Azithromycin Use in Myasthenia Gravis

Introduction to Azithromycin Risks

• The British Thoracic Society lists myasthenia gravis under "cautions" rather than absolute contraindications for azithromycin, acknowledging the risk while not prohibiting use 1

Comparative Safety of Antibiotics

• Aminoglycosides like amikacin are listed as absolute contraindications in MG due to impaired neuromuscular transmission 2

Special Considerations for Azithromycin

• Never use azithromycin as monotherapy for non-tuberculous mycobacterial infections in any patient, as this creates macrolide resistance 3
• QTc prolongation is an additional concern with azithromycin in MG patients who may already have cardiac comorbidities—contraindicate if baseline QTc >450 ms (men) or >470 ms (women) 1