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Why it's used

Azithromycin is used to treat severe cases of coughing, mucus and bronchitis caused by bacterial infections. This medicine helps by killing the bacteria. Azithromycin is also used to treat severe cases of nasal congestion caused by sinusitis, to treat certain cases of pneumonia, to treat inflammation of the throat caused by bacterial infections, to treat certain bacterial skin infections, to treat inflammation of the urethra caused by bacterial infections, to treat inflammation of the cervix, to treat certain genital diseases in men, and to treat middle ear infections in children.
When not to use
Azithromycin should not be used to treat elderly patients, patients that require hospitalization, or patients who have severe health problems such as immunodeficiency. Azithromycin cannot be used to treat viral infections such as the common cold or flu. Azithromycin should also not be used to treat all bacterial infections as this may lead to the development of drug-resistant bacteria. It should only be used for the treatment of bacterial infections where it is effective.
Macrolide Antibacterial
Azithromycin is a prescription medicine that belongs to a class of medicines called Macrolide Antibacterial. Macrolide antibacterials are a class of antibiotics that are used to treat certain kinds of bacterial infections. They are commonly used to treat mild-to-moderate infections.

How to use

Follow directions on the product label, information guide, and provided by your doctor before using Azithromycin. Use this medicine as per your doctor's instructions.
Azithromycin is used with or without food.
The typical adult dose of Azithromycin is 500 mg once daily for 3 days. The typical dose for children is 10 mg per kg of body weight once daily for 3 days. This medicine is commonly used for a period of 5 days for pneumonia, 5 days for throat infections, 3 days for middle ear infections, and 3 days for severe nasal congestion.
This medicine should be used on an as-needed basis. You should continue to use this medicine as directed by the doctor even if you feel well.
Tell your doctor if you develop new symptoms.
Older patients may see an increase in the risk of side-effects. Hence, a lower dose may be recommended.
This medicine may not be as effective if it is used for extended periods of time.
If you are giving Azithromycin to a child, be sure to use a product that is meant for use in children. Before giving this medicine, use the child's weight or age to find the right dose from the leaflet or product package. You can also read the dosage section of this page to know the correct dose for your child. Else, consult with your doctor and follow their recommendation.
If using the liquid form of this medicine, measure the dose using the provided measuring cup, spoon, or dropper. Before pouring the medicine into the measuring device, you should check the measurement markings carefully. Then, pour the dose amount into the device. After use, clean and store the measuring device in a safe place for your next use. You should not use a tablespoon or teaspoon as the dose measuring devices since it can result in an incorrect dose. If indicated on the product package, shake the medicine before use.
Your doctor may require that certain tests be performed before using Azithromycin. The doctor may ask you to have Venereal Disease Research Laboratory (VDRL) | Rapid Plasma Reagin (RPR) | Fluorescent Treponemal Antibody Absorption (FTA-ABS) | Treponema Pallidum Microhemagglutination Assay (TP-MHA) | Gonorrhea Testing test. To confirm the infection, tests for syphilis and gonorrhea are needed before using this medicine in the treatment of urethritis or cervicitis.
Medicines may be given for uses other than those listed in the medicine guide. Do not use Azithromycin for symptoms for which it was not prescribed. Do not give Azithromycin to others who may have similar symptoms as you. Self-medication can cause harm.
Store Azithromycin between 15° to 30°C (59° to 86°F), away from moisture, and away from light. Keep this medicine away from children and pets.

How to take Azithromycin

Your dose and how often you take Azithromycin will depend on the following factors:
  • age
  • weight
  • patient's health
  • the health of the patient's liver
  • medicines recommended by the doctor
  • any other medicines being used
  • herbal supplements in use

Azithromycin Dosage

Dosage for pneumonia

Adult
  • Recommended: On the first day 500 mg as a single dose. 250 mg once a day from the 2nd to 5th day.
Children
  • Recommended: On the first day a single dose of 10 mg per kg of body weight / 4.5 mg per lb of bdy weight. Followed by 5 mg per kg of body weight / 2.25 mg per lb of weight once a day from the 2nd to the 5th day.

