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Drug-drug interactions with azithromycin during COVID-19: An evidence of contribution towards patient mortality

Sidra Tanwir1, Arif Sabah1, Ambrina Khatoon2

  • 1Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, Ziauddin University, Karachi, Pakistan.

Pakistan Journal of Pharmaceutical Sciences
|July 18, 2025
PubMed

Insights

Drug-drug interactions (DDIs) involving Azithromycin were common during the COVID-19 pandemic's first wave. These interactions, particularly severe ones, were linked to increased patient mortality in Pakistan.

Area of Science:

  • Pharmacology
  • Infectious Diseases
  • Clinical Pharmacy

Background:

  • The first wave of the COVID-19 pandemic saw widespread use of Azithromycin, often in combination with other medications.
  • Understanding the potential for drug-drug interactions (DDIs) with Azithromycin is crucial for patient safety and treatment efficacy.
  • Assessing the impact of these DDIs on patient outcomes, including mortality, is essential.

Purpose of the Study:

  • To determine the prevalence of DDIs involving Azithromycin in hospitalized patients during the initial phase of the COVID-19 pandemic.
  • To investigate the association between Azithromycin-related DDIs and patient mortality.
  • To evaluate any impact on Azithromycin bioavailability.

Main Methods:

  • A retrospective, cross-sectional study was conducted on 300 inpatients receiving Azithromycin between January and December 2020.
  • Data on concurrent medications and patient outcomes were collected using a validated tool.
  • Drug-drug interactions were identified using the Medscape Drug Reference database.

Main Results:

  • A high prevalence of DDIs was observed, with 75% of patients (224 out of 300) experiencing at least one interaction involving 28 different drugs.
  • The majority of interactions were classified as severe (60%), followed by moderate (33%) and mild (7%).
  • A significant association was found between severe DDIs (e.g., with enoxaparin, hydroxychloroquine) and patient mortality (90% of deaths occurred in this group). Moderate interactions with piperacillin were associated with 10% mortality.

Conclusions:

  • Azithromycin-DDIs were highly prevalent during the first wave of COVID-19 in Pakistan.
  • Severe DDIs involving Azithromycin were strongly associated with increased patient mortality.
  • Monitoring and managing DDIs are critical when prescribing Azithromycin, especially in critically ill patients.

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