- What is azithromycin (Zithromax, Z-Pak)?
- Does azithromycin treat COVID-19 coronavirus disease?
- What are the side effects of azithromycin (Zithromax, Z-Pak)?
- What is the dosage for azithromycin (Zithromax, Z-Pak)?
- Which drugs or supplements interact with azithromycin (Zithromax, Z-Pak)?
- Is azithromycin (Zithromax, Z-Pak) safe to use during pregnancy or while breastfeeding?
- What else should I know about azithromycin (Zithromax, Z-Pak)?
What is azithromycin (Zithromax, Z-Pak)?
Azithromycin is effective against susceptible bacteria causing:
- Otitis media (infection of the middle ear)
- Uncomplicated skin and skin structure infections
- Mycobacterium avium complex
- Acute bacterial flare ups of chronic obstructive pulmonary disease (COPD)
What brand names are available for azithromycin?
Zithromax, Zithromax Tri-Pak, Zithromax Z-Pak, Zmax are the brand names available for azithromycin in the US.
Is azithromycin available as a generic drug?
Do I need a prescription for azithromycin?
Does azithromycin treat COVID-19 coronavirus disease?
Though azithromycin is an antibiotic and thus ineffective alone against viruses, some clinicians have seen limited success in COVID-19 coronavirus disease patients when adding it to chloroquine (Aralen) and/or hydroxycholoroquine (Plaquenil) in the sickest patients.
As of March 30, 2020, there is little solid evidence for this drug combination's effectiveness in general against COVID-19, however.
The initial COVID-19 data about azithromycin came from just a few patients in an observational "open label" study, which makes it difficult to isolate variables and say whether a particular drug is working.
Chloroquine and hydroxychloroquine are decades-old malaria drugs French doctors tested on coronavirus patients. Six patients in the tiny study of about 20 happened to also be on azithromycin for other conditions while also being administered the malaria drugs. All six patients recovered.
Researchers are still testing the malaria drugs and their combination with azithromycin to fight coronavirus.
As of March 30, 2020 available study results on malaria drugs' effectivness against COVID-19 were mixed, but a French study of 80 patients published that day in the International Journal of Antimicrobial Agents showed encouraging results for both the effectiveness of the malaria drugs and for the addition of azithromycin to the drug cocktail.
The FDA has released both malaria drugs for emergency use in COVID-19, despite the dearth of evidence.
What are the side effects of azithromycin (Zithromax, Z-Pak)?
The most common side effects of azithromycin are:
Other possible side effects of azithromycin include:
Possible serious side effects of azithromycin include:
- Abnormal liver tests
- Cholestatic jaundice
- Steven-Johnson Syndrome
- Serious allergic reactions
- Abnormal heart beats
Antibiotics can alter the normal bacteria in the colon and encourage overgrowth of some bacteria such as Clostridium difficile, which causes inflammation of the colon (pseudomembranous colitis). Patients who develop signs of pseudomembranous colitis after starting azithromycin (diarrhea, fever, abdominal pain, and possibly shock) should contact their physician immediately.
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What is the dosage for azithromycin (Zithromax, Z-Pak)?
- Azithromycin (except Zmax) can be taken with or without food, but food reduces stomach upset.
- Zmax should be taken on an empty stomach 1 hour before or 2 hours after a meal since food reduces its absorption.
- The adult azithromycin dose is 500-2000 mg in multiple or single doses.
- For most infections, azithromycin is taken once daily for a relatively short course of treatment (usually five days).
- The first dose is often a "double dose," twice as much as the remainder of the doses given.
- For acute bacterial sinusitis, azithromycin way be taken once daily for three days.
- Zmax usually is given as a single 2 gm dose.
Which drugs or supplements interact with azithromycin (Zithromax, Z-Pak)?
Is azithromycin (Zithromax, Z-Pak) safe to use during pregnancy or while breastfeeding?
What else should I know about azithromycin (Zithromax, Z-Pak)?
What preparations of azithromycin (Zithromax, Zithromax Tri-Pak, Zithromax Z-Pak, Zmax) are available?
