Editing Azithromycin (section)

== Medical uses ==
Azithromycin is used to treat diverse infections, including:
* Acute bacterial sinusitis due to ''[[Haemophilus influenzae|H. influenzae]]'', ''[[Moraxella catarrhalis|M. catarrhalis]]'', or ''[[Streptococcus pneumoniae|S. pneumoniae]]''. A 1999 study found Azithromycin to be faster in resolving symptoms as compared to [[Amoxicillin/clavulanic acid|amoxicillin / clavulanic]].<ref>{{cite journal|journal=American Journal of Otolaryngology|title=Azithromycin versus amoxicillin/clavulanate in the treatment of acute sinusitis|url=https://www.sciencedirect.com/science/article/abs/pii/S0196070999900443|year=1999|doi=10.1016/S0196-0709(99)90044-3 |pmid=9950107 |access-date=31 May 2024|quote=In adults with acute sinusitis, a 3-day course of azithromycin was as effective and well tolerated as a 10-day course of amoxicillin/clavulanic acid. A significantly simpler dosage regimen and faster clinical effect were the advantages of azithromycin. |volume=20 |issue=1 |pages=7–11 | vauthors = Klapan I, Culig J, Oresković K, Matrapazovski M, Radosević S |url-access=subscription }}</ref>
* Acute otitis media caused by ''H. influenzae'', ''M. catarrhalis'' or ''S. pneumoniae''. A 2021 study concluded that Azithromycin was comparable to amoxicillin/clavulanate in its treatment and that it was safer and more tolerable in children.<ref>{{cite journal|title=Efficacy and safety of azithromycin and amoxicillin/clavulanate for otitis media in children: a systematic review and meta-analysis of randomized controlled trials|year=2021|doi=10.1186/s12941-021-00434-x |doi-access=free |quote=Azithromycin is comparable to amoxicillin/clavulanate to treat otitis media in children, and it is safer and more tolerable. |journal=Annals of Clinical Microbiology and Antimicrobials |volume=20 | vauthors = Dawit G, Mequanent S, Makonnen E |issue=1 |page=28 |pmid=33894769 |pmc=8070272 }}</ref>
* Community-acquired pneumonia due to ''[[Chlamydophila pneumoniae|C. pneumoniae]]'', ''H. influenzae'', ''[[Mycoplasma pneumoniae|M. pneumoniae]]'', or ''S. pneumoniae''.<ref>{{cite journal | vauthors = Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM, Musher DM, Niederman MS, Torres A, Whitney CG | title = Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults | journal = Clinical Infectious Diseases | volume = 44 | pages = S27-72 | date = March 2007 | issue = Suppl 2 | pmid = 17278083 | pmc = 7107997 | doi = 10.1086/511159 | doi-access = free | title-link = doi }}</ref> 
* Genital ulcer disease (chancroid) in men due to ''[[Haemophilus ducreyi|H. ducreyi]]''
* Pharyngitis or tonsillitis caused by ''[[Streptococcus pyogenes|S. pyogenes]]'' as an alternative to first-line therapy in individuals who cannot use first-line therapy<ref>{{cite journal | vauthors = Randel A | title = IDSA Updates Guideline for Managing Group A Streptococcal Pharyngitis | journal = American Family Physician | volume = 88 | issue = 5 | pages = 338–40 | date = September 2013 | pmid = 24010402 }}</ref>
* Prevention and treatment of acute bacterial exacerbations of chronic obstructive pulmonary disease due to ''H. influenzae'', ''M. catarrhalis'', or ''S. pneumoniae''. The benefits of long-term prophylaxis must be weighed on a patient-by-patient basis against the risk of cardiovascular and other adverse effects.<ref>{{cite journal | vauthors = Taylor SP, Sellers E, Taylor BT | title = Azithromycin for the Prevention of COPD Exacerbations: The Good, Bad, and Ugly | journal = The American Journal of Medicine | volume = 128 | issue = 12 | pages = 1362.e1–6 | date = December 2015 | pmid = 26291905 | doi = 10.1016/j.amjmed.2015.07.032 | doi-access = free | title-link = doi }}</ref>
* Trachoma due to ''[[Chlamydia trachomatis|C. trachomatis]]''<ref>{{cite journal | vauthors = Burton M, Habtamu E, Ho D, Gower EW | title = Interventions for trachoma trichiasis | journal = The Cochrane Database of Systematic Reviews | volume = 11 | issue = 11 | pages = CD004008 | date = November 2015 | pmid = 26568232 | pmc = 4661324 | doi = 10.1002/14651858.CD004008.pub3 }}</ref>
* Uncomplicated skin infections due to ''[[Staphylococcus aureus|S. aureus]]'', ''S. pyogenes'', or ''[[Streptococcus agalactiae|S. agalactiae]]''
* [[Whooping cough]] caused by ''[[Bordetella pertussis|B. pertussis]]''.<ref name="pmid30115332">{{cite journal |vauthors=Simon L, Nguyen V |title=Pertussis: The Whooping Cough |journal=Primary Care: Clinics in Office Practice |volume=45 |issue=3 |pages=423–431 |date=September 2018 |pmid=30115332 |doi=10.1016/j.pop.2018.05.003 |title-link = doi }}</ref>
* [[Scrub typhus]] caused by ''[[Orientia tsutsugamushi]]''.<ref name="pmid38110855">{{cite journal |vauthors=Gupta N, Boodman C, Jouego CG, Van Den Broucke S |title=Doxycycline vs azithromycin in patients with scrub typhus: a systematic review of literature and meta-analysis |journal=BMC Infect Dis |volume=23 |issue=1 |pages=884 |date=December 2023 |pmid=38110855 |pmc=10726538 |doi=10.1186/s12879-023-08893-7 | doi-access = free | title-link = doi }}</ref>

