Preprint Concept Paper Version 1 Preserved in Portico This version is not peer-reviewed

Nitazoxanide/Azithromycin Combination for COVID-19: A Suggested New Protocol for COVID-19 Early Management

Version 1 : Received: 23 April 2020 / Approved: 24 April 2020 / Online: 24 April 2020 (09:24:23 CEST)

A peer-reviewed article of this Preprint also exists.

Journal reference: Pharmacological Research 2020
DOI: 10.1016/j.phrs.2020.104874

Abstract

Azithromycin has been shown to have a clinical efficacy against severe acute respiratory syndrome coronavirus 2 (SARS CoV-2); ivermectin has also demonstrated a remarkable experimental efficacy with a potential to be used for Coronavirus disease 2019 (COVID-19). Further, BCG vaccination is being considered for clinical trials aiming to test its potential for lowering COVID-19 morbidity and mortality. This article illustrates some structural and functional relationships that may gather these drugs and the author, basing on a combined pathophysiological and pharmacological approach, recommends the FDA-approved antidiarrhea drug; nitazoxanide, which has been previously suggested but unfortunately ignored, to be tested in combination with azithromycin for their potential activity against SARS CoV-2 soonest. The author recommends testing their combined administration as early during the clinical course of COVID-19 as possible. Further, basing on the same represented concept, the author recommends more trials for interferons to be tested against SARS CoV-2 especially in severe and critical cases.

Subject Areas

SARS CoV-2; COVID-19; Nitazoxanide; Azithromycin; Interferons

Comments (7)

Comment 1
Received: 24 April 2020
The commenter has declared there is no conflict of interests.
Comment: This is only a suggestion for testing a new drug. No medical protocol is found.
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Response 1 to Comment 1
Received: 1 May 2020
Commenter: Mina Kelleni (Click to see Publons profile: )
The commenter has declared there is no conflict of interests.
Comment: Forgive me Sir/Madam, I've though I've replied to you but probably and unfortunately, I've been doing so without logging in first! so perhaps this is the reason why my comment is not currently displayed! I've told my "anonymous" colleague that I humbly believe, it's not my fault that he/she can only see a suggestion for a drug which is by the way not new but ignored as explained in the manuscript, apparently he/she has not read first before posting the comment. I also wonder if he/she fairly examined the simplest definition of a protocol: "A detailed plan of a scientific or medical experiment, treatment" to check if it's present inside the manuscript or not, which I believe is fully presented and explained in the manuscript. He/she didn't even bother itself to search if the "combination" not the drug mentioned in the "title" has ever been suggested before, which has not. Well Sir/Madam, accept my deepest apology for not being able to reply further to this comment and I wish you Preprints to notify me, if another problem has occurred while I'm posting my comments, after all it's my first time to be honored with such an honor thanks to you, the honorable; Preprints. Best regards, Mina
Comment 2
Received: 26 April 2020
Commenter: Michael Botros
The commenter has declared there is no conflict of interests.
Comment: In this article and as a start, you'll find that erythromycin is a 14-membered macrolide antibiotic with ten chiral centers and two sugar substituents, but azithromycin is a 15-membered macrolide antibiotic on the market characterized by a basic nitrogen atom inserted into the macrocyclic ring.
I believe, it's this particular nitrogen atom that should be focused on.
I highly recommend you and other colleagues to look at a specific article published in 2016 by Jelić and Antolović entitled: "From Erythromycin to Azithromycin and New Potential Ribosome-Binding Antimicrobials"*

