The Role of Macrolide Antibiotics in the Prevention of Severe COVID-19 Disease Progression Via the Disruption of Bacteria/virus Co-Operation

Research on the COVID-19 vaccine and antiviral drugs is essential to stop the continuous spread of the COVID-19 pandemic. Repositioning the available drugs to control the disease could help relieve hospitals and maintain the healthcare systems worldwide. Therefore, the use of Azithromycin (ATM) to prevent the adverse effects of the COVID-19 represents a potential avenue for further research. This article reviewed the clinical evidence and specialised molecular research to describe the dual antiviral and antibacterial role of ATM, and the potential co-operation between mycoplasmas and SARS-CoV-2. Non-published data obtained from family practitioners of the Grand Est region of France who prescribed ATM and observed noteworthy results were also analysed herein. Here, we proposed to better understand the role of bacteria as a cofactor in viral amplification. Specifically, we discussed the importance of Mycoplasma pneumoniae, often hidden in the pulmonary microbiota, which escalates the disease from a viral infection in patients with mild or moderate symptoms to a "cytokine storm", as described by many authors, with potential autoimmune consequences. Such bacteria, which are generally quiescent, can participate in the development of local immune disorders leading to superinfection. Finally, we identified a few potential actions that can be taken to prevent unfavourable COVID-19 disease progression, using ATM through a family practitioner-based approach and called for further research in this area.