Efficacy of Hydroxychloroquine versus Clarithromycin in the Improvement of Dyspnea and Cough in Patients after the Treatment of Acute-Phase COVID-19

Background: Post-acute COVID-19 syndrome involves the persistence of the patient’s symptoms due to the residual inflammation of the acute phase. Objectives: In the current study, we aimed to evaluate medication intervention to accelerate the improvement of prolonged respiratory symptoms in this phase. Methods: Thirty-four patients, aged 20-50 years, in the recovery phase of COVID-19, were enrolled, who still suffered from respiratory problems even two weeks after being discharged from Rasool Akram Hospital, Tehran, Iran. They were divided into three groups based on the type of treatment for eliminating the remaining symptoms: hydroxychloroquine (HCQ, 200 mg twice daily for four weeks), clarithromycin (500 mg twice daily for four weeks), and control (receiving a placebo similar to the last two groups). At the beginning and end of the treatment, patients’ dyspnea and cough were assessed using Medical Research Council and visual analog scale (VAS), respectively, their laboratory tests were checked, and they took a 6-min walk test. Results: At the end of the treatment, the VAS of cough was 0.74 in the HCQ group, which was higher than that in the clarithromycin group. In addition, dyspnea decreased in the HCQ and clarithromycin groups by 64% and 40%, respectively, compared to the control group. Furthermore, there was a significant relationship between residual dyspnea at the end of the treatment and the severity of initial lung involvement in the acute phase. Conclusion: Based on these findings, it can be concluded that HCQ was more effective in reducing dyspnea, compared to clarithromycin, in the recovery phase, especially in patients with milder lung involvement in the acute phase. Additionally, clarithromycin was found to be more effective in improving coughs.