Dosage for pharyngitis/tonsillitis

Adult
  • Recommended: On the first day 500 mg as a single dose. 250 mg once a day from the 2nd to 5th day.
Children (children 2 years old and above)
  • Recommended: 12 mg/kg (5.44 mg/lb) once daily for 5 days
Children (8 kg / 18 lb)
  • Maximum: 500 mg total over 5 days
Children (17 kg / 37 lb)
  • Maximum: 1000 mg total over 5 days
Children (25 kg / 55 lb)
  • Maximum: 1500 mg total over 5 days
Children (33 kg / 73 lb)
  • Maximum: 2000 mg total over 5 days
Children (40 kg / 88 lb)
  • Maximum: 2500 mg total over 5 days

Dosage for skin infection

Adult
  • Recommended: On the first day 500 mg as a single dose followed by 250 mg once a day from 2nd to 5th day

Dosage for acute bacterial exacerbations of long-term obstructive pulmonary disease

Adult
  • Recommended: 500 mg once daily for 3 days or 500 mg on the first day as a single dose followed by 250 mg once a day from 2nd to 5th day

Dosage for acute bacterial sinusitis

Adult
  • Recommended: 500 mg once daily for 3 days
Children
  • Recommended: 10 mg per kg of body weight (4.54 mg per lb of body weight) once daily for 3 days

Dosage for genital ulcer disease (chancroid)

Adult
  • Recommended: 1000 mg as a single dose

Dosage for non-gonococcal urethritis and cervicitis

Adult
  • Recommended: 1000 mg as a single dose

Dosage for gonococcal urethritis and cervicitis

Adult
  • Recommended: 2000 mg as a single dose

Dosage for acute otitis media

Children (5 kg / 11 lb)
  • Recommended: 30 mg/kg (13.61 mg/lb) as a single dose or 10 mg/kg (4.54 mg/lb) once daily for 3 days or 10 mg/kg (4.54 mg/lb) as a single dose on Day 1 followed by 5 mg/kg/day (2.26 mg/lb/day) on Day 2 to 5
  • Maximum: 150 mg total over 3 or 5 days
Children (10 kg / 22 lb)
  • Maximum: 300 mg total over 3 or 5 days
Children (20 kg / 44 lb)
  • Maximum: 600 mg total over 3 or 5 days
Children (30 kg / 66 lb)
  • Maximum: 900 mg total over 3 or 5 days
Children (40 kg / 88 lb)
  • Maximum: 1200 mg total over 3 or 5 days
Children (50 kg and above (110 lb and above))
  • Maximum: 1500 mg total over 3 or 5 days

Dosage for otitis media with community-acquired pneumonia

Children (5 kg (11 lb))
  • Maximum: 150 mg for five days
Children (10 kg (22 lb))
  • Maximum: 300 mg for five days
Children (20 kg (44 lb))
  • Maximum: 600 mg for five days
Children (30 kg (66 lb))
  • Maximum: 900 mg for five days
Children (40 kg (88 lb))
  • Maximum: 1200 mg for five days
Children (50 kg and above (110 lb and above))
  • Maximum: 1500 mg for five days

Dosage for otitis media with acute bacterial sinusitis

Children (5 kg / 11 lb)
  • Maximum: 150 mg total over three days
Children (10 kg / 22 lb)
  • Maximum: 300 mg total over three days
Children (20 kg / 44 lb)
  • Maximum: 600 mg total over three days
Children (30 kg / 66 lb)
  • Maximum: 900 mg total over three days
Children (40 kg / 88 lb)
  • Maximum: 1200 mg total over three days
Children (50 kg and above (110 lb and above))
  • Maximum: 1500 mg total over three days

Minimum Age

6 months old for the treatment of ear infections, sinus infections, and pneumonia. 2 years old for infected throat or tonsils.

