Risk-benefit associated with Azithromycin: A brief review

Review Article

  • Anil Kumar Pradhan Roland Institute of Pharmaceutical Sciences Brahmapur, Odisha India- 760004
  • Ajit Nahak Royal College of Pharmacy and Health Sciences, Brahmapur, Odisha India- 760002
  • Gyanendra Narayan Mohapatra Roland Institute of Pharmaceutical Sciences Brahmapur, Odisha India- 760004
Keywords: Macrolide antibiotics, Ductopenia, Leukopenia, Conjunctivitis, Non-occupational allergic contact dermatitis, Ototoxicity


Azithromycin is the most popular prescribed antimicrobial agent around the world. It comes under the class of macrolide antibiotics. Because of its higher efficacy, tolerance, and broad-spectrum activity, it is primarily used in upper and lower respiratory tract infections, some sexually transmitted infections, and major bacterial infections. Generally, this is commercially available in solids, liquids, and ophthalmic formulations due to its minimal adverse events. It is also using in the case of COVID-19 drug therapy due to its pharmacological and therapeutic properties but a review of literature presented that it may increase the risk of cardiac death, hepatic injury, ototoxicity, hypersensitivity reactions.

Author Biographies

Anil Kumar Pradhan, Roland Institute of Pharmaceutical Sciences Brahmapur, Odisha India- 760004

Department of Pharmacology

Ajit Nahak, Royal College of Pharmacy and Health Sciences, Brahmapur, Odisha India- 760002

Department of Pharmacology

Gyanendra Narayan Mohapatra, Roland Institute of Pharmaceutical Sciences Brahmapur, Odisha India- 760004

