Azithromycin is an antibiotic used for a wide array of bacterial infections. It is a macrolide-type antibiotic that works by binding to the ribosomes of the bacteria. This drug limits the bacteria’s ability to create new proteins, slows their growth and eventually kills them. Its most common brand names are Zithromax, Zithromax Tri-Pak, Zithromax Z-Pak, and Zmax. It can be administered orally, typically through capsules, tablets, or liquid medicine. Read on to know more about using azithromycin for UTI.
As viruses have different cell structures and growth methods, azithromycin and other antibiotics do not work for viral infections (e.g., the common cold and flu). If you do not have a bacterial infection or have not consulted with your doctor, do not take antibiotics needlessly. With more exposure, bacteria can learn and adapt to antibiotics, rendering future uses less effective.
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Azithromycin for UTIs
Azithromycin treats several infections, including pneumonia, bronchitis, and sexually transmitted diseases (STDs). It also treats infections of the lungs, sinuses, ears, throat, skin, and reproductive organs. Azithromycin can limit the virulence factors and hinder the biofilm formation of some bacteria.
However, azithromycin is not the recommended medication for urinary tract infections because it reaches low urine concentration.
A urinary tract infection(UTI) is undoubtedly one of the most common types of bacterial infection. A UTI occurs when bacteria get access to the urinary tract. The infection can occur anywhere along the tract — such as the urethra, the bladder, the ureters, or the kidneys.
Women are generally more at risk of UTIs than men, as their urethra is shorter and closer to the anus, which allows easier entry of bacteria into the urinary tract. Most UTIs (roughly 70 to 90%) are caused by the bacteria Escherichia coli (E. coli).
In addition, most UTIs can be found in the lower urinary tract (which includes the urethra and the bladder). These UTIs (known as cystitis) involve the kidneys and are called pyelonephritis. Furthermore, UTIs can sometimes share similar common symptoms to yeast infections.
Typical symptoms of UTIs can include:
- Burning sensation or pain while urinating
- Pressing urge to urinate despite having an empty bladder
- More frequent urination
- Cramping or pressure in the lower abdomen or groin
- Bloody urine
Symptoms of a more acute kidney infection can include:
- High fever
- Pain around the lower back, side, and abdomen
- Vomiting or nausea
Recommended Azithromycin Dosage
The recommended dosage for azithromycin will depend entirely on your doctor’s prescription. It is in your best interests to follow the directions of your prescription to the letter. Please do not take it in smaller or larger amounts than recommended, do not skip doses, and do not prolong your treatment beyond the suggested schedule or cut it short.
Many find that their symptoms improve a few days before the antibiotic schedule has run its course and elect to stop, but this only increases the risk of further infection. If you skip doses, this antibiotic will not fully clear your UTI condition, and other diseases could potentially become antibiotic-resistant. Please do not take your prescription for granted because it was your recommended schedule was made by a medical expert.
As the infections that azithromycin treats can vary greatly, your dosage and length of treatment can differ from others. Always look to your prescription information or consult your doctor if you have questions about your dosage.
Azithromycin can be used orally with or without food. However, if you take it in liquid form, it is best to take it on an unfilled stomach, either an hour before eating or two hours after.
Tablets or Pills
If you take the single-dose packet (1 gram of azithromycin), dissolve it in two ounces of water and drink the whole glass immediately after stirring. To ensure you drink the entire dose, add more water (two ounces) to the same glass and drink it. Do not leave anything for later consumption.
If taking the oral suspension, ensure you shake it well before measuring a dose. Use a medicine cup, a dosing syringe, or a dose-measuring spoon — other measurement forms (e.g., a regular tablespoon) will not be accurate. If your antibiotics did not come with a dose-measuring device and if you do not have any at home, be sure to request one from your pharmacist.
Any mixed “extended-release formulation” azithromycin should be thrown away in 12 hours if unused. Any “immediate-release suspension” azithromycin should be thrown away in 10 days if unused. Always store your antibiotics at room temperature, ideally in a cool, dry place.
Side Effects of Azithromycin
Some of the common side effects of azithromycin include:
- stomach pain
Call your doctor and seek medical treatment immediately if you experience more severe side effects. For example, suppose you have experienced a side effect of azithromycin. You can report to the Food and Drug Administration (FDA) at 1-800-FDA-1088.
Here are side effects to look out for:
Allergic reactions: Difficulty breathing, swelling in face/throat, hives
Severe skin reaction: Purple or red skin rashes with blistering and peeling, skin pain, burning sensation in eyes, sore throat, fever
Severe drug reaction: Flu-like symptoms, swollen glands, fever, skin rash, severe weakness, muscle aches, unusual bruising, yellowing of the eyes or skin
Liver problems: Upper stomach pain, dark urine, nausea, fatigue, itchiness, loss of appetite, clay-colored stools, yellowing of the eyes or skin
Abdominal problems: Watery or bloody diarrhea and severe stomach pain
Cardiac problems: Fluttering in your chest, fast/pounding heartbeats, shortness of breath, sudden dizziness
Babies: Irritability, vomiting while nursing
Precautions Before Using Azithromycin
Before taking azithromycin:
Keep a log of all your current medications (including herbal products, vitamins, over-the-counter, and prescription drugs).