Dosage calculation for children

To calculate the dosage for children please use the weight based dose calculator to calculate the appropriate dosage as per the weight of your child.

Forms

Film-coated tablets
Strength: 250 mg, 500 mg
Oral suspension
Strength: 100 mg/5 mL and 200 mg/5 mL
Injection
Strength: 500 mg and 2500 mg
Capsule
Strength: 250 mg

Special Instructions

Oral suspension
Take this medicine with or without food.
Oral formulations (capsules and granules)

Missed Dose

Take the missed dose as soon as you remember. However, if the time for the next dose is almost there, then skip the missed dose and follow the regular dosing schedule. Avoid taking a repeated dose to make up for a missed one.

Overdose

What to do if you overdose on Azithromycin?
No specific antidote for an overdose of Azithromycin is available. The treatment depends on its symptoms.
Symptoms of an overdose of Azithromycin
If you use too much of this medicine, it could lead to dangerous levels of the medicine in your body. In such cases, symptoms of an overdose may include:
If you think you have overdosed on Azithromycin, call a poison control center immediately. You can look up the poison control center information from the Poison Center Finder at TabletWise.com.

Precautions while using Azithromycin

Before you use Azithromycin, discuss with your doctor if you are allergic to it or its ingredients. Your doctor may prescribe an alternative medicine and update your medical records to record this information. Tell your doctor if you are allergic any of the following substances: macrolides, ketolides, or erythromycin.
Before you use Azithromycin, tell your doctor of your medical and health history including the following: lungs infection caused by pneumonia, cystic fibrosis, known or suspected bacterial infection in the blood, liver problem, kidney problem, palpitation, muscle weakness, cholestatic jaundice, or liver dysfunction. Before having surgery during the use of Azithromycin, discuss with your doctor and dentist about the medicinal products you use including prescription/non-prescription/herbal medicines.
The use of this medicine may change prothrombin time. This medicine may increase the time of blood clotting in the anticoagulants such as warfarin.
Azithromycin can make you feel sleepy. Be careful when using any machinery, driving a vehicle, or doing any other activity that needs you to be fully alert. The consumption of alcohol with Azithromycin can worsen the sleepiness.
The use of Azithromycin during pregnancy should only be when required. Adequate and well-controlled studies in pregnant women are not done. The use of Azithromycin is not safe for use in women who are breastfeeding. If you are breastfeeding a baby, discuss with your doctor if you should either discontinue breastfeeding or stop using this medicine while breastfeeding. This medicine passes into the breast milk which may cause harm to the baby. Hence breastfeeding should be discontinued during treatment with Azithromycin. Discard breast-milk during treatment and up until 2 days after completion of treatment. Resume breastfeeding after that. It is not known if this medicine is safe for use in women who are conceiving. Consult with your doctor before you use Azithromycin.
This medicine may increase your sensitivity to sunlight. If this happens, use a sunscreen and cover your skin when you are outdoors. Limit your time in the sun. If you get a sunburn on your skin, consult with your doctor.
Azithromycin may cause increased incidence of side-effects in older patients. Elderly patients may see an increased risk of arrhythmia.
The effectiveness of this medicine may decrease and the bacteria may become resistant to it if it is taken for a long time.

