estefano, AU - Aguirre-Aguilar,Eduardo, AU - Rocha-González,Héctor Isaac, AU - Kammar-García,Ashuin, Y1 - 2021/02/04/ PY - 2021/01/19/received PY - 2021/02/01/accepted PY - 2021/2/25/entrez PY - 2021/2/26/pubmed PY - 2021/2/26/medline KW - COVID-19 KW - SARS-CoV-2 KW - antibiotics KW - oseltamivir KW - pharmacoepidemiology SP - 199 EP - 222 JF - EXCLI journal JO - EXCLI J VL - 20 N2 - The aim of our study was to evaluate all-cause mortality risk in patients with laboratory-confirmed COVID-19 in Mexico City treated with repurposed antivirals and antibiotics. This real-world retrospective cohort study contemplated 395,343 patients evaluated for suspected COVID-19 between February 24 and September 14, 2020 in 688 primary-to-tertiary medical units in Mexico City. Patients were included with a positive RT-PCR for SARS-CoV-2; those receiving unspecified antivirals, excluded; and groups of antivirals prescribed in < 30 patients, eliminated. Survival and mortality risks were determined for patients receiving antivirals, antibiotics, both, or none. We assessed the effect of early (<2 days) versus late (>2 days) use of antivirals on mortality in a sub-cohort of patients. Multivariable adjustment, propensity score matching, generalized estimating equations, and calculation of E-values were performed to limit confounding. 136,855 patients were analyzed; mean age 44.2 (SD:16.8) years; 51.3 % were men. 16.6 % received antivirals (3 %), antibiotics (10 %), or both (3.6 %). Antivirals studied were Oseltamivir (n=8414), Amantadine (n=319), Lopinavir-Ritonavir (n=100), Rimantadine (n=61), Zanamivir (n=39), and Acyclovir (n=36). Survival with antivirals (73.7 %, p<0.0001) and antibiotics (85.8 %, p<0.0001) was lower than no antiviral/antibiotic (93.6 %). After multivariable adjustment, increased risk of death occurred with antivirals (HR=1.72, 95 % CI: 1.61-1.84) in ambulatory (HR=4.7, 95 % CI: 3.94-5.62) and non-critical (HR=2.03, 95 % CI: 1.86-2.21) patients. Oseltamivir increased mortality risk in the general population (HR=1.72, 95 % CI: 1.61-1.84), ambulatory (HR=4.79, 95 % CI: 4.01-5.75), non-critical (HR=2.05, 95 % CI: 1.88-2.23), and pregnancy (HR=8.35, 95 % CI: 1.77-39.30); as well as hospitalized (HR=1.13, 95 % CI: 1.01-1.26) and critical patients (HR=1.22, 95 % CI: 1.05-1.43) after propensity score-matching. Early versus late oseltamivir did not modify the risk. Antibiotics were a risk factor in general population (HR=1.13, 95 % CI: 1.08-1.19) and pediatrics (HR=4.22, 95 % CI: 2.01-8.86), but a protective factor in hospitalized (HR=0.81, 95 % CI: 0.77-0.86) and critical patients (HR=0.67, 95 % CI: 0.63-0.72). No significant benefit for repurposed antivirals was observed; oseltamivir was associated with increased mortality. Antibiotics increased mortality risk in the general population but may increase survival in hospitalized and critical patients. SN - 1611-2156 UR - https://www.unboundmedicine.com/medline/citation/33628159/All-cause_mortality_among_patients_treated_with_repurposed_antivirals_and_antibiotics_for_COVID-19_in_Mexico_City:_A_real-world_observational_study. L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/33628159/ DB - PRIME DP - Unbound Medicine ER -