Authors: Chowdhury AT, Shahabz M, Karim MR, Islam J, Guo D, He D.



Background The worldwide COVID-19 pandemic was caused by a newly discovered Coronavirus. The
treatment methods for COVID-19 are emerging and rapidly evolving. Existing drugs, including Ivermectin
and Hydroxychloroquine, offer the hope of effective treatment in early disease. In this study, we
investigated and compared outcomes of Ivermectin-Doxycycline vs. Hydroxychloroquine-Azithromycin
combination therapy COVID19 patients with mild to moderate disease.
Methods Patients with mild to moderate COVID-19 disease, tested positive by RT PCR for SARS-CoV-2
infection at Chakoria Upazilla Health Complex, Cox’s Bazar, Bangladesh, were included in this study.
Patients were divided randomly into two groups: Ivermectin 200µgm/kg single dose + Doxycycline
100 mg BID for 10days in group A, and Hydroxychloroquine 400 mg 1st day, then200mg BID for 9days +
Azithromycin 500 mg daily for 5 days in group B. PCR for SARS-CoV-2 was repeated in all symptomatic
patients on the second day onward without symptoms, or, for those who were asymptomatic (throughout
the process), on the 5th day after taking medication and repeated every two days onward if the result is
positive. Time to negative PCR and time to full symptomatic recovery was measured for each group.
Results All subjects in the Ivermectin-Doxycycline group (group A) reached a negative PCR for SARS-CoV2, at a mean of 8.93days, and all reached symptomatic recovery, at a mean of 5.93days, with 55.10%
symptom-free by the 5th day. In the Hydroxychloroquine-Azithromcyin group (group B), 96.36% reached a
negative PCR at a mean of 6.99days and were symptoms-free at 9.33days. Group A patients had
symptoms that could have been caused by the medication in 31.67% of patients, including lethargy in
14(23.3%), nausea in 11(18.3%), and occasional vertigo in 7(11.66%) of patients. In Group B, 46.43% had
symptoms that could have been caused by the medication, including 13(23.21%) mild blurring of vision
and headache; 22(39.2%) increased lethargy and dizziness, 10(17.85%) occasional palpitation, and
9(16.07%) nausea and vomiting.
Conclusion The Ivermectin-Doxycycline combination showed a trend toward superiority to the
Hydroxychloroquine-Azithromycin combination therapy in the case of patients with mild to moderate
COVID19 disease, though the difference in time to becoming symptom-free and the difference in time to
negative PCR was not statistically significant.

Keywords: : Ivermectin, Doxycycline, Hydroxychloroquine, Azithromycin, Randomized Controlled Trial
(RCT), COVID-19, Bangladesh