Azithromycin Side-effects

The following side-effects may commonly occur when using Azithromycin. If any of these side-effects worsen or last for a long time, you should consult with your doctor:
  • abdominal pain
  • decreased bicarbonate in the blood
  • diarrhea
  • increase in monocytes
  • increase in neutrophils
  • increase in white blood cells
  • increased basophils
  • low lymphocyte count
  • nausea
  • vomiting
The following side-effects may commonly occur in older patients on the use of Azithromycin. Discuss with your doctor if any of these side-effects last for a long time or are severe:
  • prolonged heartbeat (QT interval prolongation)
The following side-effects may commonly occur in children when using Azithromycin. Discuss with your doctor if any of these side-effects last for a long time or are severe:
Rarely, the use of Azithromycin may cause the following side-effects:
  • abnormal bleeding from the uterus (metrorrhagia)
  • abnormal involuntary muscular movement (hyperkinesia)
  • abnormal sensations in the body
  • abnormally low body weight (anorexia)
  • allergic reaction
  • anxiety (agitation)
  • back pain
  • black tarry stools (melena)
  • blisters on the skin
  • burping
  • chest pain
  • complications after any medical procedure
  • constipation
  • cough
  • decrease in red blood cells (anemia)
  • decrease in white blood cells (leukopenia)
  • decreased number of red blood cells in total blood volume (hematocrit)
  • decreased taste sensitivity
  • difficult urination
  • dizziness
  • drowsiness
  • dry mouth
  • dry skin
  • excessive sweating
  • expanded abdomen due to gas or fluid accumulation (abdominal distension)
  • facial swelling
  • fainting
  • fatigue
  • feeling of discomfort
  • feeling of fever like heat in menopause (hot flush)
  • fever
  • fluid build-up in the lining of the lungs and chest (pleural effusion)
  • fungal infection
  • gas formation (flatulence)
  • headache
  • hives
  • increased bicarbonate
  • increased blood urea
  • increased chloride
  • increased exposure to infections (bacterial, fungal, viral infection)
  • increased glucose
  • increased platelets
  • increased salivary secretion
  • indigestion (dyspepsia)
  • inflammation of the kidneys (nephritis)
  • inflammation of the lining of the stomach (gastritis)
  • inflammation of the mucous membrane of the nose (rhinitis)
  • inflammation of the skin (dermatitis)
  • inflammation of the small intestine (enteritis)
  • inflammation of the throat (pharyngitis)
  • inflammation of the vagina (vaginitis)
  • inflammation or infection of the eyeball and eyelid (conjunctivitis)
  • insomnia
  • intestinal infection (gastroenteritis)
  • itchy skin rash (eczema)
  • jaundice
  • joint inflammation (osteoarthritis)
  • joint pain (arthralgia)
  • kidney pain
  • loss of sensitivity on touch (hypoaesthesia)
  • loss of taste and smell
  • mouth ulceration
  • muscle pain
  • neck pain
  • nervousness
  • pain
  • palpitations
  • rash
  • respiratory disorder
  • ringing in the ears (tinnitus)
  • sensitivity to sunlight (photosensitivity)
  • severe itching
  • state of over-activeness (hyperactivity)
  • sweating
  • swelling from fluid accumulation in certain areas of the body
  • swelling of peripheral tissues due to an accumulation of fluid
  • testicular disorder
  • tingling sensation
  • tongue discoloration
  • vertigo
  • visual problem
  • vomiting
  • weakness
  • yeast infection (monilia)
  • yeast infection of the mouth (oral moniliasis)
The following severe side-effects may also occur when using Azithromycin:
  • Liver damage, in the worst case, resulting in (possibly) death
    Symptoms: vomiting, fever, loss of appetite, stomach pain, change in the color of stools, weakness, dark colored urine, unusual tiredness, abdominal pain, tenderness, yellowing of the skin or of the whites of the eyes, nausea and itching
    If this happens, discontinue the medicine and consult with the doctor.
  • Worsening of skeletal muscle weakness
    If this happens, consult with the doctor.
  • Serious allergic and skin reactions including Stevens-Johnson syndrome, and drug-induced skin disease, in the worst case, resulting in (possibly) death
    Symptoms: trouble breathing or swallowing, swelling of the lips, swelling of the tongue, swelling of the face, throat tightness, abnormal voice changes (hoarseness), rapid heartbeat, faintness, skin rash (hives), new onset of fever and swollen lymph nodes
    In case of severe allergic reactions, discontinue the medicine and consult with the doctor.
  • Serious heart rhythm changes, in the worst case, resulting in (possibly) death
    Symptoms: palpitation, faintness and dizziness
    In case of serious heart rhythm changes, consult with the doctor.
  • Symptoms: fever and cramps
    If this occurs, consult with the doctor.
Your doctor has prescribed Azithromycin because they judge that the benefit is greater than the risk posed by side-effects. Many people using this medicine do not have serious side-effects. This page does not list all possible side-effects of Azithromycin.
If you experience side-effects or notice other side-effects not listed above, contact your doctor for medical advice. You may also report side-effects to your local food and drug administration authority. You can look up the drug authority contact information from the Drug Authority Finder at TabletWise.com.

