Azithromycin

How it works

     * Azithromycin kills bacteria by inhibiting bacterial protein
       synthesis.
     * Azithromycin is used to treat infections caused by susceptible
       bacteria such as Mycobacterium avium, M. intracellulare, and
       Chlamydia trachomatis.
     * Azithromycin belongs to the class of medicines known as macrolide
       antibiotics.

Upsides

     * Used to treat mild-to-moderate infections caused by susceptible
       bacteria occurring on the skin, in the lungs, in the ears, and some
       infections that have been sexually transmitted.
     * Used specifically for the treatment and prevention of mycobacterium
       avium complex (a type of respiratory infection) in people with
       advanced HIV. May be used in addition to other antibiotics.
     * Active against a wide range of microorganisms and shows good
       penetration into human tissue. Some bacteria may be resistant (not
       killed by azithromycin).
     * May be better tolerated and have more effective tissue penetration
       than other similar antibiotics such as erythromycin.
     * May be used to treat bacterial infections in people intolerant of
       penicillins.
     * Can be dosed once daily which improves adherence.
     * Available as a tablet or capsule, in an extended-release form, as a
       powder for reconstitution, and in an injectable form.
     * Generic azithromycin is available.

Downsides

   If you are between the ages of 18 and 60, take no other medication or
   have no other medical conditions, side effects you are more likely to
   experience include:
     * Nausea, diarrhea, vomiting, abdominal pain, dyspepsia, flatulence,
       fatigue, headache are some of the more common side effects.
     * Liver damage and may affect liver function, sometimes fatally. Must
       be discontinued if any signs of liver dysfunction occur.
     * May cause changes in the way the heart beats, resulting in the
       development of cardiac arrhythmias. The risk is greater in people
       with a history of QT prolongation, on other drugs known to prolong
       the QT interval, with low levels of potassium or magnesium in their
       blood, and in those receiving anti-arrhythmic agents such as
       sotalol, amiodarone, and procainamide.
     * Severe diarrhea is a potential side effect of almost all
       antibacterial agents, including azithromycin.
     * May cause severe skin reactions and photosensitivity (increased
       sensitivity to sunlight). Discontinue azithromycin and seek urgent
       medical advice should a rash develop.
     * May interact with some other medications including warfarin and
       nelfinavir.
     * Dosage may need decreasing in those with renal disease and may not
       be suitable for people with myasthenia gravis.

   Notes: In general, seniors or children, people with certain medical
   conditions (such as liver or kidney problems, heart disease, diabetes,
   seizures) or people who take other medications are more at risk of
   developing a wider range of side effects. For a complete list of all
   side effects, [84]click here.

Bottom Line

   Azithromycin is an antibiotic used to treat a variety of different
   infections. It has the distinct advantage of once-daily dosing;
   however, diarrhea is a common side effect.

Tips

     * May be taken with or without food; however, azithromycin may be
       better tolerated if taken with food.
     * Do not take aluminum or magnesium-containing antacids two hours
       before or two hours after you take azithromycin because antacids
       can make azithromycin less effective.
     * Discontinue azithromycin immediately and seek urgent medical advice
       if any sign of an allergic reaction (such as a rash or difficulty
       breathing) occurs.
     * Take exactly as directed and finish the course as prescribed by
       your doctor, even if you feel better beforehand. Skipping doses or
       not completing treatment can decrease the effectiveness of the
       treatment and promote the development of resistance.
     * Although diarrhea is common with azithromycin, contact your doctor
       if you develop severe diarrhea especially if it is very watery or
       contains blood. Sometimes diarrhea may occur one to two months
       after starting azithromycin.
     * Contact your doctor immediately if you develop any signs of liver
       disease such as yellowing of the skin or whites of the eyes, upper
       right abdominal pain, rash, clay-colored stools, severe nausea, and
       vomiting.
     * If you are allergic to other macrolides (such as clarithromycin,
       erythromycin, or telithromycin) do not take azithromycin. Also,
       avoid azithromycin if you have taken it before and it caused damage
       to your liver.
     * Take [85]azithromycin Zmax extended-release liquid at least one
       hour before or two hours after a meal. Throw away any mixed Zmax
       suspension that has not been used within 12 hours.
     * Avoid excessive exposure to sunlight or tanning beds. Use an SPF 30
       or higher sunblock when outside and wear protective clothing as
       azithromycin can make you sunburn more easily.

Response and Effectiveness

     * It takes between two and a half to just over three hours for peak
       concentrations of azithromycin to be reached. A loading dose (a
       higher than normal starting dose) may be used to reach steady
       concentrations sooner.
     * Can be dosed once daily.
     * May take several days before symptoms of infection start to abate.
       Always finish the course as prescribed.

References