- Tablets: 250, 500, and 600 mg.
- Suspension: 100 mg/5 ml (teaspoon), 200 mg/5 ml (teaspoon).
- Powder for suspension (extended release): 2 g.
- Powder for oral suspension: 1 g.
- Powder for Injection: 500 mg. Z-PAK (Blister pack containing six 250 mg tablets); TRI-PAK (Blister pack containing three 500 mg tablets).
How should I keep azithromycin (Zithromax, Zithromax Tri-Pak, Zithromax Z-Pak, Zmax) stored?
- Tablets should be stored at room temperature between 15 C to 30 C (59 F to 86 F).
- Suspension and solution for injection should be kept between 5 C to 30C (41 F to 86 F).
How does azithromycin (Zithromax, Zithromax Tri-Pak, Zithromax Z-Pak, Zmax) work?
- Azithromycin, like all macrolide antibiotics, prevents bacteria from growing by interfering with their ability to make proteins. Because of the differences in the way proteins are made in bacteria and humans, the macrolide antibiotics do not interfere with production of proteins in humans. It is an unusual antibiotic in that it stays in the body for quite a while (has a long half-life), allowing for once-a-day dosing and for shorter treatment courses for most infections.
When was azithromycin (Zithromax, Zithromax Tri-Pak, Zithromax Z-Pak, Zmax) approved by the FDA?
- The FDA approved azithromycin in November 1991.
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Azithromycin (Zithromax, Z-Pak, Tri-Pak, Zmax) is an antibiotic prescribed for the treatment of a wide variety of bacterial infections such as otitis media (middle ear infection), laryngitis, bronchitis, pneumonia, and others. Though azithromycin is an antibiotic and thus ineffective against viruses, some clinicians have seen limited success in COVID-19 coronavirus disease patients when added to chloroquine and/or hydroxycholoroquine in the sickest patients. There is little good evidence for this drug combination's effectiveness in general against COVID-19.
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Related Disease Conditions
Sinus Infection (Sinusitis)
Sinus infection (sinusitis) is caused by allergies, infection, and chemicals or other irritants of sinuses. Signs and symptoms are headache, fever, and facial tenderness, pressure, or pain. Treatments of sinus infections are generally with antibiotics and at times, home remedies.
Cough: 19 Tips on How to Stop a Cough
Coughing is a reflex that helps a person clear their airways of irritants. There are many causes of an excessive or severe cough including irritants like cigarette and secondhand smoke, pollution, air fresheners, medications like beta blockers and ACE inhibitors, the common cold, GERD, lung cancer, and heart disease.Natural and home remedies to help cure and soothe a cough include stay hydrated, gargle saltwater, use cough drops or lozenges, use herbs and supplements like ginger, mint, licorice, and slippery elm, and don't smoke. Over-the-counter products (OTC)to cure and soothe a cough include cough suppressants and expectorants, and anti-reflux drugs. Prescription drugs that help cure a cough include narcotic medications, antibiotics, inhaled steroids, and anti-reflux drugs like proton pump inhibitors or PPIs, for example, omeprazole (Prilosec), rabeprazole (Aciphex), and pantoprazole (Protonix).
Tonsil stones are small clusters of calcifications that form when food, dead cells, mucus, and bacteria get stuck in the nooks and crannies of the tonsils. Tonsil stones are hard, appear as white or yellowish formations on the tonsils, and usually smell bad due to bacteria. If symptoms occur, they may include persistent bad breath, sore throat, difficulty swallowing, ear pain, and cough.
Tonsillitis is a contagious infection with symptoms of bad breath, snoring, congestion, headache, hoarseness, laryngitis, and coughing up blood. Tonsillitis can be caused acute infection of the tonsils, and several types of bacteria or viruses (for example, strep throat or mononucleosis). There are two types of tonsillitis, acute and chronic. Acute tonsillitis lasts from one to two weeks while chronic tonsillitis can last from months to years. Treatment of tonsillitis and adenoids include antibiotics, over-the-counter medications, and home remedies to relieve pain and inflammation, for example, salt water gargle, slippery elm throat lozenges, sipping warm beverages and eating frozen foods (ice cream, popsicles), serrapeptase, papain, and andrographism Some people with chronic tonsillitis may need surgery (tonsillectomy or adenoidectomy).
