Long term azithromycin for adults with respiratory conditions

Azithromycin prophylaxis

Azithromycin is an antibiotic. It can be used for a few days to treat certain infections.

Azithromycin can also be used for a long period (months) to help protect people with some types of lung disease. This leaflet is about long term use of azithromycin for people with lung disease. This is called azithromycin prophylaxis.

Why have I been prescribed long-term azithromycin (azithromycin prophylaxis)?

You have been prescribed long term azithromycin to prevent chest infections and to improve your chest symptoms.

Azithromycin does not work for everyone with lung disease but it may help you in two ways:

it is an antibiotic and can kill some of the bugs (bacteria) that could cause chest infections
it can reduce inflammation in the airways so it can help to relieve cough, sputum production, and breathlessness

Azithromycin used in this way, is “off-label” and is different to what described in the patient information leaflet that comes with the medication. Using it like this is endorsed by the British Thoracic Society. It is important to take the medication as your Respiratory Consultant has advised.

What do I need to know before I take azithromycin?

Do not take this medication if you are allergic to azithromycin, any of its ingredients, or any other macraolide antibiotic such as erythromycin or clarithromycin.

To make sure azithromycin is the best choice for you your consultant/respiratory nurse specialist will:

ask you to provide phlegm samples, to check for non tuberculosis mycobacterium. If this bacteria is present, azithromycin cannot be used
check your heart’s rhythm using an electrocardiogram (ECG); this is also known as a heart tracing
take some blood tests and check your liver function before and one month after starting azithromycin

Azithromycin will not work if you are a current smoker. You should have stopped smoking completely before we prescribe it. Azithromycin can also make you more prone to sunburn and we recommend using sun block on hot sunny days or when on holiday. Speak to your doctor or pharmacist to see how we can support you to stop smoking.

How long will I be on this medicine?

Usually for 6 to 12 months. This gives enough time for you and your doctor to see if it works for you. If you get less chest infections or have less cough, sputum production, and breathlessness then it may be useful to stay on it for longer.

What are the common and important side effects?

Most people have no troublesome side effects.

Some people have tummy upset, feeling sick (nausea), getting sick (vomiting).
Some people get light headedness, dizziness, or fast heart rate (palpitations) and may need to get their ECG (heart tracing) checked.
A small number of people get jaundice (yellow colour of the skin or whites of your eyes) or itching because of liver upset.
A very small number of people get hearing problems (ringing in the ears or poor hearing). If you notice a change in your hearing, it is important you stop the medication and seek medical advice
A very small number of people get poor balance (unsteady on their feet).
Some people get diarrhoea caused by overgrowth of a bacteria known as C diff (Clostridioides difficile).

If you think azithromycin is causing you troublesome side effects at any time you should talk to your doctor. You may need to stop taking it.

What dose do I take?

The usual dose of azithromycin is 250mg tablets (one capsule) three times per week; normally taken on a Monday, Wednesday, and Friday. In certain situations, your doctor may prescribe you a higher dose of 500mg. Occasionally, it may be prescribed for you to take every day.

Take your dose 1 hour before food or at least 2 hours after food. Swallow whole with a glass of water.

What if I forget to take my dose?

This should not cause any problems. Take your next dose at the normal time.

Will azithromycin interfere with any other medicines that I am taking?

Azithromycin can interfere with many other medicines and herbal remedies.
Tell your doctor or pharmacist if you are taking any other medicines or herbal remedies before you start taking azithromycin.
Tell your doctor or pharmacist before you star t on any new medicines or herbal remedies while on azithromycin.
If you are prescribed another antibiotic, check with your doctor whether you should continue to take azithromycin.

What should I do if I have a flare-up of my lung condition?

Although azithromycin is an antibiotic, you may still need to take other antibiotics for any chest infections or flare-ups of your lung condition. You may need to stop your azithromycin when starting a course of antibiotics and your team will advise you.

Can I drink alcohol when taking azithromycin?

Yes, within the government guidance of no more than 14 units of alcohol per week. Azithromycin does not interact with alcohol.

More information

If you have any other questions, please speak to the doctor or nurse who prescribed you the azithromycin.