Antibiotic Management in Covid-19: Scope of Doxycycline

Transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) happens mainly through respiratory droplets from face-to-face contact and, to a lesser degree, via contaminated surfaces. Aerosol spread may likely occur, but the role of such transmission in humans yet remains to be further confirmed. An estimated 48 % to 62% of transmission may occur via pre-symptomatic carriers.

Common manifestations in hospitalized patients comprise of fever (up to 90%), dry cough (up to 86%), shortness of breath (up to 80%), fatigue (38%), myalgias (up to 44%), nausea/vomiting or diarrhoea (up to 39%), headache, weakness (25%), and rhinorrhea (7%). Anosmia or ageusia may be the sole presenting symptom in approximately 3% of individuals with COVID-19.

Laboratory abnormalities indicate lymphopenia (83%), elevated inflammatory markers (e.g., erythrocyte sedimentation rate, C-reactive protein, ferritin, tumour necrosis factor-α, IL-1, IL-6), and abnormal coagulation parameters (e.g., prolonged prothrombin time, thrombocytopenia, elevated D-dimer and low fibrinogen).

Radiographic findings in patients with COVID-19 include bilateral, lower-lobe predominate infiltrates on chest radiographic imaging and bilateral, peripheral, lower-lobe ground-glass opacities and/or consolidation on chest computed tomographic imaging.

While selecting an antibiotic, Doxycycline is cited as a potential partner in COVID-19 treatment armamentarium because of its anti-viral and anti-inflammatory effects, microbiological coverage against atypical bacterial pneumonia, and alleviating the lung sequel complications associated with COVID-19.

This is further substantiated by a recently published Asian observational study, bringing out real-life management strategy of COVID-19 Patients at a tertiary centre in Bangladesh, cited the use of Doxycycline, given at a dose of 100 mg, twice daily for 10 days added to standard care, resulting in favourable outcomes, acceptable recovery at the time of discharge and no mortality. 

√ Doxycycline is a broad-spectrum antibiotic with unique anti-inflammatory activity, pertinent to the pathophysiology of COVID-19.

√ Doxycycline possesses anti-viral properties; in-vitro studies indicating antiviral activity of against SARS-CoV-2  and potential role in overcoming respiratory distress sequels.

√ Doxycycline acts on the interleukin-6 (IL-6) pathway, thus may help in mitigating the cytokine storm which influences clinical outcomes in COVID-19. Doxycycline has proven efficacy in improving clinical outcomes in dengue, where it reduced inflammatory cytokines and improved mortality outcomes.

√ Doxycycline has endorsements for empirical use as one of the choices of antibiotics from certain global guidelines for the management of COVID-19.

√ Evidence from published scientific papers indicates the use of oral doxycycline 100 mg twice daily for 5-10 days in the treatment of COVID-19 patients.

√ Much relevant in the Indian practice settings, doxycycline is inexpensive, safe and easily available, garnering additional testimony from benefitting COVID-19 patients in a recently published Asian evidence.

While the vaccine is a few weeks to months away, and treatment modalities continue to evolve through the spectacle of emerging evidence and clinical experiences, doxycycline emerges as a promising consideration through multiple perspectives of scientific reasoning for use in the management of COVID- 19 – mechanistic, clinical benefits, past experiences, guideline recommendations, and meeting the Indian patient-centric feasibilities relevant in the real world practice settings.

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