Middle Ear Infection (Otitis Media)
Middle ear infection (otitis media) is inflammation of the middle ear. There are two forms of this type of ear infection, acute and chronic. Acute otitis media is generally short in duration, and chronic otitis media generally lasts several weeks. Babies, toddlers, and children with a middle ear infection may be irritable, pull and tug at their ears, and experience numerous other symptoms and signs. Treatment depends upon the type of ear infection.
STDs in Men
Sexually transmitted diseases (STDs) are infections transmitted during sexual contact. They may be caused by viruses, bacteria, or parasites. STDs in men cause no symptoms or symptoms like genital burning, itching, sores, rashes, or discharge. Common infections that are sexually transmitted in men include gonorrhea, chlamydia, syphilis, hepatitis C and B, genital warts, human papillomavirus (HPV), and genital herpes. Some STDs in men are treatable while others are not. STDs are diagnosed with tests that identify proteins or genetic material of the organisms causing the infection. The prognosis of an STD depends on whether the infection is treatable or not. Use of latex condoms can help reduce the risk of contracting an STD but it does not eliminate the risk entirely.
Pneumonia is inflammation of the lungs caused by fungi, bacteria, or viruses. Symptoms and signs include cough, fever, shortness of breath, and chills. Antibiotics treat pneumonia, and the choice of the antibiotic depends upon the cause of the infection.
Impetigo: Treatment, Symptoms, and Complications
Impetigo is a contagious skin infection caused by staph and strep bacteria. There are two types of impetigo: nonbullous and bullous. Symptoms of nonbullous impetigo include small blisters on the nose, face, arms, or legs and possibly swollen glands. Bullous impetigo signs include blisters in various areas, particularly in the buttocks area. Treatment involves gentle cleansing, removing the crusts of popped blisters, and the application of prescription-strength mupirocin antibiotic ointment.
Sexually Transmitted Diseases in Women (STDs)
Sexually transmitted diseases (STDs) are among the most common infectious diseases in the United States. STDs can be spread through any type of sexual activity involving the sex organs, the anus or mouth, or through contact with blood during sexual activity. Examples of STDs include, chancroid, chlamydia, gonorrhea, granuloma inguinale, lymphogranuloma venereum, syphilis, genital herpes, genital warts, trichomoniasis, pubic lice (crabs), and scabies. Treatment is generally with antibiotics; however, some STDs that go untreated can lead to death.
Chronic cough is a cough that does not go away and is generally a symptom of another disorder such as asthma, allergic rhinitis, sinus infection, cigarette smoking, GERD, postnasal drip, bronchitis, pneumonia, medications, and less frequently tumors or other lung disease. Chronic cough treatment is based on the cause, but may be soothed natural and home remedies.
Laryngitis is an inflammation of the voice box (vocal cords). The most common cause of acute laryngitis is infection, which inflames the vocal cords. Symptoms may vary from degree of laryngitis and age of the person (laryngitis in infants and children is more commonly caused by croup). Common symptoms include a "barky" cough, a hoarse cough, fever, cold, runny nose, dry cough, and loss of voice. Chronic laryngitis generally lasts more than three weeks. Causes other than infection include smoking, excess coughing, GERD, and more. Treatment depends on the cause of laryngitis.
Cystic acne is distinguised by painful nodules on the chest, face, neck, and back. This form of acne is known to scar. Treatment may incorporate the use of hormonal therapies, oral antibiotics, and prescription medications.
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Is Pneumonia Contagious?
Pneumonia is inflammation of the lung usually caused by bacterial or viral infection (rarely, also by fungi) that causes the air sacs to fill with pus. If inflammation affects both lungs, the infection is termed double pneumonia. If it affects one lung, it is termed single pneumonia. If it affects only a certain lobe of a lung it's termed lobar pneumonia. Most pneumonias are caused by bacteria and viruses, but some pneumonias are caused by inhaling toxic chemicals that damage lung tissue.