Dr. Michael T. Botros MBBS, MSc

  • Jelić D, Antolović R. From Erythromycin to Azithromycin and New Potential Ribosome-Binding Antimicrobials. Antibiotics (Basel). 2016;5(3):29. Published 2016 Sep 1. doi:10.3390/antibiotics5030029
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    Response 1 to Comment 2
    Received: 26 April 2020
    Commenter: Mina T. Kelleni
    The commenter has declared there is no conflict of interests.
    Comment: Dear Dr. Michael,
    Thank you very much for your precious comment as well as your cited amazing reference. It's quite an interesting remark, yet I humbly ask all our colleagues in colleges of pharmacy all over the world to check your worthwhile suggestion, I'm a physician like you and when I've written this wonder in the manuscript, I thought it might be a pharmacist who may give us a detailed response. I'm really proud that a fellow physician has shared with us this remark as a start.
    Best regards,
    Mina T. Kelleni, MD, PhD
    Comment 3
    Received: 29 April 2020
    The commenter has declared there is no conflict of interests.
    Comment: why you think this gonna work if you did not try it yet in any patient ?
    There is more than 500 hundred protocols currently which is tried on patients but not approved yet,
    Doing all this propaganda on some theory not proven to be correct yet is another shalawlaw.
    + Respond to this comment
    Response 1 to Comment 3
    Received: 5 May 2020
    Commenter: Mina Kelleni (Click to see Publons profile: )
    The commenter has declared there is no conflict of interests.
    Comment: Hello, once again another Mr. "Anonymous" and truly I thank you from all my heart for this comment.
    You gave me an opportunity to document something for history!
    For those readers who don't know Shalawlaw, This "Anonymous" is an Egyptian colleague and perhaps one of my friends on Facebook! On my Facebook page, I used to condemn the practice made by some Egyptian authorities which tended to allow some people who are taking about some Egyptian foods like beans or dried Mulukhiyah (shalawlaw) as a potential cure for COVID-19!!! by the way, some of those shalawlaw pro-claimers are unfortunately "scientists" and simply my fellow Egyptian wishes to say the paper is not worthwhile, he "anonymously" disagrees with 4 world renowned Professors who edited and peer reviewed it before being published at the famous and honorable Pharmacological Research that has not despised my Afro-Egyptian origin or my Asian current affiliation or accepts to publish but research with an added on value to science and pharmacology. You know, even one of my very famous Egyptian "FB friends" who used also to condemn this shalawlaw attitude that truly doesn't present Africa, Asia and Egypt, which are full of honorable scientists and researchers both inside and outside the continent, has ignored a request to reach this research to his fellow Egyptian followers, and didn't like to point that a fellow Egyptian has published a COVID-19 paper claiming a unique unprecedented combination as written and illustrated in the manuscript, this friend and many others like those Egyptian officials whom I've contacted formally through my Egyptian Minia university affiliation and moreover when I've felt depression, I've addressed all those in the Capital, Cairo on a youtube video ( https://www.youtube.com/watch?v=-g_8IguC9Lc&t=2s ) to begin trying to save lives with a safe, available, cheap protocol using FDA approved drugs basing on an accepted and published Afro-Asian-Egyptian article and they simply prefer to remain on the world wide famous hydroxychloroquine/azithromycin regimen which is being proved harmful than to try to explore the potential of this suggested protocol if came from (Mina) who is against oppression, injustice and not only a physician, if you don't know this, and he might cause troubles if he appeared again on Egyptian TV as they mistakenly believe! Actually, my friend I don't need propaganda at all, my name is by the the Grace of the Lord is widely mentioned with honor long before this paper published in hundreds of Egyptian and Arabic newspapers defending the innocent patients from toxic and carcinogenic drugs as well as defending the human rights for all. I've even been on a TV show on the famous dream TV and Ten TV addressing the potential of carcinogenic drugs widely circulating only in Egypt and developing countries as well as an honor previously offered to me by President Sisi who has congratulated me officially upon my PhD defense, though it has not been performed at this time because 2 professors of pharmacology didn't like to complete it and I've sued them! The defense has been conducted later with new honorable professors after I've made my stance to defend justice and honor and for that I'm proud and won't ever regret even if I've read one million comments like yours. I've published several papers regarding the potentially carcinogenic pioglitazone and other toxic drugs used in Egypt, I've sued the Egyptian PM and Minister of health at one time, I've struggled and I'm against the air! yet I've not yielded and I won't ever till I'm dead, trying to save my fellow humans in Egypt, Africa and elsewhere. I don't need propaganda but you need some discipline of your heart full of bias and to show your name as should it be. Please Preprints don't delete my comment to this colleague, he's not the one in particular meant by the message and I offer him love and respect regardless of his/her opinion.
    Yes, I owe you so much my "friend" because if you weren't present all my life trying to put me down, I've been never been able by the Grace of the Lord to publish this COVID-19 and trying hardly to publish 4 others honoring the name of Egypt, Africa and Asia as much as I can. I've a lot to say but I can't and I won't ever say it, because I love Egypt and I've decided to put its name first though I could be much rewarded if I didn't, and let me thank my second lovely country the amazing and honorable KSA where I'm currently working, KSA that has morally supported me and I've told them that I'm very proud to be an Egyptian in citizenship, Christian in belief and Saudi in passion and they welcome all researchers from all the world to their lovely land which is being totally improved for better of humans and humanity. I also would like to thank my beloved students and colleagues in faculties of medicine and pharmacy here in KSA (2 years) and those in faculties of medicine, nursing, dentistry and pharmacy in Egypt (12 years) who shared this achievement, regardless of the final outcomes that we should all pray to be positive, at least for the sake of humanity, heavily on twitter to be followed by others all over the world. Finally, you know there's a famous proverb telling that you would have never said so if my formal application for Canadian Citizenship through federal express entry is approved, hopefully soon, and you're reading my Canadian affiliation.
