Azithromycin Guide: How It Works and When to Use It

Azithromycin, commonly known as a "z-pack," is an antibiotic used to treat several bacterial infections. Azithromycin is from a class of antibiotics known as macrolides.   This widely used antibiotic can be a game-changer for treating bacterial infections, but how does it work?  

This article explores the uses, dosages, potential side effects, and safety considerations for azithromycin to empower you to make informed decisions about your health. 

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What is Azithromycin

Azithromycin is a widely prescribed antibiotic in the United States, often recommended for treating bacterial infections. It ranks among the most commonly prescribed antibiotics in the United States (US).

Overview of Azithromycin

Azithromycin is a macrolide antibiotic related to clarithromycin and erythromycin. It was initially developed by Pliva in Croatia and later introduced to the U.S. market through an agreement with Pfizer in 1986.

How Azithromycin Works

Azithromycin binds to bacterial ribosomes, preventing protein synthesis and bacterial growth. It has exhibited anti-inflammatory and antiviral properties in laboratory studies, leading to research on its potential effects on viral infections, including SARS-CoV-2. However, it is not FDA-approved for COVID-19 treatment.

Bacteria can develop resistance to Azithromycin by mutations of the 23S ribosomal subunit to which the antibiotic binds. Other bacteria may overexpress certain genes that cause less accumulation of the medication, which results in resistance. 

Medical Uses of Azithromycin

Azithromycin is used to treat a number of bacterial infections. 

Common Infections Treated

Some of the common infections that azithromycin is used for include:

• Respiratory infections such as pneumonia or bronchitis
• Certain types of skin infections
• Lyme disease
• Some sexually transmitted infections (STIs)
• Sinus infections

Azithromycin is the antibiotic of choice for community-acquired pneumonia (CAP).

Off-Label Uses

Azithromycin is FDA-approved for treating bacterial infections such as pneumonia, bronchitis, and certain STIs. It is also prescribed off-label for conditions like lung transplant complications, Salmonella infections, and parasitic diseases such as Babesiosis and malaria. 

Off-label use is determined by healthcare providers based on individual patient needs and available clinical evidence.

Dosage and Administration

The appropriate azithromycin dosage depends on the indication and individual patient factors. 

Standard Dosages

It is available in oral, liquid, and intravenous (IV) forms. 

• Standard Dose - Standard adult dosing is 500 mg on day 1, followed by 250 mg on days 2-5. 
• COPD and bacterial sinus infections - It may be administered at 500 mg daily for 3 days.  
• Sexually transmitted infections (STIs) - For STIs, azithromycin may be given as a single dose, usually 1000-2000 mg. 

However, dosing may vary, particularly for children and patients with specific health conditions. Always consult a healthcare provider before taking azithromycin.

Dosage Adjustments

Azithromycin doesn’t require dose adjustment for kidney dysfunction or hepatic dysfunction. 

Azithromycin may interact with other medications, including:

• Certain antacids
• Colchicine
• Some immune suppressive medications
• Certain migraine medications, such as ergotamine
• Coumadin/warfarin, a blood thinner
• Other antibiotics
• Statins

It is important to talk with your healthcare provider about all medications you may be taking, including herbal medications or supplements. 

Potential Side Effects

Like any medication, azithromycin has the potential to cause side effects.

Common Side Effects

Common side effects of azithromycin include nausea, vomiting, headaches, diarrhea, appetite loss, and feeling dizzy or tired. It is also possible to have mild allergic reactions such as a rash.

Serious Side Effects

Serious side effects of azithromycin include:

• Abnormal heart rhythm 
• Severe diarrhea, diarrhea that contains mucus or blood, 
• Pancreatitis - Severe stomach or back pain
• Yellowing of the skin, 
• Ringing in the ears
• Hearing loss.

In rare cases, severe allergic reactions such as anaphylaxis can occur. If you experience swelling of the face, hands, legs, feet, or ankles, seek immediate medical attention.  

Precautions and Contraindications

Azithromycin is contraindicated in some people.  

Who Should Avoid Azithromycin

Azithromycin should be used with caution in individuals with pre-existing heart conditions, including cardiac arrhythmias, and in people with myasthenia gravis. Those with liver or kidney disease should consult their healthcare provider before taking azithromycin to determine its safety. 

Always inform your doctor of all medications you are taking to avoid potential interactions.

Safe Use Guidelines

Azithromycin should be stored at room temperature and not exposed to moisture.  The liquid form of azithromycin should be discarded after 10 days or when you have completed the course of medication. 

Azithromycin should not be crushed or chewed. It should be taken with water at least one hour before eating or two hours after eating unless instructed otherwise by a healthcare provider or pharmacist.

Frequently Asked Questions

Can azithromycin treat COVID-19? No, while azithromycin has shown potential to help with inflammation and viral infections, not enough information is available to recommend its use in treating COVID-19. As a result, azithromycin is not approved to treat COVID-19.

How long does it take to work?  Azithromycin usually starts to work within a few days of starting treatment.  Even if you start to feel better, complete the entire course of medication; stopping the medication early can result in developing antibiotic resistance.  

Can it be taken with other medications? Some medications may interact with azithromycin. It is important to talk to your healthcare provider and pharmacist about all the medications and supplements you are taking when starting this medication.

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Key Takeaways

• Azithromycin is a common medication used to treat several infections, including respiratory and sexually transmitted infections.
• Azithromycin has a variety of formulations and doses available depending on the condition being treated.
• Azithromycin has anti-inflammatory properties and may have antiviral properties.
• Azithromycin is not currently approved to treat COVID-19
• You should discuss all your health conditions and medications, supplements, or herbs you are taking.
• If you develop serious side effects, you should seek immediate medical attention.
• Azithromycin is a powerful antibiotic with various uses, but it is important to understand its uses and limitations for safe and effective use.  Always consult a healthcare professional for recommendations based on your unique health history.   

Stay informed – check our resources for more insights on safe medication practices.