Present this list to your medical doctor and pharmacist, as it will allow them to advise you on what medicines you can start, stop, or change safely.
Never change your medications without consulting with your doctor.
It would be best if you were especially careful of:
- Blood thinners (Jantoven, Coumadin, warfarin).
Who Should Not Take Azithromycin
Anyone allergic to azithromycin (or similar drugs, like erythromycin, clarithromycin, or telithromycin) should not take it. Avoid azithromycin if you have a history of liver problems or jaundice due to previous azithromycin use. People with the following health conditions should avoid azithromycin:
- Kidney disease
- Liver disease
- Heart rhythm disorder
- Low potassium
- Myasthenia gravis
- Long QT syndrome
It is best to reach out to your healthcare professional to see if azithromycin is safe for you. As it is unknown if azithromycin passes into breast milk, you should also inform your doctor if you are breastfeeding, are pregnant, or plan to become pregnant.
Azithromycin Drug Interaction
Interactions between drugs can change the effectiveness of your medications and increase the risk of severe side effects. For azithromycin specifically, interactions between drugs that affect the heart rhythm (causes the heart to contract and relax slower), including amiodarone, disopyramide, hydroxychloroquine, ibutilide, procainamide, sotalol, and more, can be dangerous.
What Are Common Antibiotics Used To Treat Urinary Tract Infections (UTI)?
The most commonly recommended oral antibiotics for UTIs are:
- trimethoprim-sulfamethoxazole (Septra, Bactrim, and others)
- nitrofurantoin (Macrodantin, Macrobid, Furadantin)
- fosfomycin (Monurol)
Suppose these three options are not recommended: amoxicillin-clavulanate (Augmentin) and some cephalosporin-type antibiotics (e.g., cefaclor, cefdinir, cefpodoxime) are considered.
Ultimately, the antibiotics your doctor prescribes will depend on your medical history, the type of UTI, local antibiotic-resistance patterns, and costs.
Is Azithromycin Good for a UTI?
Azithromycin is not the best antibiotic for UTIs as E. coli bacteria are resistant to it.
Therefore, treatment will only increase antibiotic resistance and lead to further complications when you attempt treating the UTI with another antibiotic. In addition, azithromycin is absorbed in the gastrointestinal tract and excreted by the liver. Because the kidney does not secrete it, it does not reach the urinary tract in significant concentrations, so any azithromycin dosage will not be as effective as an antibiotic excreted by the kidney.
Azithromycin, alongside other macrolide-type antibiotics, is often better for UTIs with specific complications. For example, you may see them prescribed in scenarios that involve urethritis (inflammation of the urethra) or STD-caused urinary problems.
The decision to prescribe azithromycin is entirely up to your doctor.
How To Use Azithromycin for UTI
Using azithromycin for UTIs follows the same process as using it for any other infection. Read and understand the dosage instructions before taking the antibiotics. Azithromycin is typically taken once a day.
Depending on your situation, a doctor may prescribe a single dose or a course for three to five days. Whether you are taking capsules, tablets, or an oral suspension, it is best to take them on an empty stomach — an hour before eating or two hours after.
What To Do With Missed Doses
If you miss a dose, take it as soon as possible. If you remember close to when you need to take your following amount, skip the missed dose — do not double the dose. Taking an extra dose can increase the risk of side effects, such as diarrhea, nausea, and vomiting.
How Fast Does Azithromycin Work for a UTI?
Your UTI symptoms should improve one to two days after starting antibiotics. After that, it may take longer to notice improvement, depending on your infection’s severity and how long it was left alone before starting antibiotics. Finishing your antibiotic schedule is crucial regardless of how fast your antibiotics seem to work. Just because you no longer notice your symptoms does not mean the infection is completely gone.
How Long Does Azithromycin Take To Properly Cure UTI?
The typical dosage for azithromycin is a three to ten-day course, depending on the infection.
Some cases may only require one dose, but more severe UTIs can require 14 or more days of treatment. The average time for effective treatment is usually three to seven days.
Azithromycin Dosage for UTI
Azithromycin can be taken as a capsule, tablet, or oral suspension (liquid). The pills come in 250 mg doses, while the tablets can come in either 250 mg or 500 mg doses. The oral suspension comes as a 200 mg dose per 5 ml. The single-dose packet contains 1 gram of azithromycin, meant to be dissolved in two ounces of water. The typical recommended dose is 500 mg per day.
