Are Z-Packs Still a Good Choice for Infections?

two prescription bottles with pills next to them
Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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The Z-Pack (Zithromax, azithromycin) is an antibiotic medication that unfairly gets a bad rap. True, it’s often incorrectly prescribed for sinus infections caused by viruses, which don’t respond to antibiotics. But Z-Packs offer many benefits we shouldn’t forget. Here are some of reasons why they’re still worth considering.

First, Z-Packs are easy to use and they’re cheap. They come as a pack of five pills, which you take daily over the course of five days, and they’re highly effective. Azithromycin is well-absorbed when you take it orally, easily enters your body tissues, so it can fight the bacteria causing your infection, and stays active for a long time.

Z-Packs are also safe to take alongside numerous other medications. Many common medications are cleared from the body by special liver enzymes called cytochrome P450 enzymes. Since azithromycin isn’t one of those medications, it doesn’t interfere with these processes.

In addition to its ease of use, the Z-Pack can be a good option for the following 10 health conditions:

  1. Strep throat. Azithromycin is approved for treatment of strep throat — or as we call it, streptococcal pharyngitis. If you are allergic to penicillin antibiotics, which are usually the first choice of treatment, a Z-Pack is still a good option despite some areas reporting high rates (20%) of resistance or ineffectiveness.
  2. Skin and soft tissue infections. Infections of the skin or soft tissues — like muscles and tendons — commonly caused by Staph and Strep bacteria can be treated with Zithromax. A typical prescription consists of either 500 mg daily for five days or a single dose of 2 grams.
  3. Community-acquired pneumonia. For mild to moderate cases of pneumonia that are acquired out in the community (and not contracted in a hospital), Z-Packs are a useful option.
  4. Acute bacterial bronchitis. In folks with chronic bronchitis or other underlying lung disease, acute bacterial bronchitis can be treated with a Z-Pack.
  5. Chlamydia. For the sexually transmitted disease, Chlamydia, a single one-gram dose of azithromycin is the recommended treatment. One dose and done.
  6. Traveler’s diarrhea. Azithromycin can effectively treat traveler’s diarrhea, aka dysentery or bloody diarrhea, caused by the Shigella and Campylobacter bacteria. This makes the Z-Pack a handy companion to bring along on international travel.
  7. Nongonococcal urethritis in men. A single 1-gram dose of azithromycin can treat certain urethra infections in men. It’s much more efficient than another antibiotic, doxycycline, which you’d have to take for 7 days to get the same effect. Again, one and done!
  8. Chronic lung disease. For folks with the lung diseases, chronic bronchiectasis or chronic obstructive pulmonary disease (COPD), daily 250 mg doses of azithromycin reduces episodes of exacerbations (or sudden worsening symptoms) and slightly improves lung function and quality of life.
  9. Cystic fibrosis in kids. As with chronic lung disease patients, azithromycin effectively reduces episodes of exacerbations and improves lung function in children with cystic fibrosis.
  10. Prevention of certain infections in HIV/AIDS patients. Azithromycin effectively prevents and treats infections in HIV/AIDS patients caused by M. avium-intracellulare, a microorganism related to the bacteria that cause tuberculosis.

A note about cardiovascular risk: Though the FDA warning from 2013 remains — that current azithromycin use may be associated with an increased risk of an abnormal heart rhythm known as ventricular arrhythmia — a 2017 population-based study of over 14 million people found no increased risk of arrhythmia with azithromycin compared to another antibiotic amoxicillin.

Dr O.

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