What is a Z-Pack antibiotic. How does it work against bacterial infections. When should you use a Z-Pack. What are the potential side effects of azithromycin. Can Z-Pack treat viral infections. How to take Z-Pack correctly for optimal results.

Understanding Z-Pack: A Powerful Antibiotic Treatment

Z-Pack, also known as Zithromax or azithromycin, is a widely prescribed antibiotic in the United States. This macrolide antibiotic effectively combats various bacterial infections by inhibiting bacterial growth. Unlike some antibiotics that directly kill bacteria, Z-Pack’s bacteriostatic action halts their multiplication, allowing the body’s immune system to eliminate the weakened pathogens.

It’s crucial to understand that Z-Pack is ineffective against viral infections, including COVID-19, common colds, viral bronchitis, or most sinus infections. This distinction is vital for proper medical treatment and to prevent antibiotic resistance.

How does Z-Pack work?

Z-Pack functions by binding to the 50S subunit of the bacterial ribosome, effectively blocking protein synthesis. This mechanism prevents bacteria from growing and reproducing, ultimately leading to their demise as the body’s immune system takes over.

Common Uses of Z-Pack Antibiotic

Z-Pack is prescribed for various bacterial infections affecting different parts of the body. Here are some of the most common uses:

• Strep throat
• Bacterial pneumonia
• Bacterial bronchitis
• Bacterial sinusitis
• Tonsillitis
• Ear infections (otitis media)
• Mycobacterium Avium Complex (MAC) lung disease
• Non-gonococcal urethritis
• Pelvic Inflammatory Disease (PID)
• Cervicitis
• Early-stage Lyme disease (in some cases)

Is Z-Pack effective for strep throat?

While penicillin antibiotics are the first-line treatment for strep throat, Z-Pack is an excellent alternative for patients with penicillin allergies. Research has shown that Z-Pack is equally effective in treating strep throat in these cases. However, it’s important to note that Z-Pack is not suitable for viral throat infections.

Can Z-Pack treat pneumonia?

Z-Pack has proven effective in treating certain types of community-acquired pneumonia. Studies indicate that patients treated with azithromycin often experience shorter hospital stays, despite a briefer course of antibiotics. In some cases, healthcare providers may combine Z-Pack with another antibiotic for enhanced efficacy, as azithromycin alone may not be sufficient for all types of pneumonia.

Z-Pack Dosage and Administration

The typical Z-Pack regimen consists of a 5-day course of antibiotics. The standard dosage for adults is:

1. Day 1: 500 mg
2. Days 2-5: 250 mg daily

However, dosages may vary depending on the specific infection being treated and individual patient factors. Always follow your healthcare provider’s instructions carefully.

How should I take Z-Pack for optimal results?

To ensure the best possible outcome when taking Z-Pack:

• Take the medication at the same time each day
• You can take Z-Pack with or without food, but taking it with food may help reduce stomach upset
• Complete the entire course of antibiotics, even if you start feeling better before it’s finished
• Do not skip doses or stop taking the medication early without consulting your doctor

Potential Side Effects and Risks of Z-Pack

While Z-Pack is generally well-tolerated, it can cause side effects in some patients. Common side effects include:

• Nausea
• Diarrhea
• Abdominal pain
• Headache
• Dizziness

More serious side effects, though rare, can occur. These may include:

• Severe allergic reactions
• Liver problems
• Irregular heartbeat
• C. difficile infection

Are there any long-term risks associated with Z-Pack use?

While Z-Pack is generally safe for short-term use, repeated or prolonged use of antibiotics can lead to antibiotic resistance. This occurs when bacteria evolve to become less susceptible to antibiotics, making infections harder to treat. Additionally, frequent antibiotic use can disrupt the balance of beneficial bacteria in the gut, potentially leading to digestive issues or increased susceptibility to certain infections.

Z-Pack Interactions and Contraindications

Z-Pack can interact with various medications and medical conditions. It’s crucial to inform your healthcare provider about all medications you’re taking, including over-the-counter drugs and supplements.

Which medications can interact with Z-Pack?

Some medications that may interact with Z-Pack include:

• Antacids containing aluminum or magnesium
• Blood thinners like warfarin
• Certain heart medications, such as digoxin
• Some statins used to lower cholesterol

When should Z-Pack be avoided?

