March 18 2026
"In the early months of the COVID-19 pandemic, nearly 75% of hospitalized COVID patients received antibiotics on admission, primarily because of limited treatment options and concerns about bacterial coinfections.
One of those antibiotics was azithromycin, a macrolide antibiotic commonly used for respiratory infections. Use of azithromycin was driven in part by a study, now retracted, that suggested it could improve outcomes in COVID patients when used in combination with the antimalaria drug hydroxychloroquine. Although subsequent trials would find the combination had no benefit for COVID patients, widespread azithromycin use continued for several months.
Early in the pandemic azithromycin was “routinely used despite the absence of data supporting a clinical benefit,” according to Michael Pulia, MD, PhD, an emergency physician and associate professor at the University of Wisconsin-Madison School of Medicine and Public Health.
The use of an antibiotic to treat a viral infection reflected the desperation of “having so many ill patients and just wanting to give them something,” said Charles Lanegelier, MD, PhD, an infectious disease physician and professor at the University of California San Francisco.
“People were scrambling for anything,” Langelier said.
Now, in a new study this week in Nature Microbiology, Langelier and a team of US researchers show that, in addition to having no clinical benefit for COVID patients, use of azithromycin was associated with potentially harmful changes in the upper respiratory microbiome and increased expression of antibiotic-resistance genes after only one day of exposure.
“I think it really tells us that inappropriate or unnecessary use of azithromycin has direct and fairly rapid biological consequences in terms of driving antimicrobial resistance,” Langelier told CIDRAP News..."
LINK:https://www.cidrap.umn.edu/antimicrobial-stewardship/antibiotic-used-covid-patients-tied-increased-signs-antibiotic-resistance