    Be blessed, Eat Shalwalaw well and if, God forbids, you've caught SARS CoV-2, just wish to be treated by this protocol you've despised as hydroxychloroquine is proving ineffective and even increasing mortality as you may see, if you download the paper you criticize first trying to read it before posting such a shalawlaw comment.
    Best regards,
    Your Afro-Asian-Egyptian colleague,
    Mina
    Comment 4
    Received: 30 April 2020
    Commenter: Mina T. Kelleni
    The commenter has declared there is no conflict of interests.
    Comment: Hello, once again another Mr. "Anonymous" and truly I thank you from all my heart for this comment.
    You gave me an opportunity to document something for history!
    For those readers who don't know Shalawlaw, This "Anonymous" is an Egyptian colleague and perhaps one of my friends on Facebook! On my Facebook page, I used to condemn the practice made by some Egyptian authorities to allow mostly people who are taking about some Egyptian foods like beans and Mulukhiyah (shalawlaw) as a potential cure for COVID-19!!! by the way, some of those shalawlaw pro-claimers are unfortunately scientists and simply my fellow Egyptian wishes to say the paper is not worthwhile, he "anonymously" disagrees with 4 world renowned Professors who edited and peer reviewed it before being accepted to be published in the famous and honorable Pharmacological Research that has not despised my Afro-Egyptian origin and never accepts to publish but research with added on value to science and pharmacology. You know, even one of my Egyptian "friends" who used also to condemn this shalawlaw attitude that truly doesn't present Africa and Egypt which are full of honorable scientists and researchers both inside and outside the continent, has ignored me after I've published this paper providing a unique unprecedented combination supported by science for COVID-19 as written and illustrated in the manuscript, this friend and many others like those Egyptian officials whom I've contacted formally through my Egyptian Minia university affiliation and moreover when I've felt depression, I've addressed all those in the Capital, Cairo on a youtube video to begin to save lives with safe, available, cheap protocol using FDA approved drugs basing on an accepted and published Afro-Egyptian article and they simply prefer to remain on the world wide famous hydroxychloroquine/azithromycin regimen which is being proved harmful than to try to explore the potential of a concept paper if came from (Mina) who is against oppression, injustice and not only a physician, if you don't know this, and he might cause troubles if he appeared again! Actually, my friend I don't need propaganda at all, my name is by the the Grace of the Lord is previously mentioned with honor long before this paper in hundreds of Egyptian and Arabic newspapers and I've even been on a TV show on the famous dream TV and Ten TV addressing the potential of carcinogenic drugs widely circulating only in Egypt and developing countries and an honor previously offered to me by President Sisi who has congratulated me officially upon my PhD defense, though it has not been performed at this time for some reasons and it has been conducted later after I've made my stance to defend justice and honor and for that I'm proud and won't ever regret even if I've read one million comments like yours. I've published several papers regarding the potentially carcinogenic pioglitazone, I've sued the Egyptian PM and Minister of health at this time, I've struggled and I'm against the air, yet I've not yielded and I won't trying to save my fellow humans in Egypt, Africa and elsewhere. I don't need propaganda but you need some discipline of your heart full of bias and hatred and to show your name as should it be. Please Preprints don't delete my comment to this colleague, he's not the one in particular meant by the message and I offer him love and respect regardless of his/her opinion.
    Yes, I owe you so much my "friend" because if you weren't present all my life trying to put me down, I've been never been able by the Grace of the Lord to publish this and trying hardly to publish 3 others honoring the name of Egypt and Africa as much as I can. I've a lot to say but I can't and I won't ever say it, because I love Egypt and I've decided to put its name first though I could be much rewarded if I didn't, and let me thank my second country the amazing and honorable KSA that has morally supported me and I've told them that I'm very proud to be an Egyptian in citizenship, Christian in belief and Saudi in passion and they welcome all researchers from all the world to their lovely land which is being totally improved for better of humans and humanity. I also would like to thank my beloved students and colleagues in faculties of medicine and pharmacy here in KSA and those in faculties of medicine, nursing, dentistry and pharmacy in Egypt who shared this achievement, regardless of the final outcomes that we should all pray to be positive, at least for the sake of humanity, heavily on twitter to be followed by others all over the world. Finally, you know there's a famous proverb and perhaps you would have never said so if my formal application for Canadian Citizenship through federal express entry is approved, hopefully soon, and you're reading my Canadian affiliation.
    Be blessed, Eat Shalwalaw well and when, if, you're, infected just pray be treated by this protocol you've despised as hydroxychloroquine is proving ineffective and even increasing mortality as you may see, if you download the paper you criticize first trying to read it before posting such a shalawlaw comment.
    Best regards,
    Your Afro-Egyptian colleague,
    Mina
    + Respond to this comment

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