The Basics

Type of Medication: Rx MedicationAntibiotic (Oral)Macrolide Family

How it Works: Azithromycin is an antibiotic. Antibiotics can improve acne symptoms by limiting the growth of bacteria that contribute to Acne Vulgaris.

When is this medication used? Azithromycin is usually reserved for the treatment of mild to moderate acne symptoms (Acne Types: 2-4). Azithromycin may also be used to treat non-typical acne (eg. Acne Fulminans).

Frequency of Azithromycin Resistant P. acnes Bacteria: Common. (What does this mean?)

Official Name:  Azithromycin
Popular Brand Names: Azee, Sumamed, Z-Pak and Zithromax.
Related Medications: Erythromycin, Clarithromycin, Roxithromycin, Spiramycin and Tylosin.

Azithromycin and Acne

Although there is a lot of research supporting the use of azithromycin to treat acne, it is not a commonly used for this purpose.  Numerous studies have shown that azithromycin can produce a significant improvement of acne symptoms for some  patients.

The major limitation of the use of azithromycin to treat acne are the increasing levels of azithromycin resistant bacteria.  The research data about the antibiotic susceptibility of Propionibacterium acnes bacteria indicates that resistance to all of the macrolide family antibiotics (especially azithromycin, erythromycin and clindamycin)  is becoming more common.  Recent testing of P. acnes bacteria isolated from acne patients has indicated that a significant percentage of these bacteria are resistant to azithromycin, as well as the related erythromycin and clindamycin.

Erythromycin and clindamycin, which are closely related to azithromycin, are two of the most popular topical antibiotics for the treatment of acne vulgaris, which further contributes to the problem of macrolide resistance.  Levels of P. acnes bacteria resistant to azithromycin, erythromycin and/or clindamycin are highest in highly developed countries (eg. United States, Italy and Sweden) and are lower in less developed countries (eg. Mexico, Peru, India).   In general, research studies indicate that P. acnes bacteria are more likely to be resistant to the most commonly used anti-acne antibiotics (macrolide and tetracyclines) and less resistant to less commonly used anti-acne antibiotics (penicillins and sulfa drugs).

Important Note: The information provided on this site is intended for informational purposes only and is not intended to diagnose or treat any diseases. The Science of Acne strongly encourages you to consult a qualified medical professional before making any treatment decisions. For the complete disclaimer, click here.

Patient Reviews of Azithromycin

Sources for azithromycin user reviews: Azithromycin Reviews @ Acne.orgAzithromycin Reviews @ WebMD, Azithromycin Reviews @ Drugs.comAzithromycin Reviews @, Azithromycin Reviews @, Azithromycin Reviews @

Cost and Availability and Azithromycin

If possible, azithromycin should be obtained through consultation of a qualified medical professional.  Azithromycin is a commonly used meciation and most physicians are comfortable with the use of this antibiotic in general (but not necessarily for the treatment of acne).  Azithromycin tends to be significantly more expensive than other commonly used antibiotics. Azithromycin is available in both brand name and generic forms.    In the United States, insurance co-pays are likely to be between $5-$10 per refill. Without insurance, this medication can be significantly more expensive.

Side Effects

The most common side effects associated with azithromycin are gastrointestinal upset, diarrhea, nausea and vomiting.  The incidence of side effects is lower than most other antibiotics.  Fewer than 1% of patients stop taking the drug due to adverse effects. When allergic reactions do occur, they often involve skin reactions reactions, like hives, rashes and redness.  Symptoms of an allergic reactions to azithromycin also frequently include fever, irregular heartbeat and anaphylaxis.

Hives from allergic reaction to antibiotics

Azithromycin may interfere with the effectiveness of hormonal birth control pills, and additional forms of contraception may be required during treatment. Several blood thinning and immuno-suppressive medications are potentially contraindicated with azithromycin.  Antacids (particularly those that contain magnesium and calcium) decrease the absorption of the antibiotic from the digestive system.  As with most medications, pregnant women should consult their physician before beginning taking azithromycin.

For more in-depth information about potential side effects of azithromycin treatment, refer to the physician’s insert for azithromycin family antibiotics, or consult a medical professional.  For more information about contraindications in general, refer to Avoiding Negative Drug Interactions.

