Azithromycin

About Azithromycin

Azithromycin stops susceptible bacteria from making proteins; like other antibiotics, it does not treat viral infections such as the common cold. In adults, the label covers acute bacterial flare-ups of chronic bronchitis, acute bacterial sinusitis, community-acquired pneumonia in people well enough for treatment by mouth, strep throat and tonsillitis when first-line treatment cannot be used, uncomplicated skin infections, urethritis and cervicitis caused by chlamydia or gonorrhea, and chancroid in men. In children, it covers middle ear infections and community-acquired pneumonia from 6 months of age, and strep throat and tonsillitis from 2 years. Adults often take 500 mg on day 1 and 250 mg on days 2 to 5, 500 mg a day for 3 days, or a single 1 g or 2 g dose for some sexually transmitted infections; children are dosed by weight. Uses such as travelers’ diarrhea are not FDA-approved, and the prescriber decides.

There is no boxed warning. Azithromycin must not be taken by anyone allergic to it, erythromycin or any other macrolide or ketolide, or who had jaundice or liver problems from an earlier course of azithromycin. Serious allergic and skin reactions, some fatal, and liver injury have been reported; signs of hepatitis mean stopping it at once. It can prolong the QT interval and cause torsades de pointes, which can be fatal, so the label asks prescribers to weigh that risk with a long QT interval or past torsades, a slow heart rate, uncompensated heart failure, low potassium or magnesium, or other QT-prolonging drugs; older adults may be more sensitive. Some observational studies found a higher short-term risk of cardiovascular death in adults given azithromycin than other antibiotics, including amoxicillin, greater in the first five days; the data cannot establish or exclude a causal link, and the label says to balance this potential risk with the benefits. It can also worsen myasthenia gravis. Diarrhea, nausea, abdominal pain and vomiting are the most common side effects.

Pyloric stenosis, a blockage of the stomach outlet, has been reported in babies given azithromycin in their first 42 days, so vomiting or irritability with feeding needs a call to the doctor. Watery or bloody diarrhea, even more than two months after the last dose, can be Clostridioides difficile infection. At the recommended doses, the label says it should not be relied upon to treat syphilis. Decades of data in pregnancy have not identified a risk of major birth defects or miscarriage; azithromycin is present in breast milk, and a breastfed infant is watched for diarrhea, vomiting or rash. The labels say to use the mixed suspension within 10 days.

Taking Azithromycin

How to take it

Once a day, with or without food, for the number of days prescribed; some infections are treated with a single dose. Do not take antacids containing aluminum or magnesium at the same time; ask how many hours apart to take them. Shake the suspension well before each dose. Finish the prescription even if you feel better.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip the missed dose and carry on as usual. Do not take a double dose.

Storage

Tablets and suspension at room temperature, away from excess heat and moisture, out of reach of children. Use the mixed suspension within 10 days, and throw away any left once all doses are taken.

Interactions to know about

It may strengthen the effect of warfarin, so clotting tests are checked, and with nelfinavir the label calls for watching for liver test changes and hearing problems. Other QT-prolonging drugs, such as quinidine, procainamide, dofetilide, amiodarone and sotalol, add to the risk of a dangerous heart rhythm. Antacids with aluminum or magnesium are not taken at the same time.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Azithromycin differs from pharmacy to pharmacy

Generic azithromycin tablets and suspension have many makers, so quotes for the same course differ by each pharmacy’s fee and markup and by whether azithromycin is on its flat-price generic list. Courses use different numbers of tablets, so each prescription is quoted as written.

The suspension comes in two strengths and in bottles holding different total amounts, so the strength and bottle prescribed shape the quote. A prescription that names Zithromax and blocks substitution is filled with the brand.

Ways to pay less for Azithromycin without insurance

• Ask whether azithromycin is on the pharmacy’s flat-price generic list, and compare more than one pharmacy.
• Check that the prescription allows a generic, unless the prescriber has a reason to require Zithromax.
• For a child’s suspension, confirm that the strength and bottle size cover the whole course.
• If an older child can swallow tablets, ask the prescriber whether tablets would suit instead of the liquid.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Azithromycin

1. 1.Can I take it with my antacid, and how far apart?
2. 2.Do my heart rhythm or any of my medicines make azithromycin risky for me?
3. 3.How do I store my child’s liquid, and when do I throw it away?
4. 4.Which symptoms, such as severe diarrhea, fainting or a racing heartbeat, mean I should call?

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