Information for patients
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Why have I been prescribed Azithromycin treatment?
You have been prescribed Azithromycin to try to improve control of your chest symptoms, and hopefully to reduce the number of chest infections you have been getting.
It does this in two different ways:
It appears to have an anti-inflammatory effect in the airways. Airway inflammation is a part of many lung conditions and can increase the chance of lung infections and worsen symptoms such as cough, phlegm and breathlessness.
Azithromycin is an antibiotic and is capable of killing a number of bacteria (bugs) that cause chest infections, however it is important to know that the dose being used here is much lower than the dose used to treat infections. If you develop an infection, you may need to have more or different antibiotics.
What will happen before I start taking Azithromycin treatment?
Your doctor will need to check a few things before you start treatment to make sure it is safe.
Medical history and medication
Your doctor will check your medical history to make sure there are no health conditions that would mean this treatment would be unsuitable for you.
These would include; hearing problems, liver problems and some heart conditions.
They will also check what tablets you are taking regularly to make sure that Azithromycin will not interfere with these.
Sputum or “phlegm” samples
You will be asked to provide samples of your sputum. These will be used to check that there is no evidence that certain bacteria are living in your lungs.
An Electrocardiogram (ECG) or “heart tracing”
Very occasionally Azithromycin can upset the conduction of electricity through your heart muscle.
It is important to make sure that the electrical conduction is normal in your heart before starting treatment.
This treatment should be avoided in patients who have severe liver or kidney problems.
These blood tests will be checked before treatment to make sure it is safe to start.
What dose will I take of Azithromycin treatment?
The usual dose you will be asked to take is one tablet or capsule (250mg strength) 3 times a week on Mondays, Wednesdays and Fridays.
Occasionally, the does may be increased to 500mg, 3 times a week, depending on whether your doctor feels you may benefit from a higher dose.
How long will I be taking this treatment?
You will usually be asked to take the treatment for a minimum of 6 months.
This is normally long enough to get an idea of whether the treatment is cutting down your tendency to chest infections.
If the treatment helps, you can stay on this, often for many years.
Your team will give you the choice to stop the treatment every 6 to 12 months. the decision about stopping will be taken by you and your team.
What side effects could I have from Azithromycin treatment?
Although some of the side effects, which you are told about sound frightening it is important to remember that most people are able to continue with this treatment without side effects.
The main side effects can include:
A small number of patients will have tummy upset, diarrhoea and constipation. These side effects will not cause any permanent problems and will improve if you stop the medicine.
Sunburn or rash
Azithromycin can make you more prone to sunburn. We recommend using sun block on hot sunny days or when on holiday.
If you or your relatives notice any change in your hearing you should stop the treatment immediately and report this to your doctor.
One of the first symptoms can be tinnitus (ringing in your ears).
The change in hearing is almost always reversible but a very small number of patients’ may have permanent hearing loss.
Very occasionally this treatment can upset the liver. You may not get any symptoms or be aware of this.
This normally settles on stopping the treatment, however in an extremely small number of patients this may cause liver failure.
Azithromycin can very rarely slow or delay the conduction of electricity through your heart muscle. This can lead to abnormal heart rhythms and in extremely rare cases, death.
What checks or monitoring will I need while I am taking the treatment?
The treatment is safe and most people have no side effects. Some rare side effects, however, may not have any obvious symptoms so you will be asked to have the following:
You will be asked to have a heart tracing approximately one month after starting the treatment to make sure that the treatment is not interfering or upsetting the electrical conduction through your heart.
This can be done either at hospital or in most GP surgeries.
We will arrange for you to have a liver blood test 1 month and 3 months after starting the treatment. If you stay on the treatment after 6 months, we will arrange for a liver blood test every 6 months.
We do not normally arrange formal hearing tests when you are on the treatment, but we do ask you and your family to be aware of any changes in your hearing.
If you notice this, we ask you to stop the treatment and see your doctor as soon as possible.
How will you know if the treatment is working?
The team will check the number of chest infections you have had while taking Azithromycin and compare it to when you were not taking this.
If there has been less chest infections when taking the treatment, this normally means it it working.
They will also ask you whether your day-to-day chest symptoms feel any better while you have been taking the treatment.
What if I forget to take my Azithromycin treatment?
Do not worry, there is no cause for concern and you should just take your next dose as planned.
How long will I be on Azithromycin treatment?
Everyone is different but it is usually 4 – 6 months before we can tell if it is working.