Pelvic Inflammatory Disease (PID)
Pelvic inflammatory disease (PID) is the most common and serious complication of sexually transmitted diseases (STDs), aside from AIDS, among women. The signs and symptoms of pelvic inflammatory disease include: fever, vaginal discharge with a foul odor, abdominal pain, including pain during intercourse, and irregular vaginal bleeding. Pelvic inflammatory disease can scar the Fallopian tubes, ovaries, and related structures and lead to ectopic pregnancies, infertility, chronic pelvic pain, and other serious consequences. Pelvic inflammatory disease treatment includes several types of antibiotics.
Cystic fibrosis is a disease of the mucus and sweat glands. Cystic fibrosis is an inherited disease. The outcome of the disease leaves the body malnourished, with bulky and fouls smelling stools, vitamin insufficiency, gas, painful or swollen abdomen, infertility, susceptible to heat emergencies, and respiratory failure. There is no cure for cystic fibrosis, treatment of symptoms is used to manage the disease.
PANDAS is in part caused by an autoimmune response to a strep infection. Symptoms mimic those of OCD, ADHD, and include motor and verbal tics. Treatment involves medication and cognitive behavioral therapy.
Is Tonsillitis Contagious?
Tonsillitis is a common infection, especially in kids. Tonsillitis is caused by viruses and bacteria like the flu and herpes simplex virus, and Streptococcus bacteria. These viruses and bacterium are spread person to person. Symptoms of tonsillitis are a yellow or white coating on the tonsils, throat pain, pain when swallowing, and hoarseness.
COPD (Chronic Obstructive Pulmonary Disease)
COPD or chronic obstructive pulmonary disease is a lung condition caused by smoking tobacco, exposure to secondhand smoke, and/or air pollutants. Conditions that accompany COPD include chronic bronchitis, chronic cough, and emphysema. Symptoms of COPD include shortness of breath, wheezing, and chronic cough. Treatment of COPD includes GOLD guidelines, smoking cessation, medications, and surgery. The life expectancy of a person with COPD depends on the stage of the disease.
Group A streptococcal infections are caused by group A streptococcus, a bacteria that causes a variety of health problems, including strep throat, impetigo, cellulitis, erysipelas, and scarlet fever. There are more than 10 million group A strep infections each year.
Collapsed Lung (Pneumothorax)
A pneumothorax is free air in the chest outside the lung, that causes the lung to collapse (collapsed lung). There are two types of pneumothorax, spontaneous or primary pneumothorax and secondary pneumothorax. Symptoms include sudden chest pain, shortness of breath, rapid heart rate, rapid breathing, cough, and fatigue.
Acute Bronchitis Contagoius Symptoms, Causes, Treatment, and Recovery Time
Bronchitis is inflammation of the airways in the lung. Acute bronchitis is is short in duration (10 to 20 days) in comparison with chronic bronchitis, which lasts for months to years. Causes of acute bronchitis include viruses and bacteria, which means it can be contagious. Acute bronchitis caused by environmental factors such as pollution or cigarette smoke is not contagious. Common symptoms for acute bronchitis include nasal congestion, cough, headache, sore throat, muscle aches, and fatigue. Acute bronchitis in children also my include runny nose, fever, and chest pain. Treatment for acute bronchitis are OTC pain relievers, cough suppressants (although not recommended in children), and rest. Infrequently antibiotics may be prescribed to treat acute bronchitis.
Is Chlamydia Contagious?
Chlamydia is a sexually transmitted disease (STD) that is contagious. Chlaymida is spread through sexual contact. (You cannot get chlamyidia from kissing or sharing utensils or drinks.) Chlamydia is the most common STD in the U.S. The incubation period for chlamydia ranges from days to months, and the contagious period ends seven days after patients begin treatment. Chlamydia signs and symptoms may include painful urination, rectal irritation (proctitis), eye infections, and infertility. Women can also develop chronic pelvic pain, salpingitis, and endometritis.