Azithromycin Background

Azithromycin (Zithromax) Molecule

Azithromycin belongs to a group of antibiotics called macrolides, which also includes the antibiotics erythromycin and clarithromycin.  Azithromycin inhibits bacterial growth by blocking the ability of the bacterium to synthesize new proteins.   Azithromycin is one of the world’s most popular antibiotics and is available in brand and generic forms in most places.  Azithromycin is popular because it has a broad spectrum of activity, is available as an oral medication and it requires fewer doses than most other antibiotics.

Azithromycin has a long half-life in the body (approximately 11-14 hours) and can penetrate deeply into tissue.  The antibiotic accumulates in white blood cells and is actively transported to the site of infection.  It can also accumulate in sebum, a feature which makes it an attractive antibiotic for the treatment of acne.  Azithromycin is used to treat many different types of infections including: Traveler’s diarrhea, respiratory tract infections, cellulitis,  chlamydia, cholera, leptospirosis, lyme disease, acute otitis media and malaria.  Azithromycin has a similar spectrum of antimicrobial activity as other macrolides, but is more effective against certain Gram-negative bacteria.  Unfortunately, bacterial resistance to azithromycin is increasing and is common in some areas.  Bacteria that are resistant to azithromycin are also likely to be resistant to other macrolide antibiotics, including: Clindamycin, clarithromycin and erythromycin.

Additional Names for Azithromycin: Amixef, Astro, Azadose, AzaSite, Azatril, Azax, Azee, Azenil, Azi-500, Azibiot, Azicid, Azihexal, Azimax, Azimed, Azimycin, Azithral, Azithrocine, Azithromicina, Azitromicina, Azithromycin, Azithrox, Azithrus, Azitrin, Azitrix, Azitromax, Azitromin, Azitromicin, Azitromycine, Azitrox, Aziva, Azro, Azromax, Azycyna, Azyter, Binozyt, Clamelle, Ericiclina, Goldamycin, Goxil, Imbys, Koptin, Maazi, Ribotrex, Samitrogen, Trozocina, Ultreon, Unizitro, Vinzam, Zaret, Zetamax, Zeto, Zetron, Zithro, Zithrogen, Zithromac, Zithrome, Zitrocin, Zitromax, Zitrotek, Zmax and Zomax.

Related Articles from The Science of Acne

Azithromycin User Reviews (Comprehensive)
Share Your Personal Experience With Azithromycin
Overview: The Major Antibiotic Families
Overview: Avoiding Negative Drug Interactions
A Guide to Buying Prescription Medications on the Internet
Overview: Prescription Medications Used in Acne Treatment
In Depth: Antibiotic Susceptibility of Propionibacterium acnes

References and Sources


PDR Staff Writers. 2011. 2011 Physicians’ Desk Reference
Gallagher. 2011. Antibiotics Simplified, Second Edition
Habif. 2009. Clinical Dermatology
Goodheart. 2006. Acne For Dummies
Bartlett. 2012. Johns Hopkins Antibiotics Guide 2012

Online Resources

Azithromycin @ PubMed Health – The National Institute of Health (US) offers basic comprehensive information about most common medications.
Azithromycin @ Wikipedia – Wikipedia is an excellent resource for learning about how medications work.
Azithromycin Physician’s Insert – The physician’s insert for a medication contains nearly all of the relevant information, including indications, dosage information and background data.

Scientific Research Articles

Parsad, et al. 2001. Azithromycin monthly pulse vs daily doxycycline in the treatment of acne vulgaris.
Kus, et al. 2005. Comparison of efficacy of azithromycin vs. doxycycline in the treatment of acne vulgaris.
Rafiei, et al. 2006. Azithromycin versus Tetracycline in the Treatment of Acne Vulgaris.
Gruber, et al. 1998. Azithromycin compared with minocycline in the treatment of acne comedonica and papulo-pustulosa.
Basta-Juzbasić, et al. 2007. A dose-finding study of azithromycin in the treatment of acne vulgaris.
Kapadia, et al. 2004. Acne treated successfully with azithromycin.
Singhi, et al. 2003. Comparison of oral azithromycin pulse with daily doxycycline in the treatment of acne vulgaris.
Ross, et al. 2003. Phenotypic and genotypic characterization of antibiotic-resistant Propionibacterium acnes isolated from acne patients attending dermatology clinics in Europe, the U.S.A., Japan and Australia.
Bardazzi, et al. 2007. Azithromycin: A New Therapeutical Strategy for Acne in Adolescents.