Azithromycin

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Also indexed as:

Zithromax

About azithromycin

Azithromycin is a macrolide antibiotic used to treat a variety of bacterial infections.

Overview

Try these helpful products which may be beneficial if taken with this medicine

• Vitamin K
• To avoid depletion of vitamin K, which might cause blood clotting problems, try taking 100 mcg of the nutrient each day, or eating more leafy green vegetables while taking the drug

• Probiotics
• Taking probiotics such as Saccharomyces, Lactobacillus, and Bifidobacterium species might prevent common consequences of azithromycin therapy, such as diarrhea and yeast infections

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or pharmacist. Continue reading the full article for more information on interactions with vitamins, herbs, and foods.

Herbs

Summary of Interactions for Azithromycin

Depletion or interference	Vitamin K*
Adverse interaction	None known
Side effect reduction/prevention	Bifidobacterium longum* Lactobacillus acidophilus* Lactobacillus casei* Saccharomyces boulardii* Saccharomyces cerevisiae* Vitamin K*
Supportive interaction	Saccharomyces boulardii*
Reduced drug absorption/bioavailability	None known
Other (see text)	Digitalis Magnesium

An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

Interactions with Supplements

Magnesium

A magnesium- and aluminum-containing antacid was reported to interfere with azithromycin absorption in a study of ten healthy people.¹ People can avoid this interaction by taking azithromycin two hours before or after any aluminum/magnesium-containing products. It has not yet been shown that magnesium compounds typically found in supplements affect absorption of this drug.

Probiotics

A common side effect of antibiotics is diarrhea, which may be caused by the elimination of beneficial bacteria normally found in the colon. Controlled studies have shown that taking probiotic microorganisms-such as Lactobacillus casei, Lactobacillus acidophilus, Bifidobacterium longum, or Saccharomyces boulardii-helps prevent antibiotic-induced diarrhea.²

The diarrhea experienced by some people who take antibiotics also might be due to an overgrowth of the bacterium Clostridium difficile, which causes a disease known as pseudomembranous colitis. Controlled studies have shown that supplementation with harmless yeast-such as Saccharomyces boulardii³ or Saccharomyces cerevisiae (baker's or brewer's yeast)⁴-helps prevent recurrence of this infection. In one study, taking 500 mg of Saccharomyces boulardii twice daily enhanced the effectiveness of the antibiotic vancomycin in preventing recurrent clostridium infection.⁵ Therefore, people taking antibiotics who later develop diarrhea might benefit from supplementing with saccharomyces organisms.

Treatment with antibiotics also commonly leads to an overgrowth of yeast (Candida albicans) in the vagina (candida vaginitis) and the intestines (sometimes referred to as "dysbiosis"). Controlled studies have shown that Lactobacillus acidophilus might prevent candida vaginitis.⁶

Vitamin K

Several cases of excessive bleeding have been reported in people who take antibiotics.^{7, 8, 9, 10} This side effect may be the result of reduced vitamin K activity and/or reduced vitamin K production by bacteria in the colon. One study showed that people who had taken broad-spectrum antibiotics had lower liver concentrations of vitamin K2 (menaquinone), though vitamin K1 (phylloquinone) levels remained normal.¹¹ Several antibiotics appear to exert a strong effect on vitamin K activity, while others may not have any effect. Therefore, one should refer to a specific antibiotic for information on whether it interacts with vitamin K. Doctors of natural medicine sometimes recommend vitamin K supplementation to people taking antibiotics. Additional research is needed to determine whether the amount of vitamin K1 found in some multivitamins is sufficient to prevent antibiotic-induced bleeding. Moreover, most multivitamins do not contain vitamin K.

Interactions with Herbs

Digitalis (Digitalis lanata, Digitalis purpurea)

Digitalis refers to a family of plants commonly called foxglove that contain digitalis glycosides, chemicals with actions and toxicities similar to the prescription drug digoxin.

Erythromycin and clarithromycin (drugs closely related to azithromycin) can increase the serum level of digitalis glycosides, increasing the therapeutic effects as well as the risk of side effects.¹² While this interaction has not been reported with azithromycin, until more is known, azithromycin and digitalis-containing products should be used only under the direct supervision of a doctor trained in their use.

Other Interactions

Food

Azithromycin suspension should be taken on an empty stomach, one hour before or two hours after food.¹³ Azithromycin tablets may be taken with or without food and should be swallowed whole, without cutting, chewing, or crushing.¹⁴

References

1. Foulds G, Hilligoss DM, Henry EB, Gerber N. The effects of an antacid or cimetidine on the serum concentrations of azithromycin. J Clin Pharmacol 1991; 31:164-7.
2. Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents. A neglected modality for the treatment and prevention of selected intestinal and vaginal infections. JAMA 1996;275:870-6 [review].
3. Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents. A neglected modality for the treatment and prevention of selected intestinal and vaginal infections. JAMA 1996;275:870-6 [review].
4. Schellenberg D, Bonington A, Champion CM, et al. Treatment of Clostridium difficile diarrhoea with brewer's yeast. Lancet 1994;343:171-2.
5. Surawicz CM, Elmer GW, Speelman P, et al. Prevention of antibiotic-associated diarrhea by Saccharomyces boulardii: A prospective study. Gastroenterol 1989;96:981-8.
6. Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents. A neglected modality for the treatment and prevention of selected intestinal and vaginal infections. JAMA 1996;275:870-6 [review].
7. Suzuki K, Fukushima T, Meguro K, et al. Intracranial hemorrhage in an infant owing to vitamin K deficiency despite prophylaxis. Childs Nerv Syst 1999;15:292-4.
8. Huilgol VR, Markus SL, Vakil NB. Antibiotic-induced iatrogenic hemobilia. Am J Gastroenterol 1997;92:706-7.
9. Bandrowsky T, Vorono AA, Borris TJ, Marcantoni HW. Amoxicllin-related postextraction bleeding in an anticoagulated patient with tranexamic acid rinses. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;82:610-2.
10. Kaiser CW, McAuliffe JD, Barth RJ, Lynch JA. Hypoprothrombinemia and hemorrhage in a surgical patient treated with cefotetan. Arch Surg 1991;126:524-5.
11. Conly J, Stein K. Reduction of vitamin K2 concentration in human liver associated with the use of broad spectrum antimicrobials. Clin Invest Med 1994;17:531-9.
12. Bizjak ED, Mauro VF. Digoxin-macrolide drug interaction. Ann Pharmacother 1997;31:1077-9.
13. Threlkeld DS, ed. Systemic Anti-Infectives, Macrolides. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Oct 1998, 343-b.
14. Threlkeld DS, ed. Systemic Anti-Infectives, Macrolides. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Oct 1998, 343-b.

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Last Review: 09-01-2007

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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires December 2008.

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