Chronic bronchitis is a cough that occurs daily with production of sputum that lasts for at least three months, two years in a row. Causes of chronic bronchitis include cigarette smoking, inhaled irritants, and underlying disease processes (such as asthma, or congestive heart failure). Symptoms include cough, shortness of breath, and wheezing. Treatments include bronchodilators and steroids. Complications of chronic bronchitis include COPD and emphysema.
COVID-19 (Coronavirus, 2019-nCoV)
Infection with COVID-19 (2019 novel coronavirus, 2019-nCoV) causes respiratory problems in humans. Transmission of COVID-19 occurs mainly through contact with respiratory sections from an infected person, however, fecal contamination may also spread the virus. Symptoms start off flu-like and progress to coughing, fever, shortness of breath, shaking chills, headache, loss of sense of taste and/or smell, muscle pain, and sore throat. Treatment focuses on supportive care and symptom relief. COVID-19 vaccines are available.
Rheumatic fever is a disease that sometimes occurs after a group A streptococcal infection of the throat. Symptoms and signs include carditis, polyarthritis, Aschoff bodies, rash, Sydenham's chorea, and fever. Treatment for rheumatic fever involves eliminating the bacteria with penicillin, erythromycin, or azithromycin. Further treatment focuses on alleviating the symptoms brought on by the body's immunologic response to the bacteria.
Strep throat is a bacterial infection of the throat. Signs and symptoms of strep throat include headache, nausea, vomiting, sore throat, and fever. Strep throat symptoms in infants and children are different than in adults. Strep throat is contagious and is generally passed from person-to-person. Treatment for strep throat symptoms include home remedies and OTC medication; however, the only cure for strep throat are antibiotics.
Is a Sinus Infection Contagious?
Sinus infection (sinusitis) is infection (viral, bacterial, or fungal) or inflammation of the sinuses. Symptoms of sinus infection are cough, bad breath, coughing up greenish-yellow sputum, sinus headache, and other symptoms of the common cold. Treatments of sinus infection are home remedies to soothe symptoms and antibiotics if the infection is bacterial or fungal.
COVID-19 vs. Flu vs. Cold
When you're feeling sick, it can be difficult to distinguish the symptoms of a COVID-19 infection from the symptoms of the common cold or the flu (influenza). While fever is common with the flu and COVID-19, sneezing is typically only associated with colds. Though sore throats are typical with colds, they are uncommon with COVID-19 infections and the flu.
Is Laryngitis Contagious?
Laryngitis is inflammation and swelling of the voice box (larynx). Causes of laryngitis are viral, bacterial, fungal, strenuous singing or talking, chemical irritants, and other underlying medical conditions. Symptoms of laryngitis are hoarseness, a weak or loss of voice, sore throat, dry throat, a tickling sensation in the back of the throat, or irritated or raw throat. Treatment of laryngitis depends upon the cause.
Whooping Cough (Pertussis)
Whooping cough (pertussis) is highly contagious respiratory infection that is caused by the bacteria Bordetella pertussis. There are an estimated 300,000 plus deaths annually from whooping cough (pertussis). Whooping cough commonly affects infants and young children but can be prevented with immunization with the vaccine. First stage whooping cough symptoms are a runny nose, sneezing, low-grade fever, a mild cough with the cough gradually becoming more severe. After one to two weeks, the second stage of whooping cough begins.
Trachoma is an infectious disease caused by the Chlamydia trachomatis bacteria. Symptoms and signs include redness and irritation of the eyes with tearing. Trachoma is diagnosed by examining the eyes and eyelids. Treatment involves a single dose of azithromycin (Zithromax) or the use of topical tetracycline (Achromycin) ointment. Infected individuals should be counseled about sanitation and taught simple cleanliness.
Typhus is a disease caused by Rickettsia bacteria. Symptoms and signs include fever, headache, nausea, vomiting, diarrhea, and rash. Antibiotics are recommended as the treatment for endemic and epidemic typhus infections.
