Azithromycin Side Effects and Considerations

Common and Serious Side Effects

Azithromycin commonly causes gastrointestinal side effects, including diarrhea, nausea, abdominal pain, and vomiting, which are typically mild to moderate and rarely require discontinuation of treatment, according to the American Academy of Dermatology 1
The American Academy of Dermatology reports that azithromycin can cause QT prolongation and risk of torsades de pointes, arrhythmias, and hepatic dysfunction, although these are rare 1
The European Respiratory Journal notes that azithromycin may cause QT prolongation and risk of torsades de pointes 2
Azithromycin can cause severe skin reactions, including erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis, although these are rare, as reported by the American Academy of Dermatology 1
Hearing loss, deafness, and tinnitus are rare side effects of azithromycin, according to the American Academy of Dermatology and Thorax 1, 3
Anaphylaxis is a rare side effect of azithromycin, as reported by the American Academy of Dermatology 1

Long-term use of azithromycin may increase antimicrobial resistance to macrolides, with resistance rates reaching 48.7% with prolonged use, according to Thorax 3, 4
The Centers for Disease Control and Prevention recommends avoiding concomitant use of azithromycin with aluminum or magnesium-containing antacids, as they reduce azithromycin absorption, and monitoring patients when used with drugs metabolized by cytochrome P450 enzyme system 5
Azithromycin is contraindicated in patients with hypersensitivity to azithromycin, erythromycin, any macrolide, or ketolide, and in those with a history of cholestatic jaundice/hepatic dysfunction associated with previous azithromycin use, as reported by the American Academy of Dermatology 1

The European Respiratory Journal recommends obtaining an ECG before initiating azithromycin therapy in patients with cardiac risk factors, avoiding use in patients with known prolonged QT interval, and screening for concurrent QT-prolonging medications 6
The Centers for Disease Control and Prevention suggests monitoring liver function in patients with pre-existing liver disease and considering dose reduction if gastrointestinal side effects are problematic 5, 6

Azithromycin is classified as FDA Pregnancy Category B, and is distributed into breast milk, so use with caution in nursing women, according to the American Academy of Dermatology 1