Department of Pharmacology


Bartle W. Possible warfarin-erythromycin interaction.  Archives Of Internal Medicine,1980; 140(7): 985b-987.
Brown K, Khanafer N, Daneman N, and Fisman D Meta-Analysis of Antibiotics and the Risk of Community-Associated Clostridium difficile Infection. Antimicrobial Agents And Chemotherapy, 2013; 57(5): 2326-2332.
Chandrupatla S, Demetris A, and Rabinovitz M. Azithromycin-induced intrahepatic cholestasis. Digestive Disease And Science, 2002; 47(10): 2186-2188.
Chave J, Munafo A, Chatton J, Dayer P, Glauser M, and Biollaz J. Once- a-week azithromycin in AIDS patients: tolerability, kinetics, and effects on zidovudine disposition. Antimicrobial Agents And Chemotherapy,  1992; 36(5): 1013-1018.
Debruyne D, Jehan A, Bigot M, Lechevalier B, Prevost J, and Moulin M. Spiramycin has no effect on serum theophylline in asthmatic patients. European Journal Of Clinical Pharmacology, 1986; 30(4): 505-507.
Deshpande A, Pasupuleti V, Thota P, Pant C, Rolston D, and Sferra T et al., Community-associated Clostridium difficile infection and antibiotics: a meta-analysis. Journal Of Antimicrobial Chemotherapy,  2013; 68(9): 1951-1961.
Flavia Monteagudo Paz A, Francisco Silvestre Salvador J, Latorre Martinez N, Cuesta Montero L, & Toledo Alberola F. Allergic contact dermatitis caused by azithromycin in an eye drop. Contact Dermatitis, 2011; 64(5): 300-301.
Foulds G, Hilligoss DM, Henry EB, and Gerber N. The effects of an antacid or cimetidine on the serum concentrations of azithromycin. Journal of Clinical Pharmacology, 1991; 31: 164-7.
Guo D, Cai Y, Chai D, Liang B, Bai N, and Wang R. The cardiotoxicity of macrolides: a systematic review. Pharmazie, 2010; 65(9): 631- 640.
Hancox J, Hasnain M, Vieweg W, Crouse E, and Baranchuk A. Azithromycin, cardiovascular risks, QTc interval prolongation,torsade de pointes, and regulatory issues: A narrative review based on the study of case reports. Therapeutic Advances In Infectious Disease, 2013; 1(5): 155-165.
Higa F, and Saito A. Clinical safety of azithromycin.  Japanese Journal Of Antibiotics, 2000; 53: 125-35.
Hopkins S, and S J. Clinical toleration and safety of azithromycin in adults and children. Reviews In Contemporary Pharmacotherapy, 1994; 5: 383-9.
Huang B, Wu C, Hsia C, and Chen YC. Azithromycin-Induced Torsade De Pointes. Pacing And Clinical Electrophysiology, 2007; 30(12): 1579-1582.
Jensen C, Flechner S, Buren VC, Frazier O, Cooley D, Lorber M, and Kahan B. Exacerbation Of Cyclosporine Toxicity By Concomitant Administration Of Erythromycin. Transplantation, 1987; 43(2): 263- 270.
Kim M, Berkowitz C, and Trohman R. Polymorphic ventricular tachycardia with a normal QT interval following azithromycin. Pacing Clin Electrophysiol, 2005; 28(11): 1221-2.
Kronbach T, Fischer V, and Meyer U. Cyclosporine metabolism in human liver: Identification of a cytochrome P-450III gene family as the major cyclosporine-metabolizing enzyme explains interactions of cyclosporine with other drugs. Clinical Pharmacology And Therapeutics, 1988; 43(6): 630-635.
Lighter J and Raabe V. Azithromycin Should Not Be Used to Treat COVID-19. Open Forum Infectious Diseases, 2020; 7(6): 207.
Ludden T. Pharmacokinetic Interactions of the Macrolide Antibiotics. Clinical Pharmacokinetics, 1985; 10(1): 63-79.
Maggioli C, Santi L, Zaccherini G, Bevilacqua V, Giunchi F, and Caraceni P. A Case of Prolonged Cholestatic Hepatitis Induced by Azithromycin in a Young Woman. Case Reports In Hepatology, 2011; 2011: 1-4.
Martinez M, Vuppalanchi R, Fontana R, Stolz A, Kleiner D, and Hayashi P et al. Clinical and Histologic Features of Azithromycin-Induced Liver Injury. Clinical Gastroenterology And Hepatology, 2015; 13(2): 369-376.e3.
McMullan B, and Mostaghim M. Prescribing azithromycin. Australian Prescriber, 2015; 38(3): 87-89.
Milkovic-Kraus S, and Kanceljak-Macan B. Occupational airborne allergic contact dermatitis from azithromycin. Contact Dermatitis, 2001; 45(3): 184-184.
Milkovic-Kraus S, Macan J, and Kanceljak-Macan B. Occupational allergic contact dermatitis from azithromycin in pharmaceutical workers: a case series. Contact Dermatitis, 2007; 56(2): 99-102.
Mintz U, Amir J, Pinkhas J, and Vries A. Transient Perceptive Deafness due to Erythromycin Lactobionate.  JAMA: The Journal Of The American Medical Association, 1973; 225(9): 1122-3.
Nahata M. Drug interactions with azithromycin and the macrolides: an overview. Journal Of Antimicrobial Chemotherapy, 1996; 37(suppl C): 133-142.
Orme M, Back D, and Tjia J. The lack of interactions between azithromycin and oral contraceptive steroids. Br J Clinpharmacol, 1991; 3J: 229.
Parra-Lara L, Martinez-Arboleda J, and Rosso F. Azithromycin and SARS-CoV-2 infection: Where we are now and where we are going. Journal Of Global Antimicrobial Resistance, 2020; 22: 680- 684.
Poluzzi E, Raschi E, Moretti U, and De Ponti F. Drug-induced torsades de pointes: data mining of the public version of the FDA Adverse Event Reporting System (AERS). Pharmacoepidemiology And Drug Safety, 2009; 18(6): 512-518.
Rapeport WG, Dewland PM, Muirhead DC, and Forster PL. Lack of interaction between azithromycin and carbamazepine. In Proceedings of the British Pharmacological Society, 1991; London 1991.
Ray W, Murray K, Hall K, Arbogast P, Stein C. Azithromycin, and the Risk of Cardiovascular Death. New England Journal Of Medicine, 2012; 366(20): 1881-1890.
Russo V, Puzio G, and Siniscalchi N. Azithromycin-induced QT prolongation in elderly patient. Acta Biomed, 2006; 77(1): 30-32.
Sato R, Gray D, and Brown S. Warfarin interaction with erythromycin. Archives Of Internal Medicine, 1984;  144(12): 2413- 2414.
Sultana J, Cutroneo P, Crisafulli S, Puglisi G, Caramori G, and Trifiro G. Azithromycin in COVID-19 Patients: Pharmacological Mechanism, Clinical Evidence and Prescribing Guidelines. Drug Safety, 2020; 43(8): 691-698.
Svanstrom H, Pasternak B, and Hviid A. Use of Azithromycin and Death from Cardiovascular Causes. New England Journal Of Medicine, 2013; 368(18): 1704-1712.
Treadway G, and Pontani D. Paediatric safety of azithromycin: worldwide experience. Journal Of Antimicrobial Chemotherapy, 1996; 37(suppl C): 143-149.
Tseng A, Dolovich L, and Salit I. Azithromycin-Related Ototoxicity in Patients Infected with Human Immunodeficiency Virus. Clinical Infectious Diseases, 1997; 24(1): 76-77.
Vernillet L, Bertault-Peres P, Berland Y, Barradas J, Durand A, Olmer M Lack of effect of spiramycin on cyclosporin pharmacokinetics. British Journal Of Clinical Pharmacology, 1989; 27(6), 789-794.
Wallace M, Miller L, Nguyen M, and Shields A. Ototoxicity with azithromycin. The Lancet, 1994; 343(8891): 241.
Wrapp D, Wang N, Corbett K, Goldsmith J, Hsieh C, and Abiona O et al. Cryo-EM structure of the 2019-nCoV spike in the prefusion conformation. Science, 2020; 367(6483): 1260-1263.
How to Cite
Anil Kumar Pradhan, Ajit Nahak, Gyanendra Narayan Mohapatra. Risk-benefit associated with Azithromycin: A brief review. jpadr [Internet]. 2020Dec.1 [cited 2021Oct.16];1(2):1-. Available from: https://jpadr.com/index.php/jpadr/article/view/12