Azithromycin (brand names: Zithromax, Z-Pak, Zmax, and AzaSite) is a generic medication prescribed for treating infections caused by certain bacteria. It belongs to a class of antibiotic drugs known as macrolides.
Healthcare providers prescribe azithromycin for treating certain bacterial infections, such as pneumonia. However, azithromycin does not effectively eliminate all types of bacteria and is not recommended for treating sinus infections.
A healthcare provider can help determine whether azithromycin is an appropriate treatment choice.
This article contains information about azithromycin and why it may not be effective for treating sinus infections.
Azithromycin for Sinus Infections
Healthcare providers often do not recommend azithromycin for treating sinus infections since the majority of sinus infections are caused by viruses, not bacteria. Azithromycin is an antibiotic. It does not work to kill viruses, so it does not help in most cases.
The recommendation not to use azithromycin for sinus infections is backed by evidence. In one study, the outcomes of people receiving azithromycin for sinus infections were compared to those not taking any antibiotics.
The results suggest that about 70% of the time, sinus infections will resolve on their own within two weeks without treatment.
The evidence also shows that taking antibiotics for sinus infections can cause side effects more often than not, highlighting the potential risk of using antibiotics for sinus infections.
Antibiotic Resistance
The use of azithromycin for sinus infections raises a major concern: antibiotic resistance, in which bacteria develop ways to reduce or evade the effects of antibiotics. As resistance grows, bacteria become harder to treat or, in some cases, impossible to treat. Resistant bacteria can cause the infection to continue spreading and even lead to life-threatening illness.
Around 30% of bacterial sinus infections are caused by Streptococcus pneumoniae, a bacterium that is resistant to azithromycin. This means that approximately 1 out of every 3 people with bacterial sinus infections may not see any improvement if azithromycin is prescribed. The unnecessary use of azithromycin increases the risk of antibiotic resistance.
The length of azithromycin treatment for certain bacterial sinus infections is three days, according to the Food and Drug Administration (FDA) drug label. In the limited situations where azithromycin might be effective for a sinus infection, it is often overprescribed in terms of length of treatment. This further increases the risk of bacterial resistance.
In a study of azithromycin use, Centers for Disease Control and Prevention (CDC) researchers found that many people were prescribed the drug for up to 14 days. This extended dosing increases the risk of developing azithromycin-resistant bacteria.
Experts do not recommend using a Z-pak to treat sinus infections since the six tablets in a convenient Z-pak are for use over five days, which is two days longer than advised. This longer-term treatment, therefore, raises the risk of side effects and antibiotic resistance.
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What Is Azithromycin?
Azithromycin is a generic macrolide antibiotic used to treat a variety of mild to moderate infections. It comes in tablets and a liquid suspension for oral use, as well as in intravenous (IV) injection and eye drop forms.
The oral and injectable versions are commonly known by the brand name Zithromax; the eye drops are available as the brand AzaSite.
The FDA approved azithromycin for the treatment of certain infections caused by bacteria known or suspected to be responsive to the drug. However, the actual use of this medication in clinical practice may differ from the list of approved uses. The FDA approves azithromycin to treat certain bacterial infections in adults, including:
- Flare-ups of chronic bronchitis due to bacterial infection
- Bacterial sinus infection
- Uncomplicated skin and soft tissue infections
- Infections of the cervix or ureter
- Genital ulcers in males
- Community-acquired pneumonia
- Throat or tonsil infections
The FDA approves a more limited set of azithromycin uses in children. These include:
- Community-acquired pneumonia in children ages 6 months and older
- Ear infections in children ages 6 months and older
- Throat or tonsil infections in children ages 2 years and
- older
The approved uses of azithromycin also vary with the specific form prescribed. For instance, only the AzaSite eye drop is approved for treating bacterial conjunctivitis (pink eye) in adults and children ages 1 year and older.
Some healthcare providers may prescribe azithromycin for conditions or dosages outside of those approved by the FDA. This practice is known as off-label prescribing. Some off-label uses of azithromycin include:
- Flare-ups of chronic obstructive pulmonary disease (COPD)
- Severe acne
- Prevention of certain infections in adults and children
How Does Azithromycin Work?
Antibiotics are generally grouped based on how they work: bactericidal or bacteriostatic.
"Bactericidal" means the antibiotic kills the bacteria, while "bacteriostatic" means it stops the bacteria from growing. Macrolides, including azithromycin, are bacteriostatic.