Warnings

Development of Drug-Resistant Bacteria

Patients using Azithromycin without confirmation of bacterial infections cannot get benefitted from this medicine. In these patients, the risk of development of drug-resistant bacteria increases. This medicine can be used only after confirmation of bacterial infection.

Sexually Transmitted Infections

Patients with sexually transmitted infections like syphilis, urethritis or cervicitis are at increased risk when using this medicine. Patients with syphilis should not be dependent on the recommended dose of Azithromycin. These patients should undergo blood testing before starting treatment of urethritis or cervicitis with this medicine.

Skeletal muscle weakness

Patients using this medicine are at increased risk by worsening the existing condition. This may lead to worsening and recurrence of skeletal muscle weakness.

Bacteria associated diarrhea (CDAD)

Patients using antibacterial agents are at increased risk of developing bacteria associated diarrhea (CDAD). Use of antimicrobial medicines results in overgrowth of bacteria (Clostridium difficile) in an intestine. Start an appropriate fluid and electrolyte management, use of protein supplements, antibiotic treatment of bacteria (C. difficile) and surgery is also needed after consultation with the doctor.

Liver damage

Patients using this medicine are at increased risk of liver damage. These patients may report abnormal liver function, inflammation of the liver (hepatitis), decrease in the flow of liver secretions (cholestatic jaundice), liver cell injury (hepatic necrosis) and liver failure. Immediately stop taking this medicine if the symptoms of hepatitis occur.

Infants of up to 42 days

Use of this medicine increases risk in infants aged 42 days or less. Using Azithromycin may cause a thickening of the opening between stomach and intestine (Infantile Hypertrophic Pyloric Stenosis). The parents should contact the doctor if the child has irritability with feeding or if the infant is vomiting.

Allergy

Allergic patients are at increased risk when using this medicine. Serious allergic reactions, including swelling of the inner layer of skin, fatal allergy (anaphylaxis), and skin reactions can appear in these patients. If it occurs, this medicine should be discontinued.

