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Long term azithromycin for adults with respiratory conditions

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What is Azithromycin and how does it work?

Azithromycin is a type of macrolide antibiotic. It works in two ways:

  • As an antibiotic, it kills bacteria that can cause chest infections.
  • As an anti-inflammatory to reduce the number of chest infections.

Azithromycin may help reduce chest symptoms, such as coughing, phlegm production and breathlessness.

What do I need to know before I take Azithromycin?

Do not take this medication if you are allergic to Azithromycin, any of its ingredients or any other macrolide antibiotic, such as Erythromycin or Clarithromycin. To make sure Azithromycin is safe and appropriate for you, and before starting it, your consultant/respiratory nurse specialist will:

  • Ask you to provide three phlegm samples, to check for non-tuberculosis mycobacterium. If this bacteria is present, Azithromycin cannot be used.
  • Check your heart’s rhythm using an electrocardiogram (ECG); this is also known as a heart tracing. This should be done before and one month after starting treatment.
  • Take some blood tests and check your liver function before and one month after starting Azithromycin. Azithromycin will not work if you are a current smoker. In order for you to gain benefit, you should have stopped smoking completely before we prescribe it. Speak to your doctor or pharmacist to see how you can be supported to do this.

What dose do I need to take?

The usual dose is to take one 250mg or 500mg tablet/capsule, three times a week (usually Monday, Wednesday and Friday). You should take it whole and with a glass of water. You can take it with or without food.

Do not take any indigestion remedies e.g. lansoprazole or omeprazole for two hours before and two hours after you take Azithromycin as they will affect how well the medication works.

This is an “off-label” dose and is different to that described in the manufacturer’s patient information leaflet. It is endorsed by the British Thoracic Society. Your consultant/respiratory nurse specialist can provide you more information should you need it.

Does Azithromycin have any side effects?

In general, Azithromycin is well tolerated. Some people experience tummy upset, diarrhoea, constipation, dizziness, headaches or a skin rash.

Occasionally people experience changes in their heart tracing or it can affect their liver. This will be monitored by your consultant/respiratory nurse specialist.

Rarely, people report some hearing loss and the first symptom of this can be tinnitus (ringing in the ears). If you experience this symptom, please stop taking your Azithromycin and seek medical advice. Azithromycin may make you more prone to sunburn and we recommend using a sun block on sunny days. For further information on side effects, please refer to the manufacturer’s patient information leaflet. This will be in the box of medication.

What if I forget to take my dose?

This should not cause any problems. Take your next dose as scheduled.

How long will I have to take Azithromycin?

You are likely to need Azithromycin for three to six months to see if it is working and not causing any significant side effects. If it is reducing the number of your chest infections and reducing your symptoms (coughing, phlegm production and breathlessness), then you can continue taking it.

We may recommend you have an “Azithromycin holiday”. This is a break from taking it and is usually over the summer months. Your consultant/respiratory nurse specialist will advise you on how best to manage this.

Does Azithromycin interact with any of my other medications?

Azithromycin does interact with other medications you may be prescribed or have purchased over the counter, for example theophylline, aminophylline, warfarin, digoxin, statins and antacids.

This may require dose adjustments, stopping medication, taking additional blood tests or further monitoring. It is important that you inform your healthcare professional prescribing you a new medication that you take Azithromycin so appropriate actions can be taken.

For further information of Azithromycin’s effect on other medication, please refer to the manufacturer’s patient information leaflet. This will be in the box of medication.

What should I do if I suffer a flare-up of my lung condition?

Although Azithromycin is an antibiotic, you may still need to take other antibiotics for any chest infections or flare-ups of your lung condition. You may need to stop your Azithromycin when starting a course of antibiotics and your team will advise you accordingly.

Is Azithromycin safe in pregnancy or breastfeeding?

Azithromycin’s safety in pregnancy and breastfeeding is not fully known and the manufacturers of the drug suggest only using it if there are no other alternatives.

We recommend effective contraception for women on Azithromycin. If you are planning on getting pregnant or breastfeeding whilst on Azithromycin, please contact your GP for further advice.

Can I drink alcohol when taking Azithromycin?

Yes and in moderation. Azithromycin does not interact with alcohol.

Who can I contact for support and information?

Respiratory Nurse Specialists

COPD Nurse Specialist: 01273 523109

Bronchiectasis/ILD Nurse Specialist : 07387259261



Smith et al "British Thoracic Society guideline for the use of long-term macrolides in adults with respiratory disease" Thorax 2020.

This information is intended for patients receiving care in Brighton & Hove or Haywards Heath.

The information here is for guidance purposes only and is in no way intended to replace professional clinical advice by a qualified practitioner.

    Publication Date: April 2022

    Review Date: May 2023

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