Despite the studies to the contrary, the drug has caught on as a default treatment option for Covid-19 in the country.

Azithromycin is now considered the most abused drug in India. Anyone with a sore throat, cold, cough, or runny nose takes it as an over-the-counter drug for the treatment of Covid-19 or symptoms similar to Covid-19. The drug’s growing use has increased its popularity and recall value, which was previously exclusive to paracetamol.

Azithromycin is a relatively cheap antibiotic: the cost of a generic Azithromycin 500 mg tablet on Jan Aushadhi Portal is Rs 13.5. It is considered a safe drug with mild gastrointestinal side effects such as stomach upset, diarrhea, loose stools, nausea, vomiting, or abdominal pain.

With the onset of Covid-19 in 2020, antiviral and immunomodulatory agents were proposed as potential treatments. Drugs such as Azithromycin were tested as potential therapeutic options.

But this is not borne out in the research. A study published by the Journal of the American Medical Association on July 16, 2021, found that 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.

In a randomized trial that included 263 participants with Covid-19 infection, treatment with a single oral dose of Azithromycin compared with placebo resulted in the self-reported absence of Covid-19 symptoms at day 14 in 50 percent versus 50 percent. This was not statistically significant.

Another study published by the Journal of Family Medicine and Primary Care in January 2021 argued “the available evidence does not support the use of Azithromycin for improving any useful clinical parameter such as time to recovery or need for hospitalization in Covid-19 including that in patients of mild–moderate disease.”

“Its (Azythromycin) injudicious use in the community by primary care physicians and patients alike should be stopped, and it should be withdrawn from any government recommendations in the country,” the study said. “Otherwise, the indiscriminate use of this popular and useful antibiotic will lead to resistance and will pose a serious problem in the management of infections for which Azithromycin is currently recommended and effective.”

But in spite of the studies proving that Azithromycin has no clinical benefits as far as Covid-19, a growing number of people are using it. That too, despite some groups taking exception to its consumption.

In January, the Campaign Against Pseudo Science Using Law and Ethics, a wing of the Kerala Sasthra Sahithya Parishad, approached the State Drugs Controller, requesting the imposition of curbs on the sale of the drug.

In the same month, in an open letter to the Union Health Ministry and its state government counterparts, over 30 doctors appealed against the use of medications and diagnostics that are “inappropriate for clinical management” of Covid-19. The letter said the vast majority of patients with asymptomatic and mild symptoms of Covid-19, will require little to no medication. They stressed that prescribing vitamin combinations, Azithromycin, doxycycline, hydroxychloroquine, favipiravir, and ivermectin for treating Covid-19 is an “irrational practice.”

But so far, such advice and warnings have had little effect. On the contrary, Azithromycin has further caught on as a default treatment option.

“The highest sold medication in India is Azithromycin antibiotic,” Dr. Guru N. Reddy, founder and managing director of Continental Hospital told the New Humanitarian “You know why? Because of Covid-19. Patients just went to the pharmacy, got hold of this Azithromycin and started taking.”