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

The study was conducted to evaluate the prevalence of Drug-Drug Interactions (DDIs) of Azithromycin and its impact on patient mortality and microbial resistance during the first wave of COVID-19. The study was performed in tertiary care hospitals located in various areas of Karachi, Pakistan. A cross sectional retrospective study on a sample size of 300 patients was conducted (Jan - Dec 2020) on in-patients receiving Azithromycin as part of their therapeutic regimen. Data was collected using a structured and validated tool. The Medscape Drug Reference database was applied to assess the DDIs. The presence of DDIs was observed in 224 patients (75 %) involving 28 drugs with a total of 346 interactions. Among them, majority (60 %) were severe followed by moderate (33 %) and mild interactions (7 %). Among 300 patients, a total of 41 mortalities was observed with highest percentage (90%) in patients with drugs causing severe interactions i.e. enoxaparin and hydroxychloroquine. The moderate interaction group exhibited 10% mortality involving piperacillin. Additionally, out of 346 interactions, only one due to calcium carbonate was found to affect the bioavailability of azithromycin. Our data reveals the high prevalence of DDIs with Azithromycin during the first wave of COVID-19, which has most likely contributed towards the mortality.