Azithromycin's mechanism of action (how it works) is the same as other macrolide antibiotics. Specifically, azithromycin binds to a protein known as 23S, which is responsible for helping bacteria grow and reproduce.
When azithromycin binds to this protein, it halts the DNA processes necessary for growth and spread. Without this protein's help, the bacteria cannot reproduce and grow, which stops the infection.
Special Considerations
Taking azithromycin may result in some mild side effects. Common side effects associated with azithromycin use include:
- Diarrhea
- Nausea
- Vomiting
- Abdominal pain
In rare instances, azithromycin causes more severe side effects, such as:
- Severe allergic reactions
- Liver problems
- Heart problems, including heart arrhythmias
- Diarrhea due to Clostridioides difficile (C. diff) infection
- Infantile hypertrophic pyloric stenosis, a rare but serious complication following azithromycin use in infants
How to Safely Treat Sinus Infections
While the majority of sinus infections go away on their own within two weeks, nonprescription medications are available to help manage the symptoms. Here are some options available to you for relief:
- Flonase (fluticasone) nasal spray, an intranasal steroid, may provide relief for sinus infections, especially in chronic cases or with allergic rhinitis.
- OTC decongestants like Sudafed (pseudoephedrine) reduce sinus congestion. However, specific individuals with specific health conditions need to use it cautiously.
- Pain relievers such as Tylenol (acetaminophen) or Advil and Motrin (ibuprofen) can help alleviate headache pain associated with sinus infections.
- The Infectious Disease Society of America (IDSA) recommends Augmentin (amoxicillin/clavulanate) as the first-line treatment for bacterial sinusitis, with Levofloxacin as an alternative for those allergic to penicillin.
- Drug-free methods like drinking plenty of fluids, using warm compresses over your eyes or nose, steam inhalation, and getting enough rest can help relieve sinus pressure and congestion.
- Hygiene practices, including handwashing, vaccination for influenza and COVID-19, and quitting smoking, help prevent sinus infections.
Acute vs. Chronic Sinusitis
Sinus infections, or sinusitis, can be acute (short term) or chronic (long term). Acute sinusitis lasts less than four weeks, while chronic sinusitis persists for over 12 weeks.
Acute and chronic sinus infection symptoms are typically similar: runny nose, excess mucus, stuffy nose, and pain or pressure in the face or head. Fever can also occur with the onset of a sinus infection and usually lasts for a few days.
Most sinus infections resolve independently, but lingering infections may require a visit with a healthcare provider.
Reach out to a healthcare provider for advice if your symptoms continue for more than ten days despite treatment and self-care or if your symptoms are accompanied by a fever lasting more than three days.
Summary
Azithromycin is a generic prescription drug belonging to the macrolide class of antibiotics. It works by stopping bacteria from growing and reproducing.
Azithromycin is a relatively safe and effective treatment option for many infections. However, experts advise against using azithromycin or Z-pack for sinus infections. This is because azithromycin isn't effective against viruses, which are the most common cause of sinus infections.
Furthermore, taking azithromycin unnecessarily or for too long can promote antibiotic resistance. To relieve symptoms, it's best to try over-the-counter medications, self-care, and nondrug options like warm compresses.
If symptoms don't go away, consult a healthcare provider for advice.
Frequently Asked Questions
How can taking antibiotics contribute to antimicrobial resistance?
Antibiotics work to eliminate harmful bacteria in the body, but they can also kill off the “good” bacteria that normally live in the body. The good bacteria, or normal flora, help prevent “bad” bacteria from overgrowing. Overusing antibiotics kills more good bacteria and allows antibiotic-resistant bacteria to multiply quickly without competition.
If using an antibiotic for a sinus infection, how quickly can I expect positive results?
If your healthcare provider prescribes an antibiotic for a sinus infection, it will likely be a short course of treatment, typically three to seven days. The medication begins working quickly, but it may take the full course of treatment before your symptoms improve. If more than a week passes without improvements, talk to your provider, as the antibiotic may not be working.
Even if you begin to feel better midway through your course of antibiotics, do not stop taking it. Stopping antibiotics early may cause the infection to return and become more difficult to treat.
For treating chronic sinus infections, when would sinus surgery be necessary?
Sinus surgery is a potential treatment option for those with frequent recurrent or chronic sinus infections, especially for individuals whose primary symptom is facial pain or nasal blockage. This minimally invasive procedure can help restore normal function to the sinus cavities and reduce the likelihood of future infections.
