Azithromycin Syrup

Azithromycin is a class of semi-synthetic macrolide antibiotics used for the treatment against many bacterial infections such as respiratory tract infections, skin infections, and other sexually transmitted diseases.

The important factor of using Azithromycin syrup is that it is easy to swallow, so can be given easily to children as well to the patients who face difficulty to swallow tablets or pills.

Azithromycin is the only antibiotic which works as a broad-spectrum antibiotic that means it works against many bacteria causing infections including gram-positive, gram-negative bacteria which makes it a versatile option for treating many infections.

It also works against following bacteria:

• Staphylococcus aureus
• Streptococcus agalactiae
• Streptococcus pneumoniae
• Streptococcus pyogenes
• Haemophilus ducreyi
• Haemophilus influenzae
• Moraxella catarrhalis
• Neisseria gonorrhoeae
• Chlamydophila pneumoniae
• Chlamydia trachomatis
• Mycoplasma pneumoniae

Mechanism of action

Azithromycin acts by blocking protein synthesis of the bacteria. It works by targeting the 50S ribosomal unit of the bacteria involved in the bacterial protein synthesis.

The mechanism by which this drug works the binding of Azithromycin to the 23S rRNA, the specific region in 50S ribosomal unit which interferes with translocation process of protein synthesis required for elongation of polypeptide chain of protein, Therefore, the protein synthesis is blocked which is important for bacterial growth and replication.

As compared to other drugs in the same class of macrolides, only Azithromycin has the property of within cell accumulation which helps it for effective eradicating pathogens by accumulating inside the cell that is known as intracellular accumulation.

This accumulation causes increased half-life of Azithromycin and that is why it is given once daily for sustained therapeutic effect.

As mentioned, Azithromycin is the versatile antibiotic effective against many bacterial infections as mentioned above, so it has ample uses against many diseases such as:

• Respiratory tract infections: Mostly it is used for upper respiratory tract infection (URTI). It is also prescribed for infections like pneumonia (community acquired pneumonia), bronchitis (acute aggravation of chronic bronchitis), bacterial sinus infections commonly known as sinusitis.
• Ear infections: It is especially used in paediatric patients for treatment of otitis media.
• Lyme disease: It is the illness caused by borrelia bacteria, usually occurs from bite of tick carrying bacteria. Azithromycin is recommended for this treatment in cases where patients are allergic to other medications.
• Tonsillitis and Pharyngitis: This drug is recommended for treating tonsils and throat infections.
• Sexually Transmitted Infections (STIs): Azithromycin is recommended for certain infections such as chlamydia (in single doses), gonorrhoea (combined with other medications), non-gonococcal infections and urethritis.
• Skin and soft tissues: Certain infections such as cellulitis and impetigo can also be treated with it.
• Other infections: It is also used for treatment of other infections such as community acquired pneumonia (CAP) due to Chlamydophila pneumoniae, Haemophilus influenzae,
  Mycoplasma pneumoniae or Streptococcus pneumoniae in patients appropriate for oral therapy, chancroid, donovanosis, legionnaires pneumonia, pharyngitis, otitis media,
  Chlamydia infections, and also in multi-drug resistant typhoid patients resistant to cephalosporins and also in toxoplasmosis.

Acute bacterial exacerbations of chronic obstructive pulmonary disease due to Haemophilus influenzae, Moraxella catarrhalis or Streptococcus pneumoniae.

It has to be noted that this drug is used for the treatment of bacterial infections strictly and not for the infections caused by viruses such as the common cold or flu.

It should not be administered without consultation with healthcare professionals and also the full course of antibiotics should be done as prescribed by physicians to eliminate antibiotic resistance.

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The price of azithromycin syrup in India varies according to brand, potency, and quantities. A 15 ml bottle of azithromycin syrup will typically cost between INR 80 and INR 150. Prices, nonetheless, may change between locations and pharmacies.

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Side Effects

Certain side effects caused by Azithromycin are mentioned below:

• Gastro-intestinal infections (GIT): This includes conditions such as nausea, vomiting, diarrhoea, abdominal pain. So it is recommended to take medicine with food to avoid such problems.
• Headache
• Dizziness
• Allergic reactions: This includes rash, itching, swelling. Serious effects may include difficult breathing, swelling of face, lips, tongue which may require medical attention.
• Liver function problems: May affect altered liver enzymes quantitative values.

    More serious side effects include:

• Several cases of Q-T prolongation. Serious ventricular arrhythmias and death have been reported
• Clostridium difficile associated diarrhoea
• QT prolongation

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Azithromycin for oral suspension USP or we can say syrups are supplied in bottles containing azithromycin monohydrate powder equivalent to 300 mg, 600 mg, 900 mg or 1200 mg azithromycin, USP per bottle and includes the following inactive ingredients: 

Ammonio methacrylate copolymer, 

banana flavor/cherry flavor/ vanilla flavor

colloidal silicon dioxide

FD&C Red No. 40

hydroxypropyl cellulose

Sucrose

Xanthan gum. 

Note: After constitution, each 5 mL of suspension contains 100 mg or 200 mg of azithromycin, USP.

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If azithromycin syrup is not accessible or appropriate for a patient, there are other antibiotics that might be used depending on the illness being treated. Some popular azithromycin alternatives include:

• Clarithromycin: Clarithromycin is an alternative macrolide antibiotic with a similar range of action.
• Erythromycin: the primary macrolide antibiotic, that can be utilised in certain circumstances as an alternative.
• Doxycycline: A tetracycline antibiotic with identical prescriptions as azithromycin.

It is important to seek the advice of a healthcare practitioner for the most appropriate substitute depending on the individual’s health status and history of illness.

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• To be taken with food
• Monitor the side effects, if still facing it either stop taking drug or visit physician for further advice
• Avoid taking it if pregnant, breastfeeding or planning to get pregnant
• If already have heart disease, consult physician
• Avoid alcohol
• Take complete course as mentioned by physician
• Do not self-prescribe the medications.

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Azithromycin should not be used in patients with pneumonia who cannot take oral therapy because of moderate to severe illness or risk factors such as any of the following:

• patients with cystic fibrosis,
• patients with nosocomially acquired infections,
• patients with known or suspected bacteremia,
• patients requiring hospitalization,
• elderly or debilitated patients, or
• patients with significant underlying health problems that may compromise their ability
• to respond to their illness (including immunodeficiency or functional asplenia).
• Pharyngitis/tonsillitis caused by Streptococcus pyogenes as an alternative to first-line therapy in individuals who cannot use first-line therapy.

Other contraindications include:

• Allergy to Azithromycin
• Liver disease
• Kidney diseases
• Myasthenia Gravis
• QT prolongation of ECG

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