Azithromycin: Uses, Dose, Side Effects and Top Brands in India (2026)

• Updated 9 October 2026
• Reviewed by Sudhanshu Singhal
• 25 min read
• 29 sources

These MRPs were read from PharmEasy product listings on 9 October 2026; maximum retail prices can change, so please confirm the current price at a licensed pharmacy.

What is azithromycin?

Azithromycin is a macrolide antibacterial medicine, that is, an antibiotic that acts on susceptible bacteria and has no action on viruses. The US product label describes it as a macrolide antibacterial, while the UK Summary of Product Characteristics (SmPC) classes it under "Antibacterials for systemic use, macrolides", ATC code J01FA10, and calls it "the azalide azithromycin".

It works by binding to the 23S rRNA of the 50S ribosomal subunit of susceptible bacteria, inhibiting bacterial protein synthesis and impeding assembly of the 50S subunit, as stated in the US label. The UK SmPC describes the same action as inhibition of protein synthesis by binding the 50S subunit and inhibiting translocation of peptides.

Resistance is an important part of the picture. The US label reports cross-resistance with erythromycin, the commonest mechanism being methylation of the 23S rRNA target. The UK SmPC notes that most Gram-negative species are inherently resistant to macrolides because of low outer-membrane permeability.

After a single 500 mg oral or intravenous dose, the terminal elimination half-life is about 68 hours, which is thought to reflect extensive tissue uptake and slow release of the drug. It is eliminated mainly via the bile as unchanged drug, with about 6% of a dose appearing unchanged in urine over a week.

Forms and strengths listed in India

India's National List of Essential Medicines (NLEM 2022) lists azithromycin for Primary, Secondary and Tertiary care as tablet 250 mg, tablet 500 mg, oral liquid 200 mg/5 mL and powder for injection 500 mg, plus tablet 1000 mg under the syndromic management of sexually transmitted infections. The NPPA's ceiling-price table additionally lists capsules of 250 mg and 500 mg.

• Tablets 250 mg, commonly in strips of 6 or 10 tablets, and 500 mg in strips of 3 or 5 tablets (PharmEasy listings, October 2026).
• Oral suspensions of 100 mg/5 mL and 200 mg/5 mL in 15 mL and 30 mL bottles, and dry powder for oral suspension.
• Powder for injection 500 mg in a single-dose vial.

For reference, the US label carries 250 mg and 500 mg film-coated tablets, an oral suspension giving 100 mg/5 mL or 200 mg/5 mL after constitution, and a single-dose 500 mg lyophilised vial for intravenous use. The NHS states that tablets come in 250 mg or 500 mg, capsules are 250 mg, and the liquid is 200 mg in 5 mL.

Combination products

Some Indian packs combine azithromycin with Lactic Acid Bacillus 60 million spores, and the Vibcare range includes such combinations at the 250 mg and 500 mg strengths. Please read the pack of the product your pharmacist dispenses, and ask your doctor if anything is unclear.

What is azithromycin used for?

Azithromycin is used for a defined list of bacterial infections named in the product labels, mainly respiratory, skin, dental and some sexually transmitted infections, and it has no role in viral infections such as colds and flu.

Uses stated in the US label (adults)

• Acute bacterial exacerbations of chronic bronchitis.
• Acute bacterial sinusitis.
• Community-acquired pneumonia in patients suitable for oral therapy.
• Pharyngitis and tonsillitis due to Streptococcus pyogenes, as an alternative to first-line therapy.
• Uncomplicated skin and skin-structure infections.
• Urethritis and cervicitis due to Chlamydia trachomatis or Neisseria gonorrhoeae.
• Genital ulcer disease in men (chancroid due to Haemophilus ducreyi); efficacy in women is not established.

The same label adds an important limitation: azithromycin is not recommended for pneumonia in patients judged unsuitable for oral therapy because of moderate to severe illness or risk factors such as cystic fibrosis, hospital-acquired infection, known or suspected bacteraemia, hospitalisation, being elderly or debilitated, or significant underlying health problems including immunodeficiency or functional asplenia.

Uses stated in the US label (children)

For children, the label covers acute otitis media and community-acquired pneumonia from 6 months of age, and pharyngitis or tonsillitis from 2 years as an alternative to first-line therapy.

Uses stated in the UK SmPC

For adults and adolescents of at least 45 kg, the UK SmPC lists acute streptococcal tonsillitis and pharyngitis, acute bacterial sinusitis, acute bacterial otitis media, community-acquired pneumonia, acute bacterial skin and skin structure infections, erythema migrans (early localised Lyme disease), periodontal abscesses and periodontitis, chlamydial urethritis and cervicitis, gonococcal urethritis and cervicitis (in combination with another agent such as ceftriaxone), chronic prostatitis caused by Chlamydia trachomatis, and chancroid.

