Azithromycin
Prescription ·Exploratory record · not publication-reviewed ·Updated July 13, 2026
A macrolide antibiotic with a broad spectrum of activity against gram-positive, some gram-negative, and atypical organisms (Mycoplasma, Chlamydia, Legionella). The 5-day 'Z-Pack' course is one of the most commonly prescribed antibiotic regimens. Used for community-acquired pneumonia, acute bacterial exacerbations of COPD, sinusitis, pharyngitis (in penicillin-allergic patients), sexually transmitted infections (chlamydia, gonorrhea as adjunct), and traveler's diarrhea.
Exploratory record, not a reviewed medical publication.
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This generated database record has not completed a claim-level review by a qualified human medical reviewer. Bibliography links and evidence labels are not approval. The page remains available for reference and is excluded from search indexing.
What the research says.
A quick, data-only summary. The full evidence, dosing, and sources are below.
A macrolide antibiotic with a broad spectrum of activity against gram-positive, some gram-negative, and atypical organisms (Mycoplasma, Chlamydia, Legionella). NutriStack rates the supporting evidence as strong. Common adult dosing is Z-Pack: 500 mg day 1, then 250 mg days 2-5; single 1 g dose for chlamydia; 500 mg daily x3 days for COPD exacerbation (as prescribed by your physician), though a prescriber sets the actual dose. With long-term use it can deplete vitamin k. This profile indexes 10 sources.
The bottom line
Evidence rating strong. Most-documented uses: treats community-acquired pneumonia, treats acute bacterial sinusitis, treats acute exacerbation of copd. 10 sources indexed (2015–2025), with 0 interaction records on file.
How it works, mechanistically.
Core mechanism
Binds to the 50S ribosomal subunit of susceptible bacteria, specifically the 23S rRNA of the peptidyl transferase center. This blocks translocation of peptides during translation, inhibiting bacterial protein synthesis. Azithromycin is bacteriostatic at usual concentrations but may be bactericidal at high local concentrations. It concentrates extensively in tissues and phagocytes, achieving intracellular concentrations 10-100x higher than plasma.
Dosing & protocol.
Oral bioavailability approximately 37%. Tablets can be taken with or without food. Oral suspension should be taken on an empty stomach (1 hour before or 2 hours after meals). High tissue penetration and prolonged tissue half-life.
What it depletes.
Nutrients this medication can lower over time, and what to replace.
Vitamin K
MildBroad-spectrum antibiotic exposure can suppress gut bacteria that synthesize menaquinones, lowering vitamin K availability in susceptible patients.
Full safety detail.
Side effects
- Diarrhea
- Nausea
- Abdominal pain
- QT prolongation (rare but clinically significant)
- Headache
- Hepatotoxicity (rare)
Contraindications
Sources, by evidence tier.
Numbered references. Citations throughout the page link here.
Meta-analyses & systematic reviews
6- 1Influential predictors of azithromycin pharmacokinetics: a systematic review of population pharmacokineticsPMIDMethaneethorn J, Jiao Z, AlEjielat R et al. · Annals of medicine · 2025
Methaneethorn J, Jiao Z, AlEjielat R et al.. Influential predictors of azithromycin pharmacokinetics: a systematic review of population pharmacokinetics. Annals of medicine. 2025
- 2Azithromycin for acute bronchiolitis and wheezing episodes in children - a systematic review with meta-analysisPMIDUkkonen RM, Renko M, Kuitunen I · Pediatric research · 2024
Ukkonen RM, Renko M, Kuitunen I. Azithromycin for acute bronchiolitis and wheezing episodes in children - a systematic review with meta-analysis. Pediatric research. 2024
- 3Azithromycin in patients with COVID-19: a systematic review and meta-analysis.PMIDAyerbe L, Risco-Risco C, Forgnone I et al. · Journal of Antimicrobial Chemotherapy · 2022
Meta-analysis of RCTs found azithromycin did not reduce mortality, hospitalization, or symptom resolution in COVID-19 patients compared to standard of care or placebo, and was associated with increased antibiotic resistance.
- 4Safety of azithromycin in pediatrics: a systematic review and meta-analysis.PMIDZeng L, Xu P, Choonara I et al. · European Journal of Clinical Pharmacology · 2020
Systematic review found azithromycin had a generally favorable safety profile in children with overall adverse event rates comparable to other antibiotics; gastrointestinal effects (vomiting, diarrhea) were the most common side effects.
- 5The efficacy and safety of azithromycin in asthma: A systematic reviewPMIDTian BP, Xuan N, Wang Y et al. · Journal of cellular and molecular medicine · 2019
Tian BP, Xuan N, Wang Y et al.. The efficacy and safety of azithromycin in asthma: A systematic review. Journal of cellular and molecular medicine. 2019
- 6Use and safety of azithromycin in neonates: a systematic reviewPMIDSmith C, Egunsola O, Choonara I et al. · BMJ open · 2015
Smith C, Egunsola O, Choonara I et al.. Use and safety of azithromycin in neonates: a systematic review. BMJ open. 2015
Reviews & position papers
1- 7Effect of Hydroxychloroquine and Azithromycin Combination Use in COVID-19 Patients - An Umbrella ReviewPMIDNag K, Tripura K, Datta A et al. · Indian journal of community medicine : official publication of Indian Association of Preventive & Social Medicine · 2024
Nag K, Tripura K, Datta A et al.. Effect of Hydroxychloroquine and Azithromycin Combination Use in COVID-19 Patients - An Umbrella Review. Indian journal of community medicine : official publication of Indian Association of Preventive & Social Medicine. 2024
Reference material
3- 8Mandell LA et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007.Source linkedPMID
- 9Ray WA et al. Azithromycin and the risk of cardiovascular death. N Engl J Med. 2012.Source linkedPMID
- 10Workowski KA et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021.Source linkedPMID
Common questions.
Quick answers about Azithromycin, drawn from the data on this page.
What is Azithromycin?
A macrolide antibiotic with a broad spectrum of activity against gram-positive, some gram-negative, and atypical organisms (Mycoplasma, Chlamydia, Legionella). The 5-day 'Z-Pack' course is one of the most commonly prescribed antibiotic regimens. Used for community-acquired pneumonia, acute bacterial exacerbations of COPD, sinusitis, pharyngitis (in penicillin-allergic patients), sexually transmitted infections (chlamydia, gonorrhea as adjunct), and traveler's diarrhea.
What is Azithromycin used for?
Commonly cited benefits of Azithromycin include: Treats community-acquired pneumonia; Treats acute bacterial sinusitis; Treats acute exacerbation of COPD; Treats Chlamydia trachomatis (single dose); Short treatment course (3-5 days). NutriStack rates the overall evidence as strong.
What is a typical dose of Azithromycin?
A typical adult dose of Azithromycin is Z-Pack: 500 mg day 1, then 250 mg days 2-5; single 1 g dose for chlamydia; 500 mg daily x3 days for COPD exacerbation (as prescribed by your physician). The commonly recommended form is Oral tablets, suspension, or IV. These are general ranges, not personalized advice; confirm the right dose with a clinician.
What are the side effects of Azithromycin?
Reported side effects include diarrhea, nausea, abdominal pain, qt prolongation (rare but clinically significant), headache, hepatotoxicity (rare). This is educational information; check with a healthcare professional before use.
How strong is the evidence for Azithromycin?
NutriStack rates this as Strong, meaning multiple high-quality meta-analyses or systematic reviews converge on the same finding. Full tier criteria are at https://nutristackapp.com/methodology/evidence-tiers.
Use this with your stack
Azithromycin in NutriStack.
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