Azithromycin: Uses and Side Effects

Table of Content

• What is Azithromycin?

• Uses of Azithromycin

• Azithromycin in Pregnancy and Breastfeeding

• Azithromycin in Pediatric

• Azithromycin with Elderly People

• Azithromycin Interaction with other Drugs

• Azithromycin Side Effects

• 8 Precautionary Measures Before Taking Azithromycin

Introduction

• Azithromycin is a common antibiotic primarily used for treating a wide range of bacterial diseases, which can either be consumed orally or injected intravenously. It decreases protein production, which in turn stops the growth of bacteria. This medicine is used for ear infections, pneumonia, sore throat, traveler’s diarrhea, and many other intestinal infections. Azithromycin is also used for curing many sexually transmitted diseases/infections such as Gonorrhea and Chlamydia. Also, it can be used to treat malaria. Azithromycin is antiviral and works as an immunomodulatory agent. Therefore, it is potentially used for the treatment of coronavirus disease. However, the use of this drug for COVID-19 is still under study and not yet approved by the FDA. 

• The drug Azithromycin was discovered by Pliva Company in 1980 and approved for medicinal use in 1988.

• It is on the WHO's (World Health Organization's) list of essential medicines. The WHO classifies it as a critically essential human medicine. It is available as a generic medicine and is sold under many trade names worldwide. 

What is Azithromycin?

Azithromycin is employed to treat certain bacterial infections occurring at different body parts. It belongs to the class of antibiotics called macrolides. It works by suppressing the growth of bacteria or killing them. However, this medicine will not work for the general cold and flu.

This medicine is available only with the doctor's prescription. It is available in the following dosage forms:

• Powder for Suspension, Extended Release

• Tablet

• Powder for Suspension

Uses of Azithromycin

Azithromycin is used to treat diverse infections of the sinuses, lungs, skin, and other body parts. Some of them are:

• Airway Diseases: Azithromycin appears to effectively treat chronic obstructive pulmonary disease (COPD) by suppressing inflammatory processes and potentially valuable for asthma and sinusitis via this mechanism. Azithromycin is believed to produce its effects by suppressing specific immune responses that may contribute to inflammation of the airways.

• Prevention and treatment of acute bacterial infection of chronic obstructive pulmonary disease (COPD). 

• Community-acquired pneumonia.

• Uncomplicated skin infections. 

• Urethritis (inflammation of the urinary tube) and cervicitis (inflammation of the cervix). Azithromycin is used as a monotherapy in most cases, but the combination with ceftriaxone is recommended in case of co-infections. 

• Genital ulcer disease (chancroid) in men.

• Acute bacterial sinusitis. 

• Pharyngitis (pain, inflammation, and irritation in the pharynx) or tonsillitis (inflammation of the tonsils) is an alternative to first-line therapy in people who cannot use first-line therapy. 

Azithromycin in Pregnancy and Breastfeeding

Azithromycin does not harm pregnant women. Although, no adequate well-controlled studies are reported in pregnant women. The safety of this medicine during breastfeeding is not fully known. As reported, only low levels of Azithromycin are found in breast milk, and the medicine has also been used in children, so it is unlikely that the infants feeding on breast milk would suffer from any side effects. However, it should be kept in mind to use the drug with caution during breastfeeding. 

Azithromycin in Pediatric

Not many studies have been done on the relationship of age to the effects of Azithromycin to treat sinusitis or pneumonia in children younger than six months old. The safety and effectiveness of this drug have not yet been established in this age group.

Appropriate studies are still needed to know the relationship between age and Azithromycin's effect to treat pharyngitis or tonsillitis in children younger than two years of age. Safety and efficacy are yet to be established.

Azithromycin with Elderly People

Problems with aged people have not been appropriately described in various studies that could limit Azithromycin use in old-age people. However, these patients are more likely to have heart rhythm problems, requiring caution in patients receiving Azithromycin.

Azithromycin Interaction with other Drugs

Certain medications should never be used together. But in some cases, two different medicines may be prescribed together even if an interaction might occur. Your doctor may feel the need to change the dose or tell you about other precautions that are necessary in such cases. When you take this medicine, your healthcare professional must know if you are taking any of the medicines listed below. The following interactions have been selected based on the potential significance of these medicines and are not necessarily true in all the cases.

