Multi-drug treatment for COVID-19-induced acute respiratory distress syndrome

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), broke out in late 2019 to become a serious global threat to human health. In the absence of specific treatments for COVID-19, treatment options are being examined. Recently, the anti-SARS-CoV-2 activities of tetracyclines, macrolide antibiotics, and ivermectin, have attracted considerable attention for their potential as single or multi-drug treatment regimen. Moreover, tetracyclines, macrolide antibiotics, and ivermectin possess anti-inflammatory and immunomodulatory effects to reduce the production of cytokines. COVID-19 is characterized by early exponential viral replication, cytokine storm-associated organ damage, including acute respiratory distress syndrome (ARDS) and thrombosis. Considering anti-inflammatory and immunomodulatory effects of the aforementioned drugs and corticosteroids, early treatment with ivermectin, doxycycline, azithromycin, and corticosteroids is thought to be the most promising option for combating COVID-19-induced ARDS.