What is a Z-Pak and how does it work. What are the common uses of azithromycin. How is azithromycin dosed for different conditions. What are the potential side effects and risks of taking azithromycin. Who should avoid taking Zithromax. How does azithromycin interact with other medications.

Understanding Azithromycin and the Z-Pak

Azithromycin, commonly known as Zithromax or Z-Pak, is a widely prescribed antibiotic used to treat various bacterial infections. First approved by the FDA in 1991, this macrolide antibiotic has become a popular choice for healthcare providers due to its broad-spectrum activity and convenient dosing regimen.

The Z-Pak typically refers to a 5-day course of azithromycin, with a higher dose on the first day followed by lower doses for the remaining four days. This unique dosing schedule is made possible by azithromycin’s pharmacokinetic properties, allowing for less frequent administration compared to other antibiotics.

How does azithromycin work?

Azithromycin belongs to the macrolide class of antibiotics, which are bacteriostatic in nature. This means they inhibit bacterial growth rather than directly killing the bacteria. The drug works by:

• Binding to the 50S ribosomal subunit of susceptible bacteria
• Preventing the translation of mRNA into proteins
• Inhibiting bacterial protein synthesis and growth
• Allowing the body’s immune system to clear the weakened bacteria

One of the unique features of azithromycin is its ability to concentrate in white blood cells, which then transport the drug to sites of infection. This mechanism contributes to its prolonged half-life and allows for shorter treatment durations compared to many other antibiotics.

Common Uses of Azithromycin

Azithromycin is prescribed for a wide range of bacterial infections affecting various parts of the body. Its broad-spectrum activity makes it effective against many different types of bacteria.

What are the primary indications for azithromycin?

The most common uses for azithromycin include:

1. Respiratory tract infections (e.g., pneumonia, bronchitis, sinusitis)
2. Skin and soft tissue infections
3. Ear infections (otitis media)
4. Sexually transmitted infections (e.g., chlamydia)
5. Pharyngitis and tonsillitis
6. Pelvic inflammatory disease
7. Mycobacterium avium complex (MAC) prophylaxis in HIV patients

It’s important to note that azithromycin is not effective against viral infections, including the common cold or flu. Proper diagnosis by a healthcare professional is crucial to determine if azithromycin is an appropriate treatment option.

Dosage and Administration of Azithromycin

The dosage of azithromycin varies depending on the type and severity of the infection being treated. It’s available in several formulations, including tablets, oral suspension, and intravenous solutions.

What are the typical dosing regimens for azithromycin?

Common dosing schedules for azithromycin include:

• Z-Pak (5-day course): 500 mg on day 1, followed by 250 mg daily for days 2-5
• Tri-Pak (3-day course): 500 mg daily for 3 days
• Single-dose therapy: 1 gram (1000 mg) for certain sexually transmitted infections

For pediatric patients, dosing is typically based on body weight. The oral suspension is often used for children who have difficulty swallowing tablets.

How should azithromycin be taken?

To maximize effectiveness and minimize side effects, patients should follow these guidelines:

• Take azithromycin at the same time each day
• Can be taken with or without food, but taking with food may reduce stomach upset
• Complete the entire course of antibiotics, even if symptoms improve
• Do not crush or chew extended-release formulations
• Shake oral suspension well before each use

Adhering to the prescribed dosing regimen is crucial for preventing antibiotic resistance and ensuring the infection is fully treated.

Side Effects and Risks of Azithromycin

While azithromycin is generally well-tolerated, it can cause side effects ranging from mild to severe. Understanding these potential adverse reactions is important for patients and healthcare providers.

What are the most common side effects of azithromycin?

Frequently reported side effects include:

• Gastrointestinal disturbances (nausea, vomiting, diarrhea)
• Abdominal pain
• Headache
• Dizziness
• Fatigue
• Rash or itching

These side effects are usually mild and resolve on their own. However, if they persist or worsen, medical attention should be sought.

Are there any serious risks associated with azithromycin use?

