How Long Does Azithromycin Stay in Your System? Plus 7 More Azithromycin FAQs

Azithromycin (Zithromax) is a common antibiotic that treats many bacterial infections. It’s also been around for quite a while. Healthcare providers have prescribed it for decades as a go-to antibiotic for skin infections, pneumonia, and more.

Many people think of azithromycin as a convenient and quick medication to take. But like with every medication, there are some things to be aware of while taking it. Here, we’ll answer eight common questions about this antibiotic — including how long azithromycin stays in your system.

1. How long does azithromycin stay in your system?

Azithromycin tends to stay in your system for a while. This is because the medication can linger in places like the skin and lungs even after it has left your bloodstream.

As soon as you take a dose, your body starts to process it and break it down. Medical professionals use a medication’s half life — the time it takes half of the original dose to leave the body — to predict how long a medication will stay in your system. A medication is considered cleared from the body after 4 or 5 half lives.

In the case of azithromycin, each half life can last up to 3 days. This means for many people, azithromycin can stay in your system for up to 15 days (more than 2 weeks).

2. What is a typical azithromycin dose and how is it taken?

In most cases, you’ll take azithromycin by mouth. But it’s also available as an intravenous (IV) injection and an eye drop (AzaSite). You can take the tablets and eye drops at home, but the IV injection is given by a healthcare provider.

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Oral azithromycin is usually taken once per day. The length of time you’ll take it depends on your infection and how severe it is. Generally, courses of azithromycin are shorter than those of other antibiotics.

Some people only need one dose of azithromycin. Single-dose treatment is convenient and effective for conditions such as ear infections and sexually transmitted infections (STIs), like chlamydia.

Other situations call for a few doses of azithromycin. A prepackaged version of azithromycin, called a Z-Pak, makes this relatively easy. You’ll likely take 2 tablets (500 mg) on the first day of treatment. After that, you’ll take 1 tablet (250 mg) daily for the next 4 days. Alternatively, you might just take 500 mg once per day for 3 days.

3. Should you take azithromycin with food?

You can take azithromycin with or without food. But if the medication upsets your stomach, it may be better to take it with a small meal or snack. Food won’t interfere with azithromycin’s effectiveness, but it may help prevent symptoms such as nausea and diarrhea.

4. How does azithromycin work?

Azithromycin is a macrolide antibiotic. Other macrolides include erythromycin (Ery-Tab, E.E.S), clarithromycin (Biaxin XL), and fidaxomicin (Dificid).

These antibiotics work by preventing infection-causing bacteria from reproducing. They do this by stopping the bacteria from making important proteins. This ultimately prevents them from making copies of themselves. When they can no longer replicate, your immune system has a better chance to recover and fight the bacteria more effectively.

5. Is azithromycin safe to take?

Azithromycin is a safe and effective medication for most people. However, as with all medications, it can come with side effects. These most often include:

• Diarrhea

• Nausea

• Vomiting

• Stomach pain

Azithromycin can also cause rare but serious side effects, such as an irregular heart rhythm. Taking medications that impact your heart rhythm at the same time as azithromycin raises your risk of this side effect. Medications such as amiodarone (Pacerone), sotalol (Betapace), and quinidine are common examples. If you notice any changes to your heartbeat, contact your healthcare provider as soon as possible.

Azithromycin also has the potential to cause skin blisters and serious allergic reactions. Although rare, symptoms such as hives, facial swelling, or difficulty breathing can be dangerous if left untreated. Call 911 or go to the nearest emergency room if you think you’re experiencing a severe allergic reaction.

6. Can you take antibiotics like azithromycin during pregnancy?

Azithromycin is generally considered safe to take during pregnancy. It can also be used during labor and delivery.

However, over the years, there have been limited reports of issues with azithromycin. Some studies have reported a possible risk of miscarriage after taking azithromycin. There have also been reports that fetuses exposed to azithromycin may have a higher risk for growth and organ problems.

Azithromycin’s connection to issues such as these haven’t been proven. But they’re good to keep in mind. Azithromycin can be used if the benefits outweigh the risks. Your healthcare provider will make the final call on the antibiotic that’s safest for you.

7. Is azithromycin addictive?

No. Azithromycin isn’t addictive. It’s safe to take azithromycin to treat an infection. It’s also safe to stop taking it when your prescription runs out. 

In fact, you should finish your entire course of antibiotics — even if you’re feeling better. This will help make sure all the bacteria that made you sick are gone. This can also help stave off resistance to the medication. Antibiotic resistance makes bacteria stronger and harder to treat in the future.

Good to know: While azithromycin is only available with a prescription, it’s not a controlled substance.

8. Are there ways to save on azithromycin?

Yes. There are ways to save on azithromycin. Zithromax is available as a brand-name medication, but you can also find azithromycin as a lower-cost generic.

GoodRx can help you save over 80% off the average retail price of the generic version of azithromycin. Generic azithromycin’s price at certain pharmacies is as low as $9.38 with a free GoodRx discount.

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Written by:

Nathan Williams, PharmD, RYT

Nathan is a clinical pharmacist, certified yoga instructor, and medical content writer. His clinical practice has spanned several sub-specialties including: emergency medicine, nutrition, and pediatrics.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

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