If it improves your symptoms or it reduces the number of chest infections you have, we usually like to keep it going over the longer term. We have had some patients take this treatment for several years.
Can Azithromycin treatment react with any of my other medicines?
Azithromycin can react with certain medicines. If you are taking any of these drugs, you can still be prescribed Azithromycin but you may require additional blood tests and the doses of these drugs may need to be adjusted.
- the Ophylline tablets; these are used to treat other airway conditions. Azithromycin can increase the blood levels of these drugs and cause side effects. The trade names of this drug are; Uniphyllin, Slo-Phyllin, Nuelin SA and Phyllocontin.
- Warfarin and the heart drug Digoxin.
There are a number of other different types of medication that Azithromycin can interact with and cause side effects.
The combination can slow the electrical conduction through heart.
This is not a full list, and your team will check if they are starting any other new medication.
Moxifloxacin, Fluconazole, Ketoconazole.
Dronedarone, Sotalol, Quinidine, Amiodarone, Flecainide.
Risperidone, Fluphenazine, Haloperidol, Pimozide, Chlorpromazine, Quetiapine, Clonazepam.
Citalopram/Escitalopram, Amitriptyline, Clomipramine, Dosulepin, Dexopin, Imipramine, Lofepramine.
Domperidone, Droperidol, Ondansetron, Granesitron.
Methadone, anti-malarials and anti-retrovirals.
Can I still take Azithromycin if I need an operation?
You do not have to stop taking your tablets before an operation. If in doubt, check with your chest consultant and the consultant who is doing the operation.
Unless there are concerns, we are usually keen to continue treatment.
Can this treatment affect my fertility or pregnancy?
Azithromycin has no known effects on fertility. At present, it is not known if there are any potential problems if taken during pregnancy.
The manufacturers suggest that it only be used if there are no other alternatives. As a precaution, we highly recommend effective contraception for women taking Azithromycin.
Can I take Azithromycin if I am breast-feeding?
Azithromycin is generally thought to be ok to take during pregnancy. However this will need a careful conversation with your doctor to ensure the benefits outweigh the risks.
Azithromycin passes into the breast milk in small amounts. It has not been known to cause any side effects in breastfed babies.
Talk to your Health Visitor, Midwife, Pharmacist, or Doctor as soon as possible if:
- Your baby is not feeding as well as usual or has an upset stomatch.
- Your baby has a rash or oral thrush (a fungal infection in their mouth).
- You have any other concerns about your baby.
Can I drink alcohol when taking Azithromycin treatment?
Yes, there is no known evidence of problems.
What if I suffer a chest (or any other) infection while taking this treatment?
You may still suffer from infections or flare ups of your chest condition while taking this treatment. We would still like you to get antibiotic therapy (if your doctor wishes you to have it) in the usual way.
We may ask you to stop Azithromycin treatment while you are taking other antibiotics and then restart them after you have finished.
Who should I contact if I have any concerns?
If you have any concerns please either contact your Respiratory Consultant, GP or the lung health team from Monday to Friday 9am to 5pm. If you have concerns outside of this time please either contact 111 or the Emergency Department at North Tees Hospital.
University Hospital of North Tees
- Dr E Poyner, Dr G Miller – 01642 624296
- Dr N Leitch, Dr V Jeebun, Dr M El Bashir – 01642 624936
- Dr R Miller, Dr C Monaghan, Dr K Conroy, Dr G Wallace – 01642 624615
- Dr C Elmer, Dr V Chew – 01642 383038
- Dr J Dunleavy, Dr B Prudon – 01642 24292
- Lung Health – 01642 642936
- Department of Respiratory Medicine – 01642 624936
- Emergency Department – 01642 382899 – 24 Hours a day, 7 days a week.
- British Thoracic Society guideline for the use of long-term macrolides in adults with respiratory disease. Thorax 2020; 75:370-404.
- British National Formulary.
- Pregnancy, breastfeeding and fertility while taking azithromycin – NHS (www.nhs.uk).
Comments, concerns, compliments or complaints
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Telephone: 01642 624719
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Telephone: 01642 383551
Email: [email protected]Privacy Notices
This leaflet has been produced in partnership with patients and carers. All patient leaflets are regularly reviewed, and any suggestions you have as to how it may be improved are extremely valuable. Please write to the Clinical Governance team, North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, TS19 8PE or:
Email: [email protected]
Leaflet reference: PIL1021
Date for Review: October 2026