While rare, some serious adverse effects have been reported with azithromycin use:

• QT interval prolongation and risk of fatal heart rhythm disturbances
• Severe allergic reactions (anaphylaxis)
• Liver toxicity
• Clostridium difficile-associated diarrhea
• Increased risk of cancer relapse in certain patients (as per FDA warning in 2018)

Patients with pre-existing heart conditions or those taking other medications that affect heart rhythm may be at higher risk for cardiac side effects. It’s crucial to discuss all medical conditions and medications with a healthcare provider before starting azithromycin therapy.

Contraindications and Precautions

While azithromycin is safe for many patients, there are certain groups who should avoid its use or take it with caution.

Who should not take azithromycin?

Azithromycin is contraindicated in the following situations:

• Patients with a known hypersensitivity to azithromycin, erythromycin, or any macrolide or ketolide antibiotic
• Individuals with a history of cholestatic jaundice or hepatic dysfunction associated with prior azithromycin use
• Patients with severe liver disease

Additionally, caution should be exercised in patients with:

• Prolonged cardiac repolarization and QT interval
• Ongoing proarrhythmic conditions
• Electrolyte disturbances, particularly hypokalemia or hypomagnesemia
• Significant bradycardia
• Myasthenia gravis (may exacerbate symptoms)

Pregnant women and nursing mothers should consult their healthcare provider before using azithromycin, as its safety in these populations has not been conclusively established.

Drug Interactions with Azithromycin

Azithromycin can interact with various medications, potentially altering their effectiveness or increasing the risk of side effects. Understanding these interactions is crucial for safe and effective treatment.

What are the most significant drug interactions with azithromycin?

Some notable drug interactions include:

• Warfarin: May increase anticoagulant effects, requiring close monitoring
• Digoxin: Can increase digoxin levels, necessitating dose adjustment
• Nelfinavir: May increase azithromycin levels and risk of side effects
• Antacids containing aluminum or magnesium: Can reduce azithromycin absorption
• QT-prolonging medications: Increased risk of cardiac arrhythmias

Patients should provide a complete list of all medications, including over-the-counter drugs and supplements, to their healthcare provider before starting azithromycin therapy.

Antibiotic Resistance and Proper Use

The emergence of antibiotic-resistant bacteria is a growing global health concern. Proper use of antibiotics like azithromycin is crucial in combating this issue.

How can antibiotic resistance be prevented?

To help prevent the development of antibiotic-resistant bacteria:

• Only use antibiotics when prescribed by a healthcare professional
• Complete the entire course of antibiotics as directed
• Do not share antibiotics with others or use leftover antibiotics
• Practice good hygiene to prevent the spread of infections
• Stay up to date on vaccinations to prevent bacterial infections

Healthcare providers play a crucial role in antibiotic stewardship by prescribing antibiotics only when necessary and choosing the most appropriate antibiotic for each situation.

Azithromycin in Special Populations

Certain patient groups may require special considerations when using azithromycin. Understanding these nuances is important for safe and effective treatment.

How is azithromycin used in pediatric patients?

Azithromycin is approved for use in children, with dosing based on body weight. The oral suspension is often preferred for younger children. Common indications in pediatrics include:

• Acute otitis media
• Community-acquired pneumonia
• Pharyngitis/tonsillitis

Careful consideration of the risk-benefit ratio is necessary, particularly for infants under 6 months of age.

What precautions are needed for elderly patients?

Elderly patients may be more susceptible to certain side effects of azithromycin, particularly:

• QT interval prolongation
• Hearing loss (rarely reported)
• Drug interactions due to polypharmacy

Dose adjustments are generally not required based on age alone, but renal and hepatic function should be considered.

Can azithromycin be used during pregnancy and breastfeeding?

Azithromycin is classified as FDA Pregnancy Category B, meaning animal studies have not shown a risk to the fetus, but adequate human studies are lacking. It should be used during pregnancy only if clearly needed.

Azithromycin does pass into breast milk, but its effects on nursing infants are not well studied. The benefits of breastfeeding should be weighed against potential risks when considering azithromycin use in nursing mothers.

