Usage
- Azithromycin + Lactic acid bacillus is prescribed for the treatment of various bacterial infections, including respiratory tract infections (bronchitis, pneumonia, pharyngitis, tonsillitis, sinusitis), skin and soft tissue infections, ear infections, and sexually transmitted infections. It is also used to support gut health during antibiotic therapy.
- Pharmacological classification: Antibiotic (Azithromycin) and Probiotic (Lactic acid bacillus).
- Mechanism of action: Azithromycin inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit. Lactic acid bacillus helps restore the balance of gut flora, which can be disrupted by antibiotic use.
Alternate Names
- This combination is often referred to as Azithromycin with probiotics.
- Brand names: OZISET LB, PANZITH 500 LB, Azithox LB, AZIDO 500 LB.
How It Works
- Pharmacodynamics: Azithromycin exerts bacteriostatic or bactericidal effects depending on the bacterial species and drug concentration. Lactic acid bacillus helps maintain a healthy gut microbiome and prevents the overgrowth of pathogenic bacteria.
- Pharmacokinetics: Azithromycin is acid-stable and well-absorbed orally. It achieves high tissue concentrations and has a long half-life, allowing for once-daily dosing. It is metabolized in the liver and excreted in bile and urine. Lactic acid bacillus is not absorbed systemically; its action is primarily localized in the gut.
- Mode of action: Azithromycin inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit. It interferes with transpeptidation and translocation steps, ultimately leading to bacterial growth inhibition or death. Lactic acid bacillus produces lactic acid, creating an acidic environment in the gut that is unfavorable for the growth of many harmful bacteria. Lactobacillus also competes with pathogenic bacteria for nutrients and adhesion sites in the gut, further limiting their growth.
- Elimination pathways: Azithromycin is primarily eliminated via biliary excretion, with a smaller fraction excreted unchanged in urine.
Dosage
Standard Dosage
Adults:
- A common dosage is 500 mg once daily for 3 to 5 days, depending on the infection. Some infections may require higher initial doses (1g or 2g) followed by lower doses for several days. For long-term use in preventing chest infections, 250mg may be prescribed three times a week.
Children:
- The dosage for children is weight-based and must be determined by a pediatrician. A common pediatric regimen is 10 mg/kg/day for 3 days or 10 mg/kg on Day 1 followed by 5 mg/kg on Days 2-5. It is generally recommended for children above 6 months of age.
Special Cases:
- Elderly Patients: Dose adjustments may be necessary based on renal and hepatic function.
- Patients with Renal Impairment: Dosage adjustment may be required depending on the degree of impairment.
- Patients with Hepatic Dysfunction: Caution should be exercised, and dosage adjustments may be needed.
- Patients with Comorbid Conditions: Pre-existing conditions like myasthenia gravis, heart rhythm disorders, or electrolyte imbalances should be carefully considered.
Clinical Use Cases
- The provided sources do not specify dosage recommendations for clinical scenarios like intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations. Dosing in these cases should be guided by the specific infectious organism, patient-specific factors, and clinical guidelines.
Dosage Adjustments
- Dosage adjustments should be considered in patients with renal or hepatic impairment, severe electrolyte imbalances, and those taking interacting medications. Consult with a nephrologist or hepatologist for specific recommendations.
Side Effects
Common Side Effects
- Diarrhea
- Nausea
- Vomiting
- Stomach discomfort
- Indigestion
- Headache
Rare but Serious Side Effects
- Allergic reactions (anaphylaxis)
- Clostridioides difficile infection
- Liver dysfunction
- QT interval prolongation and related arrhythmias
- Hearing loss or tinnitus (especially with long-term use)
Long-Term Effects
- Hearing loss or tinnitus.
- Changes in gut microbiota.
- Development of antibiotic resistance.
Adverse Drug Reactions (ADR)
- Severe allergic reactions (anaphylaxis).
- Clostridioides difficile infection.
- Hepatotoxicity.
- Torsades de pointes.
Contraindications
- Hypersensitivity to azithromycin, erythromycin, other macrolides, or lactic acid bacillus.
