At one stage, azithromycin was the most commonly prescribed outpatient therapy for Covid-19. A year into the pandemic, however, its use as a treatment option against Covid-19 has gone down, given the lack of evidence that it works. Now, a new study has shown that it does not have a role in the treatment of Covid-19; it only has a placebo effect.
Azithromycin is a broad-spectrum antibiotic that is widely available. It is prescribed for various bacterial infection. Having been shown to reduce exacerbations in chronic airway diseases, it was widely prescribed for Covid-19 initially, including in India.
However, medical experts said its use has gone down since last year. It has also been taken out of national state guidelines for treatment of Covid-19.
The study was published last week in the Journal of the American Medical Association. Researchers at the University of California, San Francisco and Stanford University recruited 263 participants, of whom 171 received a single oral dose of azithromycin while 92 received matching placebo. The randomised clinical trial of azithromycin vs matching placebo was conducted from May 2020 through March 2021.
Authors Catherine Oldenburg and others wrote that among the outpatients with SARS-CoV2 infection, treatment with a single dose of oral azithromycin compared with placebo did not result in a greater likelihood of being free of symptoms at day 14. “Our study findings do not support the routine use of azithromycin for outpatient SARS-CoV2 infection,” the authors wrote.
In the early days of the pandemic, the treatment protocol from the Ministry of Health and Family Welfare had noted that there were no specific antiviral drugs proved to be effective against Covid-19, and had allowed physicians to consider hydroxychloroquine in combination with azithromycin for patients with severe disease and requiring ICU management.
While some state health departments include azithromycin in their guidelines issued three months ago as a drug that can be administered to patients in home isolation, it is no longer included in the clinical management protocol for Covid 19 issued in May this year by the Union Ministry of Health and Family Welfare.
At a virtual media briefing in April, AIIMS Director Dr Randeep Guleria had told The Indian Express that data did not support the use of hydroxychloroquine and azithromycin, and it is currently not in most guidelines. “There is no conclusive evidence that these drugs are of any benefit. However some people use HCQS as it may have some benefit and may not cause harm. The same goes for azithromycin, which is not used as an antibiotic, but as an immunomodulator. Both these drugs are used in some areas,” he had said.
Dr Sanjay Pujari, member of the National Task Force on Clinical Research of Covid-19, said azithromycin has been shown to be non-efficacious by multiple randomised controlled trials. The proportion of use may have gone down at least in hospitalised patients, he said.
Pune-based infectious diseases consultant Dr Parikshit Prayag said the use of azithromycin was stopped a long time ago. And Dr D B Kadam, Chair of the Covid task force for Pune division, said azithromycin was in use last year as an antibiotic for atypical pneumonia and possible in vitro antiviral activity. Due to cardiac side effects the use of this drug has been stopped and is not part of any guidelines this year, he said.
The authors of the new study have said that if azithromycin does not have a role in the treatment of Covid-19, avoiding its use would reduce unnecessary antibiotic consumption.
“Overuse of antibiotics during Covid-19 pandemic may lead to increased selection for antimicrobial resistance. Widespread use of azithromycin for Covid 19 in the absence of a clear bacterial indication may contribute to resistance selection,” Oldenburg and others have written.