Future Directions and Research

As with all medications, ongoing research continues to expand our understanding of azithromycin’s potential uses and risks.

What new applications are being studied for azithromycin?

Current areas of research include:

• Anti-inflammatory properties in chronic lung diseases
• Potential role in COVID-19 treatment (in combination with other drugs)
• Use in preventing exacerbations of chronic obstructive pulmonary disease (COPD)
• Efficacy in treating non-tuberculous mycobacterial infections

While these potential applications are promising, more research is needed before any new indications can be officially recommended.

How is antibiotic resistance affecting azithromycin’s future?

The rise of antibiotic-resistant bacteria poses a significant challenge to the continued effectiveness of azithromycin. Ongoing efforts to combat this issue include:

• Development of new antibiotic classes
• Combination therapies to enhance efficacy
• Improved diagnostic tools for rapid identification of bacterial infections
• Public health initiatives to promote appropriate antibiotic use

The future of azithromycin and other antibiotics will depend on successful antibiotic stewardship and the development of innovative strategies to overcome resistance.

In conclusion, azithromycin remains a valuable tool in the treatment of various bacterial infections. Its unique pharmacokinetics, broad-spectrum activity, and convenient dosing make it a popular choice among healthcare providers. However, like all antibiotics, it must be used judiciously to maintain its effectiveness and minimize the risk of adverse effects. Patients should always follow their healthcare provider’s instructions and report any concerning symptoms promptly. As research continues, our understanding of azithromycin’s benefits and risks will continue to evolve, shaping its role in future antimicrobial therapy.

Zithromax (Z-Pak) | Uses, Dosage & Azithromycin Interactions

Zithromax (azithromycin), also known as Z-Pak, is an antibiotic approved for treatment of respiratory, skin and other bacterial infections. Studies link the drug to side effects, including an increased risk of fatal heart problems. In August 2018, the U.S. Food and Drug Administration warned of an increased risk of cancer relapse and death in some patients who take the drug long-term.

What Is a Z-Pak?

Zithromax (azithromycin), also known as Z-Pak, is an antibiotic used to treat bacterial infections by inhibiting the growth of bacteria in the body. A Z-Pak is typically taken over a five-day course to treat infections such as bronchitis, pneumonia, and infections of the ears, lungs and other organs. First approved by the FDA in 1991 to treat certain respiratory and skin infections, its use has since expanded to include a wide variety of bacterial infections. These include sexually transmitted diseases, bacterial inflammation and middle-ear infections in children.

COVID-19 Alert

Medical providers are experimenting with azithromycin plus hydroxychloroquine to treat COVID-19.


Learn More

Zithromax has been highly profitable for its manufacturer, Pfizer. At the height of sales in 2002, it brought in over $1 billion for Pfizer. Although the wide availability of generics reduced the company’s revenue, sales still totaled $435 million in 2012.

This antibiotic is popular because it treats infections in adults and children. But, the drug is not without side effects — including fatal heart-related risks.

Zithromax also led to some legal trouble for Pfizer. The company was forced to pay millions to several states to settle allegations that it used misleading tactics to market the drug to children.

How Zithromax Works

Zithromax belongs to a class of antibiotics called macrolides, which are bacteriostatic — meaning they treat infections by preventing bacteria from multiplying and producing the proteins that are essential for their growth. Eventually, the remaining bacteria die or are killed by the immune system, not by the drug itself. This is in contrast to bactericidal antibiotics, which kill bacteria. Bactericidal drugs include fluoroquinolones and penicillin.

Zithromax does not break down in the body as quickly as other antibiotics. Instead of floating freely in the blood, the drug molecules are picked up by white blood cells that fight bacteria. The white blood cells take the medicine to the front lines of their struggle with germs, where it becomes concentrated in the tissues surrounding the infection. That concentration helps it remain in the body longer, which means patients need fewer doses to beat their infections.