It also lists disseminated Mycobacterium avium complex infection in advanced HIV (given with ethambutol), MAC prophylaxis in people with HIV, and, in adults only, acute exacerbation of chronic bronchitis and pelvic inflammatory disease, the latter always combined with other antibacterials.

Uses stated in the injection label

The US injection label covers community-acquired pneumonia and pelvic inflammatory disease in adults who need initial intravenous therapy.

What it does not treat, and Indian guidance

Azithromycin does not treat viral infections. The US label states that antibacterials including azithromycin do not treat viral infections such as the common cold, and that prescribing without a proven or strongly suspected bacterial infection is unlikely to benefit the patient and raises the risk of resistant bacteria. MedlinePlus states plainly that antibiotics such as azithromycin will not work for colds, flu or other viral infections.

India's ICMR Treatment Guidelines for Antimicrobial Use in Common Syndromes (2nd edition, 2019) state that antimicrobial therapy is not indicated for viral upper respiratory infection, and that acute bronchitis is predominantly viral, so antibiotics are not indicated even if the sputum is purulent; macrolides are advised for pertussis if the cough lasts over 14 days. The same guidelines list azithromycin for streptococcal pharyngitis and acute otitis media in anaphylactic penicillin allergy, as atypical cover in community-acquired pneumonia, for typhoid fever (oral cotrimoxazole or azithromycin preferred), as an alternative in rickettsial infections, for cholera, and for Campylobacter diarrhoea. The guidelines also note that susceptibility testing is not validated for azithromycin in typhoid although response is good in most clinical studies, and that Shigella resistance to azithromycin and cefixime is nearing 20 percent.

Every medicine mentioned on this page is for information only. Prescription medicines must be taken only as prescribed by a doctor, who will decide whether your infection is bacterial and which antibiotic suits it.

Dose as stated in the labels

Every dose below is copied from the product labels and is given for information only; your doctor will prescribe the dose that suits you, and you must follow that prescription exactly. Follow your prescriber's directions throughout the course, do not share the medicine with another person, and stop the medicine and seek urgent medical advice whenever the label or your doctor tells you to do so, for example if signs of hepatitis appear.

Adults: US label (ZITHROMAX tablets and oral suspension)

The table gives examples of the doses stated in this label for the listed indications; your prescriber decides the regimen that applies to you.

Adults and adolescents of at least 45 kg: UK SmPC (tablets)

The table gives examples of the doses stated in the UK SmPC for the listed indications, taken as a single daily dose; your prescriber decides the regimen that applies to you.

Children: oral suspension

Children receive weight-based doses of the oral suspension, and these must be calculated and prescribed by a doctor.

The UK suspension label sets ceilings: the daily dose must not exceed the adult 500 mg, except the single-dose otitis media course whose maximum total is 1500 mg, and the maximum total dose for any course in a child under 45 kg is 1500 mg, except the 5-day tonsillitis regimen.

Injection: US label

For community-acquired pneumonia the label states 500 mg intravenously once daily for at least two days, then 500 mg orally daily to complete 7 to 10 days; for pelvic inflammatory disease, 500 mg intravenously daily for one or two days, then 250 mg orally daily to complete 7 days. The infusion is given at 1 mg/mL over 3 hours or 2 mg/mL over 1 hour, never as a bolus or intramuscular injection, and the 500 mg vial is reconstituted with 4.8 mL of sterile water to give 100 mg/mL.

Indian guidance: ICMR 2019

For respiratory infections the ICMR guidelines give azithromycin 500 mg orally or intravenously once daily for adults and 10 mg/kg once daily for children. For gastrointestinal infections they list cholera 1 g orally stat, Campylobacter diarrhoea 500 mg for 3 days, and bacterial dysentery 1 g once daily for 3 days.

Food, timing and missed dose

Azithromycin tablets and oral suspension can be taken with or without food, according to both the US label and MedlinePlus. The UK SmPC adds that tablets may be taken with or without a meal and that taking a dose just before a meal may make it easier on the stomach; for the suspension, a dose just before a meal may improve gastrointestinal tolerability.

The NHS advises taking capsules or tablets at least 1 hour before food or 2 hours after eating, while the liquid can be taken with or without food. Because the sources differ, follow the label of the product you were given and the instruction your doctor has written.

On food effect, the US label reports that a high-fat meal raised tablet peak levels (Cmax) by 23% with no change in total exposure (AUC), and suspension Cmax by 56% with AUC unchanged. The UK SmPC reports similar exposure fed and fasted for tablets and suspension, while the 250 mg capsule had 52% lower Cmax and 43% lower AUC with a high-fat meal.