Using Azithromycin with any of the following medications is not recommended. Your doctor may decide not to prescribe you these drugs or change some of the other medicines you take. These are:

• Bepridil

• Cisapride

• Dihydroergotamine

• Dronedarone

• Ergoloid Mesylates

• Ergonovine

• Ergotamine

• Methylergonovine

• Methysergide

• Pimozide

• Piperaquine

• Saquinavir

• Sparfloxacin

• Terfenadine

• Thioridazine

• Ziprasidone

Azithromycin Side Effects

• The most common ill effects of Azithromycin are diarrhea, nausea, abdominal pain, and vomiting. Due to the side effects, fewer than 1% of people stop taking this drug. Skin reactions, nervousness, and anaphylaxis (severe allergic reaction) have been reported. Clostridium difficile infection has been reported with its use. The use of Azithromycin does not affect the efficacy of birth control, unlike some other antibiotics such as rifampin. Hearing loss has also been reported in some cases. 

• People can occasionally develop delirium (mental confusion) or cholestatic hepatitis (a liver and gallbladder disease). It was also found that the accidental intravenous overdose in an infant caused severe heart block, resulting in residual encephalopathy. 

• In the year 2013, the FDA (Food and Drug Administration) warned that the use of Azithromycin could lead to abnormal alterations in the heart's electrical activity that may cause an irregular heart rhythm which could be fatal. The FDA emphasized a study that has found the increased risk of death by using this drug, particularly in those dealing with heart ailments, compared with those who are prescribed other antibiotics like amoxicillin or no antibiotic at all. It was indicated in the study that people with preexisting conditions are at particular risks, for example, those with prolongation of QT interval, a slower than normal heart rate, low potassium or magnesium level in the blood, or those who use certain drugs to treat abnormal heart rhythm. 

• Along with this, it has been reported that Azithromycin blocks autophagy (recycling of cellular materials) and may cause mycobacterial infection in patients suffering from cystic fibrosis.

8 Precautionary Measures Before Taking Azithromycin

1. Before using Azithromycin, tell your doctor if you are allergic to it or other antibiotics (such as erythromycin, clarithromycin, telithromycin). It may contain inactive ingredients, which can cause allergic reactions and many other problems.  

2. Before using this medicine, tell your doctor or pharmacist your medical history, especially liver disease, kidney disease, or specific muscle disease.

3. Azithromycin can have an adverse effect on the normal rhythm of the heart (called QT prolongation). Abnormal heart rhythm can sometimes cause severe effects such as fast/irregular heartbeat and various other symptoms like fainting, severe dizziness, etc., that need immediate medical attention.

4. There is an increased risk of abnormal heart rhythm if you are dealing with some specific medical conditions or are taking other medicines that also cause abnormal heart rhythm. Before using Azithromycin, tell your physician of all the medicines that you are taking or if you have any of the conditions such as certain heart problems (heart failure, slow heartbeat), family history of heart problems (sudden cardiac death).

5. Low levels of magnesium (Mg) or potassium (K) in the bloodstream may also increase the risk of abnormal heart rhythm. The chance of getting abnormal heart rhythm further increases if the patient uses certain drugs (such as diuretics) or if he/she is having certain conditions such as diarrhea, severe sweating, or vomiting. It is recommended to have a detailed talk with your doctor about using Azithromycin safely.

6. Azithromycin may cause live bacterial vaccines (such as typhoid vaccine) not to work properly. Do not go for any vaccinations/ immunizations while using this medication unless your doctor tells you to.

7. Before having any surgery, tell your doctor/dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

8. During the pregnancy period, this medication should be used only when needed. Openly discuss its risks and benefits with your doctor. This drug passes into breast milk. Consult your doctor before breastfeeding.

Word of Wisdom

Azithromycin is undoubtedly a wonder drug used to treat various illnesses, but it must be consumed with all the precautions as it can result in various side effects. Remember to keep this medicine (and other medicines) out of the reach of children. Also, never share your medicines with others without consulting the doctor and use Azithromycin only as directed by the medical expert.

References

• ScienceDirect

• Taylor & Francis

• PubMed Central