Common COVID-19 antibiotic flops in clinical trial: Experts weigh in

Azithromycin was first introduced to COVID-19 care due to its anti-inflammatory properties hypothesized to help stop progression if administered early on

Azithromycin, an antibiotic used to treat COVID-19, was no more effective at freeing non-hospitalized patients of COVID-19 symptoms than a placebo, a study found. 

Findings from researchers affiliated with University of California San Francisco published in JAMA Network on July 16 analyzed 263 COVID-19 outpatients, 171 of whom were treated with a single 1.2-g oral dose of the antibiotic, while 92 patients were given a placebo. After two weeks, the study found "no significant difference in proportion of participants who were symptom free (azithromycin: 50%; placebo: 50%)." What’s more, by day 21, five participants in the treatment group were hospitalized, compared with zero in the placebo group.

"Azithromycin is not a drug that should be used to treat Covid," Dr. Aaron Glatt, who is uninvolved in the study, told Fox News in an email. 

Glatt, the chairman of the department of medicine and chief of infectious diseases at Mount Sinai South Nassau, added: "There is no evidence that it provides any benefit to treat Covid and it should not be used unless there is an appropriate bacterial indication."

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Antibiotics like azithromycin are often used to treat bacterial infections like pneumonia and sexually transmitted infections, according to Dr. Anthony J. Santella, professor of health administration and policy and university COVID-19 coordinator at the University of New Haven. 

"Thus, exploring its use to prevent symptoms of COVID-19 makes sense using a robust clinical trial design," he wrote, later adding, "we must remember this is one research study and we would never change treatment guidelines without replicating the study and getting an expert panel to independently review the study data."

The antibiotic was first introduced to COVID-19 care due to its anti-inflammatory properties hypothesized to help stop progression if administered early on, lead author Catherine E. Oldenburg, MPH, assistant professor with the UCSF Proctor Foundation, wrote in a news release posted to EurekAlert.org.

"These findings do not support the routine use of azithromycin for outpatient SARS-CoV-2 infection," Oldenburg wrote.

Another expert called the results "concerning but not totally unexpected."

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Dr. Ryan Miller, infectious disease specialist at Cleveland Clinic, noted that the antibiotic has been shown to reduce the number of readmissions of patients with chronic pulmonary obstructive disease (COPD), and adds that the treatment's known anti-inflammatory effects help mitigate the effects of COPD.

He warned that the antibiotic has significant and potentially lethal adverse effects, one of which can result in an abnormal heart rhythm preventing the blood from being pumped throughout the body, while also citing a study comparing azithromycin and amoxicillin for cardiovascular death, finding a 2.49 increased risk for those treated with azithromycin.

"For these reasons, my fellow infectious disease physicians and I tend to err on the side of reluctance when giving additional therapies without proven benefit.  Every medication has a risk of adverse reaction," he wrote.