Azithromycin

Medical information

Written and reviewed by a team of doctors. Dr Fox is regulated by the CQC & GPhC.

Recommended reading: background information on travellers' diarrhoea and NHS Fit for Travel travellers' diarrhoea information.

Travellers most likely to benefit from antibiotics:

• If going to a remote location with little or no access to good medical assistance.
• If you are at high risk of the diarrhoea leading to severe illness e.g. poorly controlled diabetes, renal impairment, heart failure, reduced CD4 HIV, or other reduced immunity.
• With pre-existing bowel problems where infection may trigger a relapse e.g. ulcerative colitis, Crohn's disease, coeliac disease, and previous bowel surgery.
• With a tendency to severe travellers' diarrhoea (on the basis of previous travel experience)

Note: azithromycin is not licensed to treat travellers' diarrhoea, but it has been prescribed by doctors as a treatment for many years.

Cautions

If you have known allergy to azithromycin, erythromycin, or clarithromycin you should not take azithromycin for travellers' diarrhoea.

There are some medical conditions where you should not take azithromycin:

• a tendency to irregular heartbeat or other heart disease
• myasthenia gravis
• liver disease
• kidney disease

It is not recommended to take azithromycin when trying to conceive, or during pregnancy and breastfeeding, without first discussing with your own GP.

Dosage

Treatment with azithromycin is 500mg once a day for 3 days. Start the course as soon as you get diarrhoea, not before. It is not a preventative. The symptoms of travellers' diarrhoea should improve within 24 hours of starting antibiotic.

Side effects

If there are any side effects the most common are stomach upset, nausea, and diarrhoea. For details see the patient information leaflet supplied with the tablets.

Seeking help

Symptoms should start to improve within 24 hours of starting azithromycin. Medical advice should be sought if symptoms are not improving after 2 or 3 days, or are worsening, or if any of the following occur:

• Profuse diarrhoea and vomiting lead to dehydration.
• Blood and green or yellow slime in the motions with severe abdominal pains.
• Diarrhoea associated with rashes.
• High fever and headache with diarrhoea (particularly in malaria areas).

Treating diarrhoea

• Try to get plenty of rest.
• Drink plenty of fluids, even if vomiting (at least 3-4 litres/day).
• Continue to eat simple foods such as rice and dried bread, appetite permitting.
• Pay attention to personal hygiene, to prevent spread.

Azithromycin is effective in reducing the symptoms of travellers' diarrhoea, particularly if taken with Loperamide.

Azithromycin 500mg Patient Leaflet

Antibiotic guardianship

To combat antibiotic resistance please:

• Only use antibiotics when needed
• Never share antibiotics
• Always complete course as instructed
• Take unused medicine to local pharmacy for disposal

Authored 22 March 2010 by Dr Tony Steele
Last updated 15 January 2021

Reviewed by Dr A. Wood, Dr B. Babor, Dr P. Hunt
Last reviewed 15 January 2021