Zithromax and Z-Pak Dosage

Zithromax is most familiar to the public as the “Z-Pak,” a convenient five-day pill regimen with a dose of 500 mg (2 tablets of 250 mg) the first day and 250 mg for the remaining four days. But, as of 2022, Zithromax comes in several dosages and forms, including oral tablets and liquids for oral use, injections and intravenous drips.

Dosage forms and strengths

Tablets

250 mg, 500 mg, 600 mg

Oral suspension (liquid)

100 mg/5 mL, 200 mg/5 mL, 1,000 mg/5 mL

Injection and IV

10 mL vial of 500 mg

A doctor determines the dose depending on the infection being treated. For example, for pneumonia, pharyngitis or skin infections the recommended dose is the standard 500 mg for the first day and 250 mg for the remaining 4 days.

For more a complicated disease such as acute sinusitis, doctors prescribe 500 mg a day for three days. In the case of sexually transmitted diseases, the dose is 1 gram, or 1,000 mg, in a single dose.

Who Shouldn’t Take Zithromax?

According to the medication insert, certain people should not take Zithromax. Patients with allergies to azithromycin, erythromycin, or any macrolide or ketolide should not take Zithromax. People with liver problems or who had jaundice with prior use of Zithromax should not take it again.

Sexually Transmitted Infections

Antibiotics used at high doses for short periods of time may mask or delay the symptoms of incubating gonorrhea or syphilis (meaning the disease is already present and developing in the body but symptoms have not yet appeared). Therefore, Zithromax, at the recommended dose, should not be relied upon to treat gonorrhea or syphilis, two types of sexually transmitted diseases (STDs) caused by bacterial infections.

All patients who are diagnosed with or suspected of having sexually transmitted urethritis (urethral inflammation) or cervicitis (irritation or infection of the cervix) should also be tested for gonorrhea and syphilis prior to starting treatment with Zithromax. If infection is confirmed, treatment for those diseases should be initiated with a more appropriate antibacterial drug.

Pregnancy

In animal studies on mice and rats, researchers did not find evidence of birth defects at 3.2 times the human daily dose of 600 mg. But, because there are no actual studies on pregnant humans, pregnant mothers should only use Zithromax while pregnant if necessary. Since it can pass into breast milk, health care providers should use caution in administering Zithromax to breastfeeding mothers, according to the medication label.

Seniors

In clinical trials, 9 percent of patients were at least 65 years of age, and 3 percent were at least 75 years of age. Researchers did not find any differences in effectiveness or safety between young patients and seniors.

Side Effects

In most cases, patients don’t experience side effects from Z-Paks. In clinical trials, adverse reactions occurred in about 12 percent of patients, and less than 10 percent of the reactions were severe.

The most common side effects were gastrointestinal and included diarrhea, stomach pain and nausea. Generally, side effects were more severe with a higher dose.

Serious side effects are rare but can be life-threatening. These include severe allergic reactions, liver injury and diarrhea associated with antibiotic-resistant bacteria.

In March 2013, the FDA warned azithromycin, including brand names Zithromax, Zmax, Azithrocin and Azin, “can cause abnormal changes in the electrical activity of the heart that may lead to a potentially fatal irregular heart rhythm.”

More recently, in August 2018, the FDA warned long-term use of Zithromax can cause cancer relapse and death in people who have had blood or lymph node cancer and have received donor stem cell transplants.

Zithromax Drug Interactions

In clinical trials, Zithromax had the potential to interact with two different types of drugs. Taking Zithromax with alcohol could also intensify side effects.

Drugs that react to Zithromax include:

Nelfinavir

is a drug doctors prescribe to treat HIV infections. This drug can increase the amount of Zithromax in the blood. The medication insert does not recommend the use of these two drugs together. Health care providers should check for liver abnormalities and hearing impairment.

Warfarin

is a blood thinner. Taking Warfarin with Zithromax increased the blood thinning effect. Doctors should monitor patients taking both drugs.

