Azithromycin Misuse in COVID-19 and Echoes in Medical Literature

Azithromycin Misuse in COVID-19 and Echoes in Medical Literature

As the COVID-19 pandemic unfolded, the global medical community faced unprecedented challenges. In the early stages, clinicians explored various therapeutic options to combat the virus, often repurposing existing medications. One such drug was azithromycin, a widely used antibiotic known for its broad-spectrum antimicrobial activity. However, its use in COVID-19 treatment has raised significant concerns about misuse and potential adverse effects. This article explores ongoing echoes of azithromycin misuse in COVID-19 treatment, as documented in medical literature. The DrugCard platform periodically discovers such articles, highlighting the magnitude of this issue.

The Early Hype and Subsequent Azithromycin Misuse

In the initial months of the pandemic, azithromycin was often used in combination with hydroxychloroquine based on preliminary studies suggesting potential benefits. This combination leveraged azithromycin’s anti-inflammatory properties and hydroxychloroquine’s antiviral effects. However, subsequent rigorous clinical trials failed to demonstrate significant benefits, leading to widespread misuse and overprescription.

Pharmacovigilance data has revealed a troubling pattern of adverse drug reactions (ADRs) associated with azithromycin misuse. These ADRs include cardiac arrhythmias, QT interval prolongation, and other severe cardiovascular events. The antibiotic’s extensive use without evidence of efficacy has underscored the necessity for vigilant pharmacovigilance practices.

Reverberations in Medical Literature on Azithromycin Misuse

The DrugCard platform identified a medical literature article detailing two cases of severe cholestatic pruritus following azithromycin misuse for mild COVID-19 infections.

In one case, a 60-year-old male patient experienced progressively worsening yellowing of the eyes, severe generalized itching, pale stools, and darkened urine. His pruritus severely impacted his sleep and quality of life. Six weeks prior, he had self-isolated at home with mild COVID-19 and completed a five-day course of over-the-counter azithromycin. His liver injury profile showed a cholestatic pattern, with typical results from infectious and autoimmune liver panels.

Another case involved a 48-year-old female with a two-week history of intense nighttime itching, rated 10/10 on the itch scale. She had recently been diagnosed with mild COVID-19 pneumonia and had used over-the-counter azithromycin for five days. Apart from widespread pruritic marks, her systemic examination was unremarkable except for signs of cholestatic liver injury.

Lessons Learned and Future Directions

The azithromycin misuse episode during the COVID-19 pandemic offers valuable lessons for the pharmacovigilance community:

  • Emphasizing the need for high-quality, evidence-based data before adopting widespread therapeutic interventions. This helps prevent the premature use of medications without robust clinical evidence.
  • Enhancing the capacity of pharmacovigilance systems to handle large-scale public health emergencies. This includes improving ADR reporting infrastructure and investing in advanced data analytics.
  • Fostering collaboration between clinicians, pharmacovigilance specialists, researchers, and regulatory authorities to ensure comprehensive monitoring and management of drug safety.
  • Increasing public awareness about the potential risks of off-label drug use and the importance of adhering to prescribed treatments. Educating healthcare professionals about the dangers of azithromycin misuse and the necessity of following evidence-based guidelines is crucial. This education should extend to patients, ensuring they understand why specific treatments are prescribed and the risks of self-medicating or deviating from medical advice.


The misuse of azithromycin during the COVID-19 pandemic has highlighted critical issues in drug safety and the essential role of pharmacovigilance. By learning from this experience, pharmacovigilance specialists can better prepare for future public health crises, ensuring that drug safety remains a top priority. Through vigilant monitoring, robust data analysis, and effective communication, the pharmacovigilance community can help mitigate the risks associated with drug misuse and safeguard public health.

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