Interactions with Azithromycin

When two or more medicines are taken together, it can change how the medicines work and increase the risk of side-effects. In medical terms, this is called as a Drug Interaction.
Your doctor's guidelines may need to be followed while taking this medicine along with cisapride, which is used to treat symptoms of heartburn due to gastroesophageal reflux disease. When Azithromycin is used with cisapride, it may increase the risk of abnormally rapid heart rhythms that occur in the heart and prolonged heartbeat (QT interval prolongation and torsades de pointes). Patients should avoid using both drugs in combination.
Azithromycin interacts with antacids, which are used to control the acid levels in the stomach. When these medicines are used in combination, it reduces the level of antacids in the blood. Take Azithromycin at least 1 hour before or 2 hours after taking a dosage of antacids.
There may be an interaction of Azithromycin with anticoagulants (such as warfarin), medicines that prevent the formation of blood clots. When Azithromycin is used with anticoagulants, it may increase the blood clotting time. Patients undergoing treatment with both the drugs should be monitored for prothrombin time.
Azithromycin may interact with nelfinavir, which is a medicine used in the treatment of human immunodeficiency virus (HIV) infection. Nelfinavir increases the level of Azithromycin in the body which may result in hearing problems and liver enzyme abnormalities. No dose adjustment of nelfinavir is required. Patients undergoing treatment with both the drugs should be monitored for side effects such as hearing problems and liver enzyme abnormalities.
Special instructions need to be followed while taking this medicine along with ergotamine derivatives, which are medicines used to treat a migraine type headache. When Azithromycin is used with ergotamine derivatives, it may result in a fungal disease of cereal grasses (ergotism). Patients should not take Azithromycin and ergotamine derivatives in combination.
Your doctor's guidelines may need to be followed while taking this medicine along with zidovudine, which is used to prevent and treat HIV related complications. When Azithromycin is used with zidovudine, it increases the level of zidovudine in blood cells with a round nucleus (peripheral blood mononuclear cells). Patients should be cautious while using both medicines together.
Azithromycin interacts with cyclosporin, which is used to prevent organ rejection in people who have received a heart, liver, or kidney transplant. When these medicines are used in combination, it increases the level of cyclosporin in the blood. Monitoring of cyclosporin levels and dose adjustment is required while using this combination.
Special instructions need to be followed while taking this medicine along with digoxin, which is used to treat various heart conditions. When Azithromycin is used with digoxin, it increases the level of digoxin in the blood. Patients should take necessary precautions while taking both drugs in combination.
There may be an interaction of Azithromycin with rifabutin, an antibiotic which is used for the treatment of tuberculosis (TB). When Azithromycin is used with rifabutin, it may result in a decreased number of white blood cells (neutropenia). Patients should take necessary precautions while taking both drugs in combination.
Azithromycin may interact with atorvastatin, which is used to lower the levels of cholesterol in the blood. When Azithromycin is used with atorvastatin, it may increase the chances of the breakdown of muscle tissues (rhabdomyolysis). Patients should take necessary precautions while taking both drugs in combination.
Azithromycin may interact with colchicine, which is used to treat red, painful, hot, and swollen joints (gout). When Azithromycin is used with colchicine, it increases the colchicine level in the blood. Patients should take necessary precautions while taking both drugs in combination.
There may be an interaction of Azithromycin with fluconazole, which is used to prevent and treat fungal infections. When Azithromycin is used with fluconazole, it decreases the level of Azithromycin level in the blood. Patients should take necessary precautions while taking both drugs in combination.
This page does not contain all the possible interactions of Azithromycin. Share a list of all medicines that you use with your doctor and pharmacist. Do not start, stop, or change the dose of any medicines without the approval of your doctor.

Traveling With Medication

  • Ensure that you carry enough doses of each of your prescription medicines to last the entire trip. The best place to store your medicines is in the carry on baggage. However, while flying, if carrying liquid medicines, make sure you do not go over the limits imposed for carry-on liquids.
  • While traveling overseas, make sure that you can carry each of your prescription medicines legally to your destination country. One way to ensure this is by checking with your destination country's embassy or website.
  • Make sure that you carry each of your medicines in their original packaging, which should typically include your name and address, and the details of the prescribing doctor.
  • If your travel involves crossing time zones, and you are required to take your medicine as per a fixed schedule, make sure that you adjust for the change in time.

Expired Medication

Taking a single dose of expired Azithromycin is unlikely to cause a side-effect. However, please discuss with your doctor or pharmacist, if you feel unwell or sick. An expired medicine may become ineffective in treating your prescribed conditions. To be on the safe side, it is important not to use an expired drug. You are much safer by always keeping a fresh supply of unexpired medicines.

Safe Disposal of Medication

  • If there are disposal instructions on the package, please follow the instructions.
  • If there are medicine take-back programs in your country, you should contact the respective authority to arrange for the disposal of the medicine. For example, in the USA, the Drug Enforcement Administration regularly hosts National Prescription Drug Take-Back events.
  • If there are no take-back programs, mix the medicine with dirt and place them in a sealed plastic bag. Throw the plastic bag in your household trash. Separately, remove all personal information including the prescription label from the medicine packaging and then dispose off the container.
  • If specifically indicated on the medicine package that it needs to be flushed down the toilet when no longer needed, perform the required step.

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