The need-to-know information about Azithromycin


Some pearls and fun nuggets

1. Azithromycin is very affordable 💵 The wholesale cost is about US$0.18 to US$2.98 per dose.[8] In the United States it is about US$4 for a course of treatment as of 2018.[9]

2. Some countries love it, some don’t 🌎 In 2010, azithromycin was the most prescribed antibiotic for outpatients in the US,[32] whereas in Sweden where outpatient antibiotic use is a third as prevalent, macrolides are only on 3% of prescriptions.[33]

3. Side effects are common, but not terrible 💁Most common adverse effects are diarrhea (5%), nausea (3%), abdominal pain (3%), and vomiting. Fewer than 1% of people stop taking the drug due to side effects.

4. Azithromycin doesn’t kill everything 😐 It has relatively broad but shallow antibacterial activity. It inhibits some Gram-positive bacteria, some Gram-negative bacteria, and many atypical bacteria.

5. Don’t give it out like candy 🍭 Extensive use of azithromycin has resulted in growing Streptococcus pneumoniae resistance.[20]

Patient Perspectives

“I’ve been super sick for the past week really bad chest congestion shortness of breath coughing phlegm body aches headaches fever the works. I took over the counter medicine then started albuterol every 4-5 hours and still feel horrible. The coughing has been constant Today on the 7th day I got prescribed the zpack literally within 5 hours I already felt a huge relief on my chest which is instantly felt better. The medicine is definitely working and it’s only day 1, so happy that soon my life will feel normal once again thankful”


“I was prescribed a 250mg Z-Pak for bronchitis/upper respiratory infection (which I’m sure was viral, but whatever). I experienced horrible diarrhea starting on day 2. After 4 pills, I gave up and called my doc, who told me to discontinue use. Guess I’ll add this to my list of allergies.”


“A visit to the doctor resulted in a chest X-ray and blood test which confirmed an inflammation of the lungs and bacterial infection. I was given a 3-day dosage of Azithromycin for the inflammation and warned it can cause diarrhea. I was also prescribed an inhaler as a lung test showed 25% restriction. First day no side effects except for heavy drowsiness. Second day could already feel the symptoms reducing. Second day, 20 minutes after taking the meds, I got strong stomach pains (felt in the colon area not stomach) followed by heavy drowsiness. Third day I made sure to eat before the pill, which minimized the stomach pain but I got one bout of diarrhea in the evening. Day 5′ symptoms have improved although I still have a runny nose and cough.”

Brandon Simpson, PA-C
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