What do azithromycin, doxycycline, hydroxychloroquine, favipiravir, and ivermectin have in common? Besides complex names, these are unnecessary medications people are popping like candy to treat mild cases of Covid19. This has perturbed health experts who are identifying an irrational use of antibacterials and antivirals.

In a letter last week, more than 30 health experts wrote to the central and state governments urging an “evidence-based response” to the current wave of Covid. What tipped off their concern? “Unwarranted medications, tests, and hospitalizations” which were mindlessly recommended to Covid patients. They highlighted that Covid “kits” and cocktails, vitamin combinations, and a host of medicines were being prescribed to patients — including azithromycin, an antibiotic, or an anti-bacterial drug.

The most evident misuse comes in the form of home isolation Covid19 kits. These prescriptions contain various combinations of the aforementioned drugs — despite their widespread debunking over the last two years. A host of studies have repeatedly debunked ivermectin as an anti-Covid19 medication; the same goes for hydroxychloroquine and azithromycin. Think of it this way: what can azithromycin, an antibacterial, do against Covid19, a viral infection?

“Inundated with calls, messages from anxious patients, parents — they [doctors] share the prescriptions given to them. An exotic bhelpuri of Azithromycin Doxycycline Ivermectin Fabiflu HCQs (still!?) VitD, Vit C, Zinc, antihistamine, PPI, cough syp, betadine gargles, and… paracetamol,” Rajani Surendar Bhat, an interventional pulmonologist, said. These are thoughtless prescriptions of inexpensive pills, being amplified even two years in the pandemic. As far as guidelines are concerned, the Indian Council of Medical Research (ICMR), along with other international bodies, strictly advises against flippant use of these medications.

“The vast majority of patients with Covid-19, with asymptomatic and mild symptoms, will require little to no medications,” experts also noted in their letter. According to the current guidelines, “mild” Covid19 refers to patients with upper respiratory tract symptoms (scratchy throat) with or without fever, without shortness of breath, and having oxygen saturation at room air of more than 93%.

The pill-popping is not innocuous. The trend of irrational usage has one end: “You develop antibiotic resistance! So the next time when you actually have a bacterial infection, Azithromycin won’t work on you!” as one doctor noted.

Related on The Swaddle:

Antibiotic Overuse is Driving Drug‑Resistant Bacteria in India: ICMR

Antibiotic resistance (AMR) is emerging to be a formidable foe; it already has the potential to become the “next global pandemic.” “AMR is said to occur when microorganisms, or microbes — like bacteria, fungi, and viruses — evolve to become unresponsive to antimicrobial drugs… Excess usage of antibiotics, antifungals, and antiviral drugs resulting from over-prescription by doctors as well as self-medication are contributing to AMR,” an article in The Swaddle noted last year.

This was based on a study conducted by ICMR during 2020; it found a sustained increase in drug-resistant pathogens among Indians. In other words, the existing medications were proving ineffective in treating infections. Another study from July indicated a surge in antibiotic usage in India during the first wave — despite them not being effective against Covid19.

Health experts who urged caution this month, in light of rising cases, also noted ramifications. “Such wanton use of drugs is not without harm as the Delta wave has shown. Outbreaks of opportunistic fungal infections like mucormycosis in India, and aspergillosis in Brazil were attributed to the widespread abuse of inappropriate medications,” experts noted in the letter. The 2020 ICMR study also showed many Covid19 patients developed secondary bacterial or fungal infections during hospitalization.

“During the peak of the pandemic in June-September 2020, consumption was estimated at 216.4 million excess doses of non-CAF antibiotics and 38 million excess doses of Azithromycin – which is equivalent to 6.2 million Azithromycin treatment courses,” an article noted.

On the edge of a third wave, the antiviral molnupiravir seems to be prone to abuse. The ICMR limited its use for people with comorbidities only, after pointing out fatal side-effects for other age groups. It was also removed from the government’s Covid19 protocol, but the drug continues to be widely prescribed and distributed at different public health tiers.

The whole saga follows a strange but familiar pattern. It begs the question: what have we learned so far, and why are we immune to the lessons?