Doxycycline to Azithral: Are tablets prescribed for COVID-19 treatment effective?

Many of the prescriptions for COVID-19 patients include antibiotics and antiparasitic medicines as part of the treatment.
Remdesivir injection
Remdesivir injection
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Doxycycline, Azithromycin, Azithral — these are some of the medicines that doctors prescribe for patients who test positive for the SARS-CoV-2 virus that causes COVID-19. These are medicines that are also on this list. However, none of these drugs is effective or proven to be effective in treating COVID-19 patients, say medical experts. Most of the tablets prescribed for COVID-19 patients are nothing but antibiotics, antiparasitic or vitamins that are not proven to completely ‘cure’ the disease but only helps in symptomatic treatment, say doctors.  

According to the handbook released by the World Health Organisation, titled ‘Drugs to prevent COVID-19’, “Current use of drugs to prevent COVID-19 is variable, reflecting large-scale uncertainty. Numerous randomised trials of many different drugs are underway to inform practice.” Hence, there is no clear medication prescribed for treating COVID-19 patients. TNM looks into some of the commonly used medicines, including antibiotics and antiparasitic tablets, which COVID-19 patients are prescribed as part of treatment.

Several doctors are divided over prescribing medicines to treat COVID-19. A lot of treatment procedures and medicines are still being experimented with as the disease is fairly new to medical and public health experts. Madhu Pai, a professor and Canada Research Chair of Epidemiology and Global Health at McGill University in Montreal, says that drugs such as Ivermectin, Azithromycin, Baricitinib, Bevacizumab, Doxycycline, Favipiravir, Fluvoxamine, Hydroxychloroquine, Itolizumab, Interferon alpha-2b, 2-DG are not proven and not routinely advised for COVID-19. 

Some doctors also suggest convalescent plasma therapy for treatment, which uses the blood of people who recovered from COVID-19 to treat others with moderate illness. However, experts have pointed out the therapy has no proven benefits. After several recommendations, on May 17, the Union government dropped plasma therapy from the COVID-19 management guidelines, as it was found that it did not reduce the progression to severe disease or death.  

Some prescriptions for COVID-19 patients, which TNM accessed, include Ivermectin, an antiparasitic drug. Several international drug and health agencies have not recommended the use of Ivermectin for treating or preventing COVID-19. However, in India, many doctors recommend its use based on a few studies that have shown it can prevent the virus from replicating.  The ICMR also recommends Ivermerctin for mild infection but has also said that the drug has “low certainty of evidence.”

Among the antiparasitic medicines for COVID-19, Ivermectin has shown positive improvements among certain patients, said Dr Shanti Ravidranath, a geriatrician and a member of the Doctors Association for Social Equality. “There are positive reviews for Ivermectin and patients on the drug have shown improvement. Though WHO has not advised the use of Ivermectin, this is a less costly and easily available drug. The drug also doesn’t have any side effects and AIIMS protocol still suggests the use of Ivermectin,” the doctor said. 

According to Dr Shanti, who is providing free consultations for COVID-19 patients, “During the pandemic, WHO has been recommending different medicines for both developed and developing countries. So, the scenarios may be different and we have to use the available resources. Besides, there is less research, so the decisions keep changing based on understanding. Hence, use of Ivermectin can be continued for selected patients.”

However, the World Health Organisation clarified that Ivermectin can only be used for clinical trials. “The current evidence on the use of Ivermectin to treat COVID-19 patients is inconclusive. Until more data is available, WHO recommends that the drug can only be used within clinical trials,” it said. 

Meanwhile, in Tamil Nadu, the state government removed Ivermectin from the treatment protocol. However, antibiotics such as Azithromycin continue to be prescribed for COVID-19 patients or those suspected to have the infection and are getting treatment at Primary Health Centre or COVID Care Centre with an oxygen level of 90-94%. 

Several doctors across the country are sometimes even prescribing more than one antibiotic tablet such as Azithromycin or Azithral. “Antibiotics can be completely avoided since they cannot treat viral infections and antibiotics are required only when there is the identification of bacterial infection,” said Dr Shanti Ravindranath. 

Antibiotic, antiparasitic medicines have no role

Several senior virologists are also against the use of antibiotics and antiparasitic medicines to treat COVID-19. Renowned virologist Dr T Jacob John, who is a former professor at Christian Medical College (CMC) in Vellore, said that antibiotics and antiparasitic medicines have no role in COVID-19 treatment as it is a purely viral infection. “Nothing will happen if antibiotic or antiparasitic medicines are taken but they should not be taken without any reason. If you have a proven or suspected bacterial infection, then you can take the antibiotics,” he said.

Remdesivir is yet another antiviral drug that has been in huge demand since the second wave of the pandemic began in March. Several public health experts and doctors have insisted that Remdesivir is not a life-saving drug. Some doctors say that it helps expedite the recovery process in a few patients with mild symptoms. However, the WHO’s Solidarity Trial found no evidence that it improves survival or other outcomes in COVID-19 patients. 

“There are only limited medicines for COVID-19 treatment, such as Remdesivir and dexamethasone. But antiviral drug Remdesivir has a very limited role in very carefully selected patients. Dexamethasone, too, shows effects in a select group of people for a very short time,” said Dr Jacob.

Dr Shanti stressed that all medicines should be prescribed by a doctor.

Don’t self-medicate

In the current scenario of divided opinions and limited research on medicines, both doctors expressed their concern over several patients relying on WhatsApp forwards with medical prescriptions for medications. The doctors warn against self-medication.

The doctors said several patients are visiting them and are claiming to follow prescriptions from social media. Patients take several unnecessary medicines, which if and when overused, can lead to long-term side effects. 

Doctors advised patients to get treatment only from a registered medical practitioner. “Every illness should be treated by a physician. Self-medication, self-diagnosis is not good. Patients should receive treatment only from a registered medical practitioner,” Dr Jacob John said. 

Dr Shanti said, “The government is telling us not to waste time and wait till RT-PCR results and treat all patients as COVID-19 suspects unless proven otherwise. So, patients seek medical help at the earliest and must get treatment from approved doctors instead of believing in social media forwards.”

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