Does Azithromycin Treat UTI Completely?
Azithromycin is effective against a wide array of bacterial infections, but it is not the best candidate for treating a UTI thoroughly. This is because the most common bacteria that cause UTI, E. coli, is resistant to macrolide-type antibiotics, including azithromycin.
As it is not the most effective antibiotic against UTIs, macrolides are not recommended for UTI treatment. Antimicrobial susceptibility testing for Azithromycin suggests it is not an optimal treatment option. In addition, the bacteria may develop an increased antibiotic resistance after treatment with azithromycin.
What To Avoid When Using Azithromycin for UTI
When using azithromycin, always take your doses on time. Avoid double dosing (taking two doses at the same time or taking an extra dose to make up for a missed one) — if you miss a dose and notice it soon before the next dose, skip it.
In addition, avoid using azithromycin for UTIs if you have an allergy to azithromycin or similar macrolides (e.g., clarithromycin, erythromycin, or telithromycin). You should also avoid taking azithromycin alongside other drugs that can affect heart rhythm.
When To See a Doctor
If you suffer severe side effects while taking azithromycin, including:
- an allergic reaction or skin reaction (hives, skin rashes, etc.),
- liver problems (stomach pain, clay-colored stools, jaundice, etc.),
- heart rhythm problems (pounding heartbeats, shortness of breath, etc.),
- severe stomach pain,
- water or bloody diarrhea,
It would be the best option to see a doctor immediately.
Frequently Asked Questions (FAQs)
Sexual activity can heighten the risk of a UTI, especially for women. This is because the friction from thrusting and similar maneuvers can push bacteria into the urethra and urinary tract. Depending on the activity, bacteria can pass from the anus to the urethra.
If you want to prevent getting a UTI from having sex, it is good to urinate immediately after sex. Urinating after sex flushes out bacteria in the bladder and urethra and decreases the risk of a UTI.
Other good practices include urinating before sex and washing the genital area before sex.
Uncomplicated UTIs, which occur in otherwise healthy adults and don’t involve any complications, can be resolved at home through staying hydrated, drinking cranberry juice, peeing when the urge arises, using probiotics, getting vitamin C, and practicing good hygiene.
Short-course antibiotics (schedules lasting around three days) can also be prescribed.
In other cases, a longer course of antibiotics may be required. For example, a UTI may require treatment in a hospital and antibiotic therapy through an IV if it is severe. After the infection improves, IV antibiotics can be administered orally.
If the antibiotics prescribed do not affect your symptoms, the doctor may recommend a longer course, a different way to take it, or another antibiotic.
Azithromycin and other macrolides (erythromycin, clarithromycin, or telithromycin) are not especially effective against the bacteria that cause UTIs. In addition, azithromycin typically does not reach the urinary system when ingested.
Z-Pak, or azithromycin, can theoretically resolve UTIs because they are bacterial infections, but the most common bacteria that causes UTIs is resistant to azithromycin.
The typical dose for azithromycin is 500 mg per day, taken as a capsule, tablet, or oral suspension. The course can last three to ten days.
You can use Zithromax for a UTI, but it is neither recommended nor effective.
Azithromycin is not particularly effective against UTIs. Therefore, if you have been prescribed azithromycin, wait for the entire duration of your antibiotics course.
Azithromycin can treat bacterial infections, such as pneumonia, bronchitis, several STDs, and infections of the skin, throat, sinuses, ears, lungs, and reproductive organs.
Amoxicillin is a penicillin-type antibiotic, while azithromycin is a macrolide-type antibiotic.
Penicillin interferes with the structural integrity of bacteria, while macrolides prevent bacteria from growing and multiplying.
Yes, you can take azithromycin with amoxicillin. Only take these drugs together upon the advice of a doctor to avoid unwanted drug interactions.
While you may not become sick, taking antibiotics unnecessarily is never a good idea. Taking antibiotics builds up your resistance to them, reducing their efficiency when you need them to fight sickness.
Taking azithromycin will not cause urinary problems but can lead to liver problems.
You should not take azithromycin for kidney infections as it will not be effective.
The dosage schedule for azithromycin can take three to ten days. However, it is not recommended for UTI treatment.
The best antibiotics for UTIs are trimethoprim-sulfamethoxazole (Septra, Bactrim, and others), nitrofurantoin (Macrodantin, Macrobid, Furadantin), and fosfomycin (Monurol).
Most UTIs (about 70 to 90%) are caused by the bacterial strain called Escherichia coli (E. coli). Some risk factors that can increase the risk of UTI include:
- Use of urinary catheters
- Structural anomalies in the urinary tract (e.g., enlarged prostate)
- Weaker immune system (older adults and young children)
- Sexual activity
- Poor hygiene
- Changes in the bacteria inside the vagina (caused by lower estrogen levels, elevated vaginal pH, menopause, using spermicides, etc.)