Z-Pack may not be suitable for patients with certain medical conditions, including:

• Liver disease
• Kidney disease
• Heart rhythm disorders
• Myasthenia gravis

Always consult your healthcare provider about potential risks and contraindications before starting Z-Pack treatment.

Alternatives to Z-Pack

While Z-Pack is effective for many bacterial infections, it’s not always the first-choice antibiotic. Depending on the specific infection and patient factors, healthcare providers may prescribe alternative antibiotics.

What are some common alternatives to Z-Pack?

Alternative antibiotics that may be prescribed instead of Z-Pack include:

• Amoxicillin
• Doxycycline
• Cephalosporins (e.g., cefuroxime)
• Fluoroquinolones (e.g., levofloxacin)
• Clarithromycin

The choice of antibiotic depends on various factors, including the type and severity of the infection, patient allergies, local antibiotic resistance patterns, and potential side effects.

Z-Pack and Antibiotic Resistance: A Growing Concern

Antibiotic resistance is a significant global health issue, and the overuse of antibiotics like Z-Pack contributes to this problem. When bacteria are repeatedly exposed to antibiotics, they can develop mechanisms to survive the treatment, making infections harder to treat over time.

How can we prevent antibiotic resistance?

To help combat antibiotic resistance:

• Only use antibiotics when prescribed by a healthcare professional
• Complete the full course of antibiotics as prescribed
• Don’t share antibiotics with others or use leftover antibiotics
• Practice good hygiene to prevent the spread of infections
• Get vaccinated to reduce the need for antibiotics

Healthcare providers play a crucial role in preventing antibiotic resistance by prescribing antibiotics judiciously and educating patients about their proper use.

When to Seek Medical Attention

While Z-Pack can effectively treat many bacterial infections, it’s essential to know when to seek medical attention. Consult a healthcare provider if you experience:

• Persistent or worsening symptoms despite antibiotic treatment
• Severe side effects from the medication
• Signs of an allergic reaction (rash, itching, swelling, difficulty breathing)
• New or unusual symptoms during or after treatment

Can I get antibiotics online?

Many healthcare providers now offer telemedicine services, allowing patients to consult with a doctor online. While antibiotics can be prescribed through these platforms, it’s important to note that responsible providers will only prescribe antibiotics when necessary and appropriate. Always provide accurate and complete information about your symptoms and medical history during these consultations.

The Future of Antibiotic Treatment: Beyond Z-Pack

As antibiotic resistance continues to be a pressing concern, researchers are exploring new approaches to combat bacterial infections. These include:

• Development of new classes of antibiotics
• Combination therapies to enhance effectiveness
• Phage therapy using viruses that target specific bacteria
• Immunotherapies to boost the body’s natural defenses
• Targeted delivery systems for more efficient antibiotic use

What role will Z-Pack play in future antibiotic treatments?

While Z-Pack remains an important tool in treating bacterial infections, its use may become more targeted and limited in the future. As new treatment options emerge and our understanding of antibiotic resistance grows, healthcare providers may increasingly reserve Z-Pack for specific cases where it’s most effective and necessary.

The future of antibiotic treatment will likely involve a more personalized approach, considering factors such as the patient’s microbiome, genetic makeup, and the specific characteristics of the infecting bacteria. This tailored strategy aims to maximize treatment efficacy while minimizing the risk of antibiotic resistance.

Z-Pack in Special Populations: Considerations for Pediatric and Geriatric Patients

While Z-Pack is generally safe and effective for adults, special considerations must be taken into account when prescribing it to pediatric and geriatric populations.

Is Z-Pack safe for children?

Z-Pack can be used in children, but dosing is typically based on body weight. The safety and effectiveness of azithromycin in children younger than 6 months have not been established for most indications. For children, healthcare providers must carefully weigh the benefits against potential risks, especially considering the impact on developing immune systems and the risk of antibiotic resistance.

What precautions should be taken when prescribing Z-Pack to older adults?

