All-cause mortality among patients treated with repurposed antivirals and antibiotics for COVID-19 in Mexico City: A real-world observational study

Authors

  • Javier Mancilla-Galindo 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 https://orcid.org/0000-0002-0718-467X
  • Jorge Óscar García-Méndez 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 https://orcid.org/0000-0002-7365-051X
  • Jessica Marquéz-Sánchez Departamento de Infectología, Instituto Nacional de Pediatría, Mexico City, Mexico https://orcid.org/0000-0002-8320-7570
  • Rodrigo Estefano Reyes-Casarrubias 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 https://orcid.org/0000-0003-4404-581X
  • Eduardo Aguirre-Aguilar Departamento de Atención Institucional Continua y Urgencias, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico https://orcid.org/0000-0001-6809-7337
  • Héctor Isaac Rocha-González Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico https://orcid.org/0000-0002-3199-5683
  • Ashuin Kammar-García Departamento de Atención Institucional Continua y Urgencias, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, Vasco de Quiroga 15, Tlalpan, Col. Belisario Domínguez Sección XVI, CP 14080 Ciudad de México, México. Tel: +52 5554870900, ext. 5010. E-mail: kammar_nutrition@hotmail.com https://orcid.org/0000-0002-3875-0945

DOI:

https://doi.org/10.17179/excli2021-3413

Keywords:

SARS-CoV-2, COVID-19, oseltamivir, antibiotics, pharmacoepidemiology

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.

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Published

2021-02-04

How to Cite

Mancilla-Galindo, J., García-Méndez, J. Óscar, Marquéz-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

Issue

Vol. 20 (2021)

Section

Original articles

License

Copyright (c) 2021 Javier Mancilla-Galindo, Jorge Óscar García-Méndez, Jessica Marquéz-Sánchez, Rodrigo Estefano Reyes-Casarrubias, Eduardo Aguirre-Aguilar, Héctor Isaac Rocha-González, Ashuin Kammar-García

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