Long term azithromycin for adults with respiratory conditions

You have been prescribed Azithromycin to try to prevent your lung condition getting worse if you have an infection.

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.

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.

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.

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.

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

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.