Macrolides

are a class of antibiotic, and Zithromax belongs to this class. Researchers observed interactions between other macrolides and two drugs: digoxin and phenytoin. Patients who use Zithromax with digoxin and phenytoin should be carefully monitored for drug interactions.

Zithromax Effectiveness in Clinical Trials

In clinical trials, Zithromax was effective at fighting bacterial infection, including some antibiotic-resistant strains.

Studies conducted before approval of the drug measured its minimum inhibitory concentration (MIC) in relation to a host of bacteria. MIC is the lowest concentration of an antibiotic that will inhibit the growth of bacteria and thereby kill them. A lower MIC means a more effective antibiotic.

In a 1991 study in the European Journal of Clinical Microbiology and Infectious Diseases, researchers found Zithromax had a markedly low MIC against some bacteria compared with three other types of antibiotics, meaning it was highly effective — for example, resolving 92 percent of gonorrhea infections treated.

Zithromax Litigation

In 2003, Pfizer agreed to pay $6 million to settle deceptive Zithromax marketing allegations from 19 states. Oregon’s attorney general at the time, Hardy Myers, led the investigation. According to court documents, Pfizer misrepresented the effectiveness of Zithromax in its ads and failed to disclose the risks of antibiotic overuse.

Pfizer Settlement

Pfizer admitted no wrongdoing and said the FDA approved its advertising and promotional materials. It claimed it was settling to avoid unnecessary costs.

The drugmaker created a mascot for Zithromax, a zebra named Max, to use in its marketing. Pfizer sent plastic zebras that hang on stethoscopes and medical journals wrapped in zebra stripes to pediatricians. It also donated a zebra named Max to the San Francisco Zoo and invited children to a naming celebration.

The 2013 FDA heart rhythm warning prompted some lawyers to investigate and file Zithromax lawsuits. According to plaintiffs, Zithromax caused abnormal heart rhythms. But there have been no settlements or trial dates set.

Zithromax Facts

Please seek the advice of a medical professional before making health care decisions.

TELL US WHAT YOU THINK

Did You Find Drugwatch Helpful?

Yes

No

Thank you for your feedback. Do you have any thoughts you’d like to share about Drugwatch.

com?

This article changed my life!

This article was informative

I have a question

How can we improve this page?

This article contains incorrect information

This article doesn’t have the information I’m looking for

I have a question

How can we improve this page?

Thank You for Your Feedback

We appreciate your feedback. One of our content team members will be in touch with you soon.

We appreciate your feedback. One of our content team members will be in touch with you soon.

How and when to take azithromycin

Dosage and strength

Azithromycin tablets come as either 250mg or 500mg strengths. The capsules are 250mg. The liquid comes as 200mg in 5ml.

The usual dose is 500mg a day for 3 to 10 days depending on the infection being treated.

For some infections, you’ll be given a one-off higher dose of 1g or 2g.

The dose may be lower for children or if you have liver or kidney problems.

Azithromycin is sometimes prescribed long-term to prevent chest infections if you keep getting them. In this case you will usually need to take it 3 times a week, often on a Monday, Wednesday and Friday.

Important

Carry on taking this medicine until the course is completed, even if you feel better. If you stop your treatment early, your infection could come back.

How to take it

You’ll usually take azithromycin once a day. Try to take your medicine at the same time each day.

Swallow tablets and capsules whole with a drink of water. If you are taking azithromycin capsules, take them at least 1 hour before food or 2 hours after eating. If you have tablets or liquid, you can take them with or without food.

The liquid can have a bitter aftertaste, so it can be a good idea to offer children a drink of fruit juice afterwards.

Do not take medicines for indigestion 2 hours before or after you take this medicine.

Azithromycin liquid is available for children and people who find it difficult to swallow tablets.

If you, or your child, are taking azithromycin as a liquid, your pharmacist will usually make it up for you. The medicine will come with a syringe or spoon to help you measure the right amount. If you do not have one, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not measure the right amount.

If you forget to take it

If you forget to take a dose, take it as soon as you remember, unless it’s nearly time for your next one. In this case, just leave out the missed dose and take your next dose at the usual time.