Azithromycin Do's And Don'ts: What Happens If You Combine Zithromax And Alcohol?

For about 30 years, the antibiotic azithromycin, better known in the English-speaking world as Zithromax, has been wonderfully useful in treating staph, strep, and urinary tract infections. Overuse of the drug, especially in Canada, however, has led to rise of antibiotic-resistant strains of bacteria for which the medication is no longer useful. Moreover, in recent years there have been increasing numbers of cases of serious side effects. Here is what everyone needs to know to ask the doctor when being offered azithromycin.

If you have had a heart attack, or if you have stents in the coronary arteries around your heart, does your doctor know?

The most serious potential complication of azithromycin (Zithromax) is something its makers 30 years ago could not have anticipated. In people who have had placement of cardiovascular stents, and in people who have had certain kinds of heart attacks, using the antibiotic increases the risk of irregular heart rhythms, including sudden death. This is also a problem with other antibiotics, including erythromycin and clarithromycin.

Is your doctor sure that you have a bacterial infection?

Neither azithromycin nor any other antibiotic can treat a viral infection, such as colds or flu. They simply won't work. However, taking the antibiotic you don't need can (1) kill the useful, probiotic bacteria in your digestive tract, increasing the risk you actually will need an antibiotic for some other infection and (2) kill the bacteria that keep normally harmless disease-causing bacteria in check. Using an antibiotic you don't need can result in your having two infections, not just one.

Can you afford the medication, or will you have to try to buy azithromycin (Zithromax) online?

In the United States, a Z-Pack, five tablets of Zithromax you take over five days, costs about $75 without insurance. Many people simply can't afford the cost of the medication and try to buy it online, but that involves letting the medication go untreated until the delivery is eventually made, usually from a overseas, having to go through customs. Your doctor may say "It's really affordable," but ask how "affordable" it will be first.

See Also: New Bugs, Old Drugs: How Old Antibiotics Can Help Fight New Infections

Is Zithromax really what I need for this infection?

Many doctors almost automatically prescribe azithromycin because patients like drugs they only have to take for five days, instead of ten. (It's always essential to take the entire course of a prescribed antibiotic even if you start feeling better, so a few especially nasty germs don't get a chance to multiply unchecked and cause an even worse rebound infection.) However, there are some kinds of infections doctors really should treat with a different antibiotic first.

• Earaches in children usually should be treated with another medication, amoxicillin, if the recipient of the medication is not allergic to penicillin. 
• Sinusitis, with persistent "snotty" drainage, facial pain, halitosis, and similar symptoms, is usually treated with amoxicillin if the recipient of the medication is not allergic to penicillin.
• When there is a penicillin allergy, typically causing a break-out in hives, amoxicillin cannot be used. However, even then, doctors should try clindamycin and cefpodoxime before they try Zithromax.

Azithromycin And Alcohol

Even when azithromycin is exactly what is needed for treating an infection, not everyone should have it. One of the most significant drug interactions with azithromycin (Zithromax) antibiotic is alcohol, that is wine, beer, and spirits used as a beverage.

Whether you drink or not, of course, this drug doesn't kill all kinds of bacteria. It is used for treating infections with Gram-positive bacteria, microbes that have a kind of tough protein lining, such as staph, strep, and Klebsiella. However, it continues to kill these bacteria whether or not your drink. The problem is, when you use azithromycin, your liver becomes much more susceptible to damage by alcohol. If you are a heavy drinker, especially if you have alcoholic cirrhosis of the liver, if you have hemochromatosis (iron-overload disease), if you have either acute or chronic viral hepatitis, or if you have a disease called pancreatitis, you simply cannot drink if you use azithromycin (Zithromax or Z-Pack). However, if you can manage not to drink while you are on this drug, alcohol-related peptic ulcers may spontaneously improve.

See Also: Antibiotics & Alcohol: The Truth And Myths

There are other applications of azithromycin that you probably won't find in a casual search of the Internet:

• People who have chronic obstructive pulmonary disease (COPD) or chronic bronchitis are less likely to suffer respiratory infections if they take azithromycin as a preventive measure. (Erythromycin has a similar effect.) Sometimes antibiotic treatment has the unexpected result of improving quality of sleep. However, no one should take the antibiotic for more than 6 to 12 months at a time to avoid developing antibiotic-resistant infections.
• Azithromycin is often the first treatment of choice for cat-scratch fever, a sometimes serious infection caused, as its name suggests, by scratches from cats. A cat scratch can transmit microorganisms that can cause serious damage to the spleen.
• The World Health Organization has arranged for mass distribution of a single dose of azithromycin (instead of the usual five) to eradicate a tropical disease called yaws. This condition begins as a hardening of the skin 2 to 5 cm (about 1 to 2-1/2 inches) in diameter. The skin breaks open and forms an ulcer. The ulcer eventually heals, but later more skin lesions appear with destruction of the joints. Just a single dose of azithromycin offers enough protection to prevent "oozing" of the ulcer stage so that the disease is not passed from child to child.
• Many American doctors prescribe a Z-Pack (five tablets of azithromycin) as a preventive measure for traveler's diarrhea. This usually isn't a good idea, because the medicine then could not be used to treat the more severe cases of "invasive" infections that can be caused by waterborne bacteria. It is better to make sure you wash your hands before you eat, to avoid salads, untreated water, and uncooked food. Anything you take to stop diarrhea before it occurs actually traps disease bacteria in your body and can make you sicker. The best approach to traveler's diarrhea is treatment, not prevention.