Toxoplasmosis (toxo) is a parasitic infection that causes flu-like symptoms, swollen lymph nodes, and muscle aches and pains that may last from a few days to several weeks. Toxoplasmosis can be contracted by touching the hands to the mouth after gardening, cleaning a cat's litter box, or anything that came into contact with cat feces. Toxoplasmosis can also be contracted by eating raw or partly cooked meat, especially pork or lamb, or touching the hands to the mouth after contact with raw or undercooked meat
Nontuberculous Mycobacterial Lung Disease (NTM, Symptoms, Treatment, Side Effects)
Nontuberculous mycobacteria (NTM), most commonly, M. avium complex or MAC, is a mycobacteria that causes lung infections and disease. Nontuberculous mycobacteria are commonly found in soil, air, and water. Examples of how NTM lung infection are transmitted include swimming, using a hot tub (NTM bacteria are aerosolized), or playing with or handling soil. The most common symptoms of NTM lung infection are chronic, dry cough, and shortness of breath. Sometimes the cough may have mucous or blood. Other symptoms of NTM lung disease include fatigue, chest pain, malaise, and weakness. As NTM lung disease progresses, fevers, night sweats, and appetite loss may occur. Treatment guidelines for NTM lung disease depend upon the type and extent of the infection, and the person's health.
Antibiotic Resistance (Drug Resistance, Antimicrobial Resistance)
Antibiotics are medications used to kill or slow the growth of bacteria and some fungi. The definition of antibiotic resistance is the ability of bacteria to change (mutate) and grow in the presence of a drug (an antibiotic) that would normally slow its growth or kill it. These antibiotic-resistant bacteria and fungi become harder to treat. Antibiotic-resistant infections can lead to longer hospital stays, higher treatment costs, and more deaths.
COVID-19 (Coronavirus) Prevention Tips
COVID-19 is a novel coronavirus that spreads from person to person via infected respiratory droplets. The main symptoms of COVID-19 infection include cough, fever, and shortness of breath. Occasionally, people infected with COVID-19 may experience diarrhea, a sore throat, a runny or stuffy nose, or aches and pains. Avoiding contact with infected people, social distancing, not touching your face, frequent hand washing, cleaning, and disinfecting of frequently touched surfaces can help to reduce your risk of contracting the 2019 novel coronavirus.
Legionellosis is an infection caused by the Legionella pneumophila bacterium. There are two forms of legionellosis: Pontiac fever and Legionnaires' disease, which is the more severe of the two infections. Symptoms of Pontiac fever include fever, headache, muscle aches, and chills. Symptoms of Legionnaires' disease include cough, chills, fever and sometimes muscle aches, headaches, loss of appetite, diarrhea, and severe pneumonia. While Pontiac fever resolves on its own, Legionnaires' disease must be treated with antibiotics.
Travelers should prepare for their trip by visiting their physician to get the proper vaccinations and obtain the necessary medication if they have a medical condition or chronic disease. Diseases that travelers may pick up from contaminated water or food, insect or animal bites, or from other people include: malaria, meningococcal meningitis, yellow fever, hepatitis A, typhoid fever, polio, and cholera.
Sexually Transmitted Diseases and Pregnancy (STDs)
When you are pregnant, many sexually transmitted diseases (STDs) can be especially harmful to you and your baby. These STDs include herpes, HIV/AIDS, genital warts (HPV), hepatitis B, chlamydia, syphilis, gonorrhea, and trichomoniasis. Symptoms include bumps, sores, warts, swelling, itching, or redness in the genital region. Treatment of STDs while pregnant depends on how far along you are in the pregnancy and the progression of the infection.
Emphysema, Chronic Bronchitis, and Colds
If you have a COPD such as emphysema, avoiding chronic bronchitis and colds is important to avoid a more severe respiratory infection such as pneumonia. Avoiding cigarette smoking, practice good hygeine, stay away from crowds, and alerting your healthcare provider if you have a sinus infection or cold or cough that becomes worse. Treatment options depend upon the severity of the emphysema, bronchitis, or cold combination.
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FDA Prescribing Information
"Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial"
Philippe Gautret, et al
International Journal of Antimicrobial Agents
Some data on COVID-19 use from Aileen Chi, Pharm. D., of Dova Pharmaceuticals