If you miss a dose, the UK SmPC says to take it as soon as possible if 12 hours or less have passed since the usual time; if more than 12 hours have passed, wait for the next scheduled dose. The NHS adds that you should never take two doses together. The US label warns that skipping doses or not completing the course may decrease the effectiveness of the treatment and increase the likelihood of resistant bacteria.

The UK SmPC states that no dose adjustment is needed for a GFR of 10 mL/min or above (with caution below that), none for mild or moderate hepatic impairment (with caution in severe impairment, and no data in Child-Pugh C), and none for the elderly.

Side effects

Most side effects reported in the azithromycin trials were mild to moderate and reversible on stopping, but a small number of reactions are serious and need urgent medical help. In the US 5-day multiple-dose trials about 0.7% of patients stopped treatment because of treatment-related reactions, and these were mostly gastrointestinal (nausea, vomiting, diarrhoea, abdominal pain).

Common side effects and their frequencies

The frequencies below are those printed in the labels, so they are a guide to what was observed in studies, not a prediction for any individual.

• US label, adults on multiple-dose regimens: diarrhoea or loose stools 4 to 5%, nausea 3%, abdominal pain 2 to 3%, with nothing else above 1%.
• US label, single 1 gram dose: diarrhoea or loose stools 7%, nausea 5%, abdominal pain 5%, vomiting 2%, dyspepsia 1%, vaginitis 1%.
• US label, single 2 gram dose: nausea 18%, diarrhoea or loose stools 14%, vomiting 7%, abdominal pain 7%, vaginitis 2%, dyspepsia 1%, dizziness 1%.
• UK SmPC, very common (1 in 10 or more): diarrhoea. Common (1 in 100 to under 1 in 10): headache, vomiting, abdominal pain, nausea and some blood-test changes (lymphocyte count decreased, eosinophil count increased, bicarbonate decreased).
• UK SmPC, uncommon (1 in 1,000 to under 1 in 100): candida or thrush, dizziness, taste change, tingling, drowsiness, rash, itching, urticaria, indigestion, constipation, raised AST/ALT, fatigue and myalgia. Rare: AGEP, DRESS, photosensitivity, abnormal liver function, cholestatic jaundice and agitation.
• US label, children: in the 5-day pneumonia course, diarrhoea or loose stools 5.8%; in the 5-day pharyngitis course, vomiting 5.6% and diarrhoea 5.4%.

Serious side effects that need urgent medical help

Macrolides including azithromycin can prolong the QT interval and cause torsades de pointes. People at higher risk include those with known QT prolongation, a history of torsades, congenital long QT, bradyarrhythmias, uncompensated heart failure, uncorrected low potassium or magnesium, and users of QT-prolonging drugs; the elderly may be more susceptible. In 116 healthy volunteers given azithromycin with chloroquine, the maximum mean QTcF rise was 5, 7 and 9 milliseconds with 500, 1000 and 1500 mg.

Some observational studies showed about a two-fold higher short-term risk of acute cardiovascular death with azithromycin compared with other antibacterials including amoxicillin, in the range of 20 to 400 per million treatment courses over five days; the data are insufficient to establish or exclude causation.

Abnormal liver function, hepatitis, cholestatic jaundice, hepatic necrosis and hepatic failure have been reported, some fatal, and treatment must stop immediately if signs of hepatitis occur. The UK SmPC lists rapidly developing weakness with jaundice, dark urine, bleeding tendency or hepatic encephalopathy as warning signs.

Angioedema, anaphylaxis, AGEP, Stevens-Johnson syndrome, toxic epidermal necrolysis and DRESS have been reported, some fatal, and allergic symptoms can recur after initial treatment because of the long tissue half-life. Diarrhoea caused by Clostridioides difficile, ranging from mild diarrhoea to fatal colitis, can occur up to more than two months after antibiotics, so watery or bloody stools should prompt a call to the doctor.

Other labelled warnings include worsening of myasthenia gravis, infantile hypertrophic pyloric stenosis after use in newborns up to 42 days of life, and post-marketing reports of hearing loss, deafness, tinnitus and loss or distortion of taste and smell. The UK SmPC lists seizures, syncope, thrombocytopenia, haemolytic anaemia, acute kidney injury, tongue discolouration, arthralgia, pseudomembranous colitis and pancreatitis among reactions whose frequency is not known.

MedlinePlus advises stopping the medicine and calling a doctor or seeking emergency care for a fast, pounding or irregular heartbeat, rash with