What is Azithromycin?
Azithromycin is an antibiotic used to treat infections caused by bacteria. It is from a group of antibiotics called ‘macrolides’. However, it also has a useful anti-inflammatory property, helping to reduce the number of flare ups of Chronic Obstructive Pulmonary Disease (COPD) and Bronchiectasis.
Why have I been prescribed Azithromycin?
Azithromycin is a treatment used to prevent chest infections in COPD and Bronchiectasis. It helps to both kill bacteria and to reduce inflammation in the airway or breathing pipes. We use Azithromycin ‘outside of the product licence’, but clinical studies have shown it to be of significant benefit (see references below).
What do you need to know before taking it?
1. If you have had an allergic reaction to any macrolide antibiotic, such as Clarithromycin or Erythromycin, in the past you should not take Azithromycin.
2.We will check some blood tests, a sputum sample and an ECG before starting this treatment.
3.There are potential side effects, as with all medications. Please see the list below describing possible side effects.
How long will you be taking Azithromycin?
Initially for six months and then reviewed. If the benefit is significant, we may recommend this long term.
What dose do I need?
Usually 250mg or 500mg tablets three times a week (Monday, Wednesday and Friday).
Flare ups or exacerbations
Please let your doctor know if you are suffering from symptoms of a chest infection. You may still need to complete an appropriate different course of antibiotics if necessary. You may need to stop taking your Azithromycin during this time but this will be a decision made by your doctor.
Possible side effects
• Azithromycin is usually well tolerated.
• Less than 1 in 10 of patients report tummy upset, diarrhoea, constipation, dizziness, headaches or a rash.
• Less than 1 in 100 of patients report hearing impairment, with the first symptom being ringing in the ears. If you experience this, please stop taking Azithromycin straight away. Hearing changes usually improve.
• Less than 1 in 1000 of patients develop abnormal heart rhythms or liver inflammation, hence checking an ECG and blood tests.
• There is an increased risk of an unusual infection called non-tuberculous mycobacterial (NTM) in patients with Bronchiectasis. We therefore check sputum for this prior to starting Azithromycin.
Which medication may interact with Azithromycin?
A short list of common medications include:
• Warfarin
• Digoxin
• Amiodarone
• Edoxaban
• Dabigatran
Azithromycin can still be used depending on the situation but caution is required and we may suggest an alternative combination. There are many other drugs that interact. However, the impact is often minor. Please let your doctor, pharmacist or other prescribing healthcare professional know all the medications you are taking. As we may need to increase monitoring and/or adjust doses of the medication you may be prescribed.
Frequently asked questions
What if I forget a dose?
Do not worry, just take the next dose as scheduled.
Should Azithromycin be stopped for surgery?
It commonly should not need to be stopped, if you have any questions please check with your respiratory / surgical doctor.
Does Azithromycin alter fertility or pregnancy?
We recommend a careful discussion concerning the advantages and disadvantages of continuing Azithromycin in order to make a balanced judgement concerning stopping or continuing.
Can I drink alcohol while on azithromycin?
There is no significant interaction between Azithromycin and alcohol.
References
https://jamanetwork.com/journals/jama/fullarticle/1672237 – BAT Study
https://www.thelancet.com/journals/lancet/article/PIIS0140- 6736(12)60953-2/fulltext – EMBRACE Study
Albert RK et al N Engl J Med 2011, 365(8) 689