- History of cholestatic jaundice or hepatic dysfunction associated with prior azithromycin use.
Drug Interactions
- Antacids may reduce the absorption of azithromycin.
- Azithromycin may enhance the effects of warfarin and other anticoagulants.
- Concomitant use with drugs that prolong the QT interval (e.g., antiarrhythmics, some antipsychotics) should be avoided.
- Interactions with colchicine, cyclosporine, digoxin, nelfinavir, zidovudine, and theophylline have been reported.
- Alcohol should be avoided, as it can worsen some side effects.
Pregnancy and Breastfeeding
- While generally considered safe in pregnancy, caution is advised, and it should only be used if clearly needed. Some studies suggest potential risks with high doses or multiple courses during pregnancy.
- Azithromycin passes into breast milk. While generally considered safe during breastfeeding, it is advisable to monitor the infant for potential side effects such as diarrhea or thrush.
Drug Profile Summary
- Mechanism of Action: Azithromycin inhibits bacterial protein synthesis; Lactic acid bacillus supports gut health.
- Side Effects: Diarrhea, nausea, vomiting, stomach discomfort, indigestion, headache. Rarely, allergic reactions, liver problems, and QT prolongation.
- Contraindications: Hypersensitivity to azithromycin, macrolides, or lactic acid bacillus; history of cholestatic jaundice/hepatic dysfunction with prior azithromycin use.
- Drug Interactions: Antacids, anticoagulants, QT prolonging drugs, colchicine, cyclosporine, digoxin, nelfinavir, zidovudine, theophylline, alcohol.
- Pregnancy & Breastfeeding: Generally safe but use with caution. Monitor infant for side effects during breastfeeding.
- Dosage: Adults: 500mg daily for 3-5 days (or as directed). Children: Weight-based dosing.
- Monitoring Parameters: Liver function tests, ECG (for QT interval), complete blood counts, signs of superinfection (e.g., C. difficile).
Popular Combinations
- The combination of Azithromycin and Lactic acid bacillus itself is a popular combination to treat bacterial infections while minimizing gut flora disruption. No other specific combinations are noted in the sources.
Precautions
- General Precautions: Assess for allergies, liver and kidney function, concomitant medications, and history of QT prolongation. Advise patients to complete the full course of therapy even if symptoms improve.
- Specific Populations: Pregnancy and breastfeeding (use with caution); children (weight-based dosing); elderly (consider renal/hepatic function).
- Lifestyle Considerations: Avoid alcohol during treatment.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Azithromycin + Lactic acid bacillus?
A: Adults: Typically 500mg once daily for 3-5 days, depending on the infection. Children: Weight-based dosing, usually 10mg/kg/day for 3 days or a 5-day regimen.
Q2: What are the common side effects?
A: Diarrhea, nausea, vomiting, stomach upset, and indigestion.
Q3: Can this combination be used in pregnancy or breastfeeding?
A: Generally safe, but consult a physician. Monitor the infant for side effects during breastfeeding.
Q4: What are the serious side effects to watch out for?
A: Allergic reactions, liver problems, C. difficile infection, and QT prolongation/arrhythmias.
Q5: What are the drug interactions to be aware of?
A: Antacids, anticoagulants, QT prolonging drugs, colchicine, cyclosporine, digoxin, nelfinavir, zidovudine, theophylline, and alcohol.
Q6: What should patients be advised regarding lifestyle during treatment?
A: Avoid alcohol. Maintain a balanced diet and adequate hydration.
Q7: How does lactic acid bacillus help when taking azithromycin?
A: It helps prevent antibiotic-associated diarrhea and maintain a healthy gut flora balance.
Q8: Can Azithromycin + Lactic acid bacillus treat viral infections?
A: No. It is effective only against bacterial infections.
Q9: Can I take this medicine if I have liver or kidney problems?
A: Consult your doctor. Dosage adjustments may be necessary.
Q10: What should I do if I miss a dose?
A: Take the missed dose as soon as you remember, unless it’s close to the time of your next dose. Do not double the dose.
