azithromycin (Zithromax): For COVID-19, Uses, Dosage, Side Effects, Interactions, Pregnancy (2024)

What Is It?
- What is azithromycin (Zithromax, Z-Pak)?
- What else should I know about azithromycin (Zithromax, Z-Pak)?
For COVID-19
- Does azithromycin treat COVID-19 coronavirus disease?
Side Effects
- What are the side effects of azithromycin (Zithromax, Z-Pak)?
Dosage
- What is the dosage for azithromycin (Zithromax, Z-Pak)?
Drug Interactions
- Which drugs or supplements interact with azithromycin (Zithromax, Z-Pak)?
For Pregnancy
- Is azithromycin (Zithromax, Z-Pak) safe to use during pregnancy or while breastfeeding?
Comments
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Generic Name:Azithromycin

Brand Name:Zithromax,Zmax

Drug Class:Macrolides

What is azithromycin (Zithromax, Z-Pak)?

Azithromycin is a semi-synthetic macrolide antibiotic chemically related to erythromycin and clarithromycin (Biaxin).

Azithromycin is effective against susceptible bacteria causing:

Otitis media (infection of the middle ear)
Tonsillitis
Laryngitis
Bronchitis
Pneumonia
Sinusitis
Uncomplicated skin and skin structure infections
Mycobacterium avium complex
Acute bacterial flare-ups of chronic obstructive pulmonary disease (COPD)

It also is effective for acute pelvic inflammatory disease and several sexually transmitted infectious diseases (STDs) such as nongonococcal urethritis and cervicitis.

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.

Do I need a prescription for azithromycin?

Yes

Does azithromycin treat COVID-19 coronavirus disease?

Though azithromycin is antibiotic and thus ineffective aloneagainst viruses, some clinicians have seen limited success in COVID-19 coronavirus disease patients when adding itto chloroquine (Aralen) and/or hydroxychloroquine (Plaquenil)in the sickest patients.

As of March 30, 2020, there is littlesolidevidence 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 coronaviruspatients. 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.

What are the side effects of azithromycin (Zithromax, Z-Pak)?

The most common side effects of azithromycin are:

Diarrhea or loose stools
Nausea
Abdominal pain
Vomiting

Other possible side effects of azithromycin include:

Rash
Nervousness
Vaginitis
Tongue discoloration
Ringing in the ears
Indigestion

Possible serious side effects of azithromycin include:

Angioedema
Abnormal liver tests
Cholestatic jaundice
Steven-Johnson Syndrome
Serious allergic reactions
Abnormal heartbeats

Antibiotics can alter the normal bacteria in the colon and encourage the 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 istaken 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)?

Azithromycin (except Zmax) should not be taken at the same time as aluminum- or magnesium-based antacids, such as Mylanta or Maalox, because antacids will bind the azithromycin and prevent it from being absorbed from the intestine.

Is azithromycin (Zithromax, Z-Pak) safe to use during pregnancy or while breastfeeding?

There are no adequate studies of azithromycin in pregnant women. Azithromycin should only be used during pregnancy if it is clearly necessary.
It is not known if azithromycin is secreted in breast milk.

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, macrolide antibiotics do not interfere with the 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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Summary

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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Treatment & Diagnosis

Procedures & Tests

FAQs & Doctor's Views

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How Do the COVID-19 Coronavirus Tests Work?

Pneumonia FAQs
Strep Streptococcal Throat Infection FAQs
Ear Infection FAQs
COPD (Chronic Obstructive Pulmonary Disease) FAQs
Bronchitis FAQs
Wuhan Coronavirus FAQs
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Medication Disposal
Antibiotics 101
Generic Drugs, Are They as Good as Brand-Names?

Medications & Supplements

Medications

FDA Drug Labels on RxList.com

azithromycin - intravenous, Zithromax
azithromycin 250/500 mg - oral, Zithromax
Drugs: Questions to Ask Your Doctor or Pharmacist about Your Drugs
Drug Interactions
erythromycin
Types of Coronavirus Disease 2019 (COVID-19) Medications
clarithromycin, Biaxin
Prophylactic Antibiotics for Head and Neck Surgery
Why Are Antibiotics Given Before Cutaneous Surgery?
COVID-19 vaccine, viral vector-Janssen (investigational)
sotrovimab
The Moderna COVID-19 Vaccine
Veklury (remdesivir)
The Pfizer-BioNTech COVID 19 Vaccine
Aralen
How Do COVID-19 Vaccines Work?

Prevention & Wellness

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Report Problems to the Food and Drug Administration

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.

See more info: azithromycin on RxList

References

Medically reviewed by John P. Cunha, DO, FACOEP; Board Certified Emergency Medicine

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
March 2020
International Journal of Antimicrobial Agents

Some data on COVID-19 use from Aileen Chi, Pharm. D., of Dova Pharmaceuticals