Older adults may be more susceptible to certain side effects of Z-Pack, particularly those affecting the heart. Additionally, they may be more likely to have pre-existing conditions or be taking medications that could interact with azithromycin. Healthcare providers should consider factors such as:

• Decreased kidney and liver function
• Increased risk of QT interval prolongation
• Potential drug interactions with other medications commonly used by older adults
• Higher susceptibility to C. difficile infections

Careful monitoring and potentially adjusted dosing may be necessary when prescribing Z-Pack to geriatric patients.

Z-Pack and the Environment: Ecological Impacts of Antibiotic Use

The widespread use of antibiotics like Z-Pack not only affects human health but also has significant environmental implications. Antibiotics can enter the environment through various routes, including human and animal excretion, improper disposal of unused medications, and pharmaceutical manufacturing processes.

How does antibiotic use affect ecosystems?

Environmental exposure to antibiotics can lead to:

• Development of antibiotic-resistant bacteria in soil and water
• Disruption of natural microbial communities in ecosystems
• Potential impacts on aquatic life and food chains
• Accumulation of antibiotic residues in agricultural products

To mitigate these effects, it’s crucial to use antibiotics responsibly and dispose of unused medications properly. Many pharmacies and healthcare facilities offer drug take-back programs to ensure safe disposal of unused antibiotics.

The Role of Probiotics in Mitigating Z-Pack Side Effects

While Z-Pack effectively targets harmful bacteria, it can also disrupt the balance of beneficial bacteria in the gut microbiome. This disruption can lead to side effects such as diarrhea and may increase the risk of opportunistic infections like C. difficile.

Can probiotics help reduce Z-Pack side effects?

Probiotics, which are live beneficial bacteria, may help mitigate some of the gastrointestinal side effects associated with Z-Pack use. Some potential benefits of taking probiotics during and after antibiotic treatment include:

• Reducing the risk of antibiotic-associated diarrhea
• Helping to restore balance to the gut microbiome
• Potentially lowering the risk of C. difficile infection
• Supporting overall digestive health

While research on the effectiveness of probiotics in conjunction with antibiotic use is ongoing, many healthcare providers recommend taking probiotics during and after a course of antibiotics. However, it’s important to consult with your healthcare provider before starting any probiotic regimen, as the timing and specific strains of probiotics may affect their efficacy.

Z-Pack in the Context of Global Health: Access and Equity Issues

While Z-Pack is widely available in many developed countries, access to this and other antibiotics remains a significant challenge in many parts of the world. This disparity in access to effective antibiotics has important implications for global health and the fight against infectious diseases.

What are the challenges in ensuring global access to antibiotics like Z-Pack?

Several factors contribute to the unequal distribution of antibiotics worldwide:

• Cost barriers in low- and middle-income countries
• Limited healthcare infrastructure in some regions
• Supply chain issues and counterfeit medications
• Lack of diagnostic capabilities to guide appropriate antibiotic use
• Regulatory challenges in drug approval and distribution

Addressing these challenges requires a coordinated global effort involving governments, pharmaceutical companies, healthcare organizations, and international bodies. Initiatives aimed at improving access to essential medicines, strengthening healthcare systems, and promoting responsible antibiotic use are crucial for combating infectious diseases and reducing health inequities worldwide.

As we continue to rely on antibiotics like Z-Pack to treat bacterial infections, it’s essential to balance the need for access with the imperative to prevent antibiotic resistance. This delicate equilibrium underscores the complexity of managing antibiotic use on a global scale and highlights the need for continued research, innovation, and collaboration in the field of infectious disease treatment.

What is a Z-Pak? Side Effects and More

Zithromax, sometimes called Z-Pak, is a popular form of the antibiotic azithromycin. Azithromycin is the most commonly prescribed antibiotic in the United States.

It is a macrolide antibiotic that treats some bacterial infections by stopping the growth of the bacteria. This process of stalling bacteria growth is why Z-Pak is called “bacteriostatic”—instead of killing bacteria outright, it stops them from growing and multiplying.

The body’s natural defenses can then remove what’s left of the bacteria. Azithromycin has no use in treating viral infections, including COVID-19, common colds, viral bronchitis, or most sinus infections. If you’re wondering what a Z-Pak (or Z-Pack) is, how to use this medication, or whether it’s effective, this guide will help.

In this article, I’ll discuss the Z-Pak’s uses, doseage, and effectiveness, as well as risks and side effects. I’ll talk about when not to take a Z-Pak, and some alternatives to Zithromax. I’ll finish by outlining when you should see a doctor about your symptoms.

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Z-Pak Uses

Azithromycin (Zithromax or Z-Pak) can be used to treat some bacterial infections of the skin, respiratory, and genitourinary system. Here are some infections for which your doctor may prescribe a Z-Pak.

Strep Throat

Strep throat, or streptococcal pharyngitis, is a bacterial infection of the throat. It typically manifests as a sore throat, pain with swallowing, as well as a fever or a rash.

Penicillin antibiotics are the preferred treatment for strep throat, but some patients are allergic to these antibiotics. In these cases, your doctor may prescribe Zithromax instead. Research has shown that Z-Paks treat strep throat just as well as penicillin for those with a penicillin allergy. Azithromycin does not work for viral throat infections.  

Pneumonia

Z-Pak is also effective for treating some types of community-acquired pneumonia, an acute respiratory infection contracted outside of the hospital. Studies show that for patients treated with azithromycin, hospital stays were shorter despite a shorter course of antiobiotics. 

Your provider may also choose to treat pneumonia with a combination of Z-Pak and another antibiotic for a stronger effect, as azithromycin does not treat all types of pneumonia well. Azithromycin does not work for COVID-19 pneumonia or other viral pneumonias.

Bronchitis

Bronchitis is an infection of the main chest airways called bronchi. While most bronchitis is caused by viruses, the infection is sometimes caused by bacteria. In these bacterial cases, Z-Pak may be useful for treatment. 

Most of the time, though, your doctor will probably not prescribe an antibiotic for bronchitis: A study in American Family Physician showed that antibiotics provide very little benefit in most cases of acute bronchitis.

However, when the bronchitis is caused by whooping cough or other specific bacteria, macrolides like Z-Pak are efficient for reducing the spread. 

Other Uses

Other bacterial infections that can be managed with azithromycin are:

• Bacterial sinusitis: According to a study comparing the impact of amoxicillin-clavulanate and azithromycin, Z-Packs can treat sinus infections caused by bacteria. However, most sinus infections are caused by viruses, and do not need antibiotics at all. And when sinusitis is caused by bacteria, other antibiotics are generally preferred and more effective.

• Tonsillitis: Z-Pak works for treating tonsillitis in adults and children who cannot take penicillin-based antibiotics, though it may have more side effects.

• Ear infections (otitis media): Azithromycin is also effective for treating infections of the middle ear that are caused by bacteria in those who cannot take other preferred antibiotics.  

• Mycobacterium Avium Complex (MAC) Lung Disease: Z-Pak is used to manage MAC lung disease, often seen in patients with HIV.

• Non-gonococcal urethritis: This inflammation of the male urethra, caused by the sexually-transmitted disease chlamydia, can be treated with azithromycin, though doxycycline is often the preferred antibiotic.

• Pelvic Inflammatory Disease (PID): PID should be treated with the antibiotic doxycycline, but in those who cannot take doxycycline, azithromycin may be used in combination with another antibiotic. 

• Cervicitis: Experts recommend either doxycycline or azithromycin for the treatment of chlamydial cervicitis, though doxycycline is the recommended treatment. When cervicitis is caused by gonorrhea, a different antibiotic is required.

• Lyme disease: The CDC recommends that people with early Lyme disease who cannot tolerate doxycycline, cefuroxime, or amoxicillin be treated with azithromycin—although it is less effective than the other three in this case.

Dosage of Zithromax

Azithromycin comes in various dosages, but a Z-Pak is a specific, five-day course of azithromycin. The Z-Pak contains six tablets, each containing 250 mg of azithromycin.

Two tables are taken on the first day (for a 500 mg dose), followed by one 250 mg tablet taken each of the next four days. This is a common dose for many types of infections. Azithromycin is available as oral tablets, oral suspension (liquid), and injections or intravenous (IV) medication.

Each of the available forms come in several strengths. 

• Oral tablets: Available as 250 mg and 500 mg tablets.
• Oral suspension: Available as 100 mg/5 mL and 200 mg/5 mL suspensions.
• Injection and IV: Available as 10 mL vial of 500 mg.

Your doctor will decide what dosage is appropriate for you depending on your age and the infection. The prescribed strength and form may also vary over the course of your treatment.  

For example, the recommended dose for strep throat is 500 mg oral tablets once on the first day, followed by 250 mg oral tablets for the next four days. But for non-gonococcal urethritis, it’s a one-time, 1000 mg dose. 

How Long to Take It

Take your azithromycin for the duration prescribed by your provider. Usually, this is between 3-10 days. Make sure to take the medication on time and complete the full treatment course before discontinuing the drug—even if you’ve begun to feel better. 

Starting and quitting the drug before the specified day can cause bacteria to become resistant to antibiotics.

Effectiveness of Azithromycin

Azithromycin is a versatile and highly effective antibiotic when used appropriately. It works well in treating a wide range of bacterial infections both in children and adults. 

Azithromycin is especially effective in treating some sexually transmitted infections, like chlamydia and chlamydia-related infections. One clinical showed that azithromycin showed a 98% eradication for chlamydia and other bacteria.  

Possible Risks and Side Effects of Azithromycin

The most common side effects of azithromycin are not life-threatening for most people. Still, it’s worth knowing what they are so you don’t panic, and can get help from your doctor if needed.

Side effects you may experience with azithromycin are:

• Upset stomach
• Loose stools or diarrhea
• Nausea
• Vomiting
• Dizziness or fainting
• Skin rash 
• Abdominal pain
• Vaginal itchiness from yeast overgrowth
• Headache
• Ringing ears
• Blurred vision
• Nervousness
• Liver problems

Drug Interactions

Azithromycin may interact with several other medications, causing them to be ineffective, or potentially causing serious side effects. Be sure to mention all your current medications to your prescriber before receiving a prescription for azithromycin.

A few drugs that interact with azithromycin are:

• Antidepressants
• Antipsychotic medications
• Anti-malarial medications 
• Heart rhythm medications
• Cholesterol-reducing medication
• Blood pressure medication
• Anti-diarrheal medications 
• HIV medicines

If you take any of these medications, your provider may need to prescribe alternative medication or recommend pausing them for the duration of your antibiotic treatment.

When to Not Take Azithromycin

In some cases, azithromycin is not the right choice. Here are some situations in which you should avoid azithromycin.

STIs

While azithromycin works for treating some sexually transmitted infections, specifically those caused by chlamydia, it should not be used to treat gonorrhea and syphilis, or trichomonas. 

The CDC recommends using ceftriaxone (Rocephin) injection to treat gonorrhea and benzathine penicillin (Bicillin) injections for syphilis.

The CDC also now recommends doxycycline as the first-line treatment for chlamydia, not azithromycin. If you have an allergy or other inability to take doxycycline, then azithromycin may be used.

Age

Children under six months of age should not be treated with azithromycin. Recent studies show that azithromycin is safe for use in the elderly.

Pregnant

While azithromycin does not cause fetal malformations in the uterus, it has been associated with an increased risk of miscarriage.  

Heart Problems

If you have heart problems—especially irregular heartbeats like QT prolongation—it would also be best to avoid using azithromycin. A study in the New England Journal of Medicine showed that use of the antibiotic increased the risk of sudden death linked to heart arrhythmias.

Viral Illnesses

Many common infections, including colds, sinus infections, bronchitis, and some ear and throat infections, are caused by viruses. Unfortunately, when your illness is caused by a virus, an antibiotic will not help at all, and can cause uncomfortable or serious side effects. 

Alternatives to Azithromycin

For those unable to use azithromycin or other macrolides such as erythromycin and clarithromycin, there are other antibiotics you can be prescribed instead.

Amoxicillin

Amoxicillin is a penicillin-like antibiotic that treats many of the same bacterial infections azithromycin does. Because of antibiotic resistance, it is sometimes used with clavulanate as amoxicillin-clavulanate (Augmentin).  

This broad-spectrum antibiotic treats everything from respiratory tract infections to gastrointestinal infections. And it is safe for most people, including those who are pregnant.

Doxycycline

Doxycycline (Monodox) is especially useful for urogenital infections such as chlamydia. Some studies have shown it to be more effective than azithromycin, and the CDC now recommends doxycycline as the first-line treatment for sexually transmitted infections caused by chlamydia. 

Ceftriaxone

Ceftriaxone (Rocephin) treats bacterial pneumonias, ear infections, and throat infections, and may be used instead of, or in addition to, azithromycin for some types of infections.

Your doctor or healthcare provider will make the best choice for you when they know which medications you’re on and which other medical conditions you have.

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When to See a Doctor

If you have worrying signs of an infection, it’s best to see your primary care physician before beginning antibiotic treatment using azithromycin. Many common infections are actually viral, and will resolve on their own without antibiotics.

Azithromycin is not the right treatment for all types of bacterial infections. Your provider can determine if antibiotics are needed at all, which antibiotics are safe and effective for your infection, and what dosage will work best.

If you have already begun using azithromycin and are not seeing improvement in your symptoms or are getting worse, speak to your healthcare provider.

How K Health Can Help

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Frequently Asked Questions

Are there good alternatives for Z-Pak (Zithromax)?

It depends on the type of infection! In general, there are many other antibiotic options that treat the bacterial infections that azithromycin is often used for. Your healthcare provider can help you figure out if an antibiotic is needed, and if azithromycin or another option is the correct choice.

Is azithromycin a steroid?

No. Azithromycin is a macrolide antibiotic that works by inhibiting the growth of bacteria.

Can Z-Pak be used to treat COVID-19?

No. Studies have shown that azithromycin does not treat COVID-19. COVID-19 is a viral infection, and azithromycin only treats bacterial infections. Azithromycin will not help with any viral illness, including COVID-19.

K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

K Health has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions,
and medical associations. We avoid using tertiary references.

• Azithromycin. (2021).
  https://www.ncbi.nlm.nih.gov/books/NBK548434/

• Azithromycin for community treatment of suspected COVID-19 in people at increased risk of an adverse clinical course in the UK (PRINCIPLE): a randomised, controlled, open-label, adaptive platform trial. (2021).
  https://www.thelancet.com/article/S0140-6736(21)00461-X/fulltext

• Doxycycline as an Alternative to Azithromycin in Elderly Patients. (2021).
  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7779281/

• Use of antibiotics during pregnancy and risk of spontaneous abortion. (2017).
  https://pubmed.ncbi.nlm.nih.gov/28461374/

• Management of non-gonococcal urethritis. (2015).
  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-015-1043-4

• Effectiveness of azithromycin in aspiration pneumonia: a prospective observational study. (2014).
  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4265472/

• Azithromycin for Elderly Patients With Pneumonia. (2014).
  https://jamanetwork.com/journals/jama/article-abstract/1910101

• Azithromycin and the Risk of Cardiovascular Death. (2012).
  https://www.nejm.org/doi/full/10.1056/NEJMoa1003833

• Diagnosis and Treatment of Acute Bronchitis. (2010).
  https://www.aafp.org/afp/2010/1201/p1345.html

• Newest Approaches to Treatment of Pelvic Inflammatory Disease: A Review of Recent Randomized Clinical Trials. (2007).
  https://academic.oup.com/cid/article/44/7/953/462098

• Single dose azithromycin for the treatment of uncomplicated otitis media. (2004).
  https://pubmed.ncbi.nlm.nih.gov/14770073/

• Is azithromycin the first-choice macrolide for treatment of community-acquired pneumonia? (2003).
  https://pubmed.ncbi.nlm.nih.gov/12746768/

• Randomized Double-Blind Study Comparing 3- and 6-Day Regimens of Azithromycin with a 10-Day Amoxicillin-Clavulanate Regimen for Treatment of Acute Bacterial Sinusitis. (2003).
  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC182642/

• Chlamydial Infection Among Adolescents and Adults. (2021).
  https://www.cdc.gov/std/treatment-guidelines/chlamydia.htm

• Azithromycin versus penicillin V for treatment of acute group A streptococcal pharyngitis. (2002).
  https://pubmed.ncbi.nlm.nih.gov/12075761/

• Azithromycin-Containing Regimens for Treatment of Mycobacterium avium Complex Lung Disease. (2001).
  https://academic.oup.com/cid/article/32/11/1547/461472

• Azithromycin vs cefuroxime plus erythromycin for empirical treatment of community-acquired pneumonia in hospitalized patients: a prospective, randomized, multicenter trial. (2000).
  https://pubmed.ncbi.nlm.nih.gov/10809032/

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