=== Bacterial susceptibility ===
Azithromycin has relatively broad but shallow antibacterial activity. It inhibits some Gram-positive bacteria, some Gram-negative bacteria, and many atypical bacteria.<ref name="Sybilski-2020">{{cite journal | doi=10.15557/PiMR.2020.0048 | title=Azithromycin – more than an antibiotic | date=2020 | journal=Pediatria I Medycyna Rodzinna | volume=16 | issue=3 | pages=261–267 | vauthors = Sybilski AJ | doi-access = free | title-link = doi }}</ref><ref name="pmid23650453">{{cite journal |vauthors=Opitz DL, Harthan JS |title=Review of Azithromycin Ophthalmic 1% Solution (AzaSite) for the Treatment of Ocular Infections |journal=Ophthalmol Eye Dis |volume=4 |issue= |pages=1–14 |date=2012 |pmid=23650453 |pmc=3619494 |doi=10.4137/OED.S7791}}</ref><ref name="pmid30226949">{{cite journal |vauthors=Amano A, Kishi N, Koyama H, Matsuzaki K, Matsumoto S, Uchino K, Yamaguchi H, Yokomizo A, Mizuno M |title=In vitro activity of sitafloxacin against atypical bacteria (2009-2014) and comparison between susceptibility of clinical isolates in 2009 and 2012 |journal=Jpn J Antibiot |volume=69 |issue=3 |pages=131–142 |date=September 2016 |pmid=30226949}}</ref>

'''Aerobic and facultative Gram-positive microorganisms'''
* ''[[Staphylococcus aureus]]'' (Methicillin-sensitive only)
* ''[[Streptococcus agalactiae]]''
* ''[[Streptococcus pneumoniae]]''
* ''[[Streptococcus pyogenes]]''

'''Aerobic and facultative anaerobic Gram-negative microorganisms'''
* ''[[Bordetella pertussis]]''
* ''[[Haemophilus ducreyi]]''
* ''[[Haemophilus influenzae]]''
* ''[[Legionella pneumophila]]''
* ''[[Moraxella catarrhalis]]''
* ''[[Neisseria gonorrhoeae]]''

'''Anaerobic microorganisms'''
* ''[[Peptostreptococcus]]'' species
* ''[[Prevotella bivia]]''

'''Other microorganisms'''
* ''[[Chlamydia trachomatis]]''
* ''[[Chlamydophila pneumoniae]]''
* ''[[Mycoplasma genitalium]]''
* ''[[Mycoplasma pneumoniae]]''
* ''[[Ureaplasma urealyticum]]''

===Pregnancy and breastfeeding===
While some studies claim that no harm has been found with use during pregnancy,<ref name=AHFS2015/> more recent studies with mice during late pregnancy has shown adverse effects on embryonic testicular and neural development of prenatal azithromycin exposure (PAzE)  . One recent  study claims ''obvious fetus changes were observed under high-dose, mid-pregnancy and multi-course exposure''.<ref>{{cite journal | vauthors = Wang H |title=Azithromycin exposure during pregnancy disturbs the fetal development and its characteristic of multi organ toxicity |journal=Elseiver Life Sciences |date=Sep 2023 |volume=329 |doi=10.1016/j.lfs.2023.121985 |pmid=37516432 |url=https://www.sciencedirect.com/science/article/abs/pii/S0024320523006203|url-access=subscription }}</ref> However, there need to be more well-controlled studies in pregnant women.<ref name="Zithromax FDA label">{{cite web | title=Zithromax- azithromycin dihydrate tablet, film coated; Zithromax- azithromycin dihydrate powder, for suspension | website=DailyMed | date=29 September 2023 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b749df83-49b0-433e-8a62-589a048dd716 | access-date=26 April 2024}}</ref>

The safety of the medication during [[breastfeeding]] is unclear. It was reported that because only low levels are found in breast milk and the medication has also been used in young children, it is unlikely that breastfed infants would have adverse effects.<ref name=Breast2015/>

===Airway diseases===
Azithromycin has beneficial effects in the treatment of asthma. It possesses antibacterial, antiviral, and anti-inflammatory properties which contribute to its effectiveness. Asthma exacerbations can be caused by chronic neutrophilic inflammation, and azithromycin is known to reduce this type of inflammation due to its immunomodulatory properties. The recommended dosage for controlling asthma exacerbations with azithromycin is either 500&nbsp;mg or 250&nbsp;mg taken orally as tablets three times a week. In adults with severe asthma, low-dose azithromycin may be prescribed as an add-on treatment when standard therapies such as [[inhaled corticosteroid]]s or long-acting beta2-agonists are not sufficient. Long-term use of azithromycin in patients with persistent symptomatic asthma aims to decrease the frequency of asthma exacerbations and improve their quality of life. While both its anti-inflammatory and antibacterial effects play crucial roles in treating asthma, studies suggest that responsiveness to azithromycin therapy depends on individual variations in lung bacterial burden and microbial composition, collectively referred to as the [[lung microbiome]]. The richness (diversity) of the lung microbiome has been identified as a key factor in determining the effectiveness of azithromycin treatment. Azithromycin has significant interactions with the patient's microbiome. Long-term use of azithromycin reduces the presence of ''H. influenzae'' bacteria in the airways but also increases resistance against macrolide antibiotics. The specific pharmacological mechanisms through which azithromycin interacts with the patient's microbiome remain unknown {{as of|2024|lc=y|post=;}} research continues to explore how changes in microbial composition influence drug efficacy and patient outcomes.<ref name="pmid37650889">{{cite journal |vauthors=Chan M, Ghadieh C, Irfan I, Khair E, Padilla N, Rebeiro S, Sidgreaves A, Patravale V, Disouza J, Catanzariti R, Pont L, Williams K, De Rubis G, Mehndiratta S, Dhanasekaran M, Dua K |title=Exploring the influence of the microbiome on the pharmacology of anti-asthmatic drugs |journal=Naunyn-Schmiedeberg's Arch Pharmacol |volume=397 |issue=2 |pages=751–762 |date=February 2024 |pmid=37650889 |pmc=10791706 |doi=10.1007/s00210-023-02681-5 }}</ref>

Azithromycin appears to be effective in the treatment of [[chronic obstructive pulmonary disease]] through its suppression of inflammatory processes.<ref name="simoens">{{cite journal | vauthors = Simoens S, Laekeman G, Decramer M | title = Preventing COPD exacerbations with macrolides: a review and budget impact analysis | journal = Respiratory Medicine | volume = 107 | issue = 5 | pages = 637–48 | date = May 2013 | pmid = 23352223 | doi = 10.1016/j.rmed.2012.12.019 | doi-access = free | title-link = doi }}</ref> Azithromycin is potentially useful in [[sinusitis]] via this mechanism.<ref>{{cite journal | vauthors = Gotfried MH | title = Macrolides for the treatment of chronic sinusitis, asthma, and COPD | journal = Chest | volume = 125 | issue = 2 Suppl | pages = 52S-60S; quiz 60S-61S | date = February 2004 | pmid = 14872001 | doi = 10.1378/chest.125.2_suppl.52S | url = https://journal.chestnet.org/article/S0012-3692(15)32220-0/fulltext | access-date = 22 March 2020 | archive-date = 27 August 2021 | archive-url = https://web.archive.org/web/20210827234741/https://journal.chestnet.org/article/S0012-3692%2815%2932220-0/fulltext | url-status = live | url-access = subscription }}</ref> Azithromycin is believed to produce its effects through suppressing certain immune responses that may contribute to inflammation of the airways.<ref>{{cite journal | vauthors = Zarogoulidis P, Papanas N, Kioumis I, Chatzaki E, Maltezos E, Zarogoulidis K | title = Macrolides: from in vitro anti-inflammatory and immunomodulatory properties to clinical practice in respiratory diseases | journal = European Journal of Clinical Pharmacology | volume = 68 | issue = 5 | pages = 479–503 | date = May 2012 | pmid = 22105373 | doi = 10.1007/s00228-011-1161-x | s2cid = 1904304 | doi-access = free | title-link = doi }}</ref><ref>{{cite journal | vauthors = Steel HC, Theron AJ, Cockeran R, Anderson R, Feldman C | title = Pathogen- and host-directed anti-inflammatory activities of macrolide antibiotics | journal = Mediators of Inflammation | volume = 2012 | pages = 584262 | date = 2012 | pmid = 22778497 | pmc = 3388425 | doi = 10.1155/2012/584262 | doi-access = free | title-link = doi }}</ref>