Introduction
Azithromycin is a semisynthetic macrolide antibiotic. It is frequently used to treat mild-to-moderate bacterial infections caused by pathogens. Azithromycin is bacteriostatic against gram-positive bacteria, including streptococci and staphylococci, just like other antibiotics like Erythromycin. However, Azithromycin is more effective than Erythromycin against several gram-negative bacteria, including Mycoplasma pneumonia. Macrolide antibiotics attach to the 50S ribosomal subunit and prevent bacteria from synthesizing proteins. However, multiple processes contribute to resistance.
Since its approval for usage in the United States in 1994, Azithromycin has become the most frequently prescribed antibiotic. Common conditions that require Azithromycin include:
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Community-acquired pneumonia.
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Severe flare-ups of chronic bronchitis.
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Other infections from susceptible bacteria.
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Disseminated infections with the Mycobacterium complex are similarly managed with Azithromycin.
Azithromycin is sold as 250 mg and 500 mg pills under the brand name Zithromax. Liquids and powders for suspension forms are also available. Usually, Azithromycin is used once a day for 5 to 7 days. Azithromycin is used chronically to treat atypical mycobacterial (a type of germ) infections and prevent common bacterial infections in people susceptible to them. When treating moderate-to-severe disorders, parenteral (given through any other route than oral), Azithromycin is commonly administered in 500 mg IV (intravenous) daily for the first few days of treatment. Generally, Azithromycin is well tolerated. However, it can cause a rash, headache, nausea, diarrhea, dyspepsia (indigestion), abdominal pain, and headache. Severe hypersensitivity reactions include Stevens-Johnson syndrome (a disorder of the skin and mucous membrane) and toxic epidermal necrolysis (blistering and peeling of the skin).
What Are the Adverse Health Effects of Azithromycin?
Azithromycin has been related, like other macrolide antibiotics, to a low rate of acute, temporary, and asymptomatic rise in serum aminotransferases, which happens in 1 % to 2 % of people treated for short periods and a slightly more significant proportion of patients administered Azithromycin long term.
A rare side effect of Azithromycin is clinically apparent liver damage. Because Azithromycin is now so widely used, it has also emerged as one of the most frequent contributors to drug-induced liver damage. The typical liver damage caused by Azithromycin is self-limited, cholestatic hepatitis (when the bile from the liver is blocked) that develops within 1 to 3 weeks of beginning treatment. It is similar to the liver damage described with other macrolides.
It occasionally appears after stopping Azithromycin and may do so even after a brief period of 2 or 3 days. Fatigue, jaundice, and abdominal pain are common symptoms. Immune allergic symptoms are often not apparent. However, fever and eosinophilia (increased eosinophil count in the blood) may also be present. Although this type of Azithromycin-induced liver damage is primarily benign, it can occasionally be accompanied by prolonged jaundice and the persistence of abnormal liver test results for at least six months. In these situations, the liver's histology typically shows bile duct loss, which, if severe, can lead to vanishing bile duct syndrome and chronic liver failure, ultimately calling for liver transplantation. Other cases of bile duct loss and protracted cholestatic hepatitis eventually resolve. However, persistent increases in serum alkaline phosphatase may accompany them.
Azithromycin can potentially result in symptoms and jaundice from hepatic damage. The lag in these situations is often brief, maybe around only 1 to 3 days. Alkaline phosphatase results are typically less than twice the upper limit of normal. However, they may increase to more significant levels with time. In addition, serum aminotransferase levels are noticeably raised. Azithromycin can cause severe hepatocellular liver damage that can result in abrupt liver failure, death, or require a last-minute liver transplant. However, recovery usually happens within 4 to 8 weeks.
Azithromycin has been demonstrated to have some antiviral action in cell culture and to suppress the SARS-CoV-2 coronavirus, which is the culprit for the devastating COVID-19 pandemic that broke out in 2019 and resulted in more than 3 million fatalities worldwide. Since Azithromycin has antiviral and anti-inflammatory properties, it has been repurposed as a potential COVID-19 treatment. Despite initial positive reports, later randomized controlled trials revealed little effect in either infection prevention or slowing the progression of COVID-19 sickness. Early in 2020, Azithromycin received an emergency use authorization; however, that authorization was later revoked for COVID-19 treatment.
What Is the Histopathology of Liver Injury?
The idiosyncratic liver damage brought on by Azithromycin has an unclear underlying etiology, but its sudden onset raises the possibility of hypersensitivity.
What Is the Management of Azithromycin Toxicity?
Whether or not Azithromycin is stopped, the level of serum aminotransferase increases. The symptoms that develop during Azithromycin medication are often benign, asymptomatic, and disappear quickly. However, acute hepatic damage with jaundice can last long and be problematic, leading to the disappearance of intrahepatic bile ducts and vanishing bile duct syndrome. Jaundice may appear after Azithromycin is ceased, but its occurrence in someone using Azithromycin should urge rapid removal of the medication. Azithromycin-induced liver damage has occasionally resulted in abrupt liver failure and fatalities. People with chronic liver illness may be more vulnerable to adverse effects. Although it has not been well studied, additional macrolide antibiotics will likely cause liver damage.
Can Azithromycin Interact With Other Medications?
The oral tablet form of Azithromycin may interfere with vitamins, herbs, or other prescriptions the patient may be taking. When a substance modifies how a drug functions, there is an interaction. This could be hazardous to health or prevent the medication from working correctly. The doctor should carefully monitor all of the medicines to help prevent interactions. The patient should tell the doctor about all the drugs, vitamins, and herbal supplements.
Interactions That Increase the Chances of Side Effects:
The risk of adverse effects from some medications increases when Azithromycin is taken alongside them. This is because Azithromycin may interact with several medicines, for instance:
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Nelfinavir: Combining this antiviral medication with Azithromycin may result in issues with the liver or hearing. The doctor should carefully monitor these adverse effects.
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Warfarin: When used with Azithromycin, this blood-thinning medication may raise the risk of bleeding. If these medications are taken concurrently, the doctor should constantly monitor them.
Conclusion
Azithromycin successfully treats community-acquired pneumonia in patients who are candidates for oral antibiotic therapy. A 5-day course of Azithromycin is as practical as a 7- to 10-day period of several daily doses of other oral antibacterial medications. Unfortunately, Azithromycin also has some adverse health effects, including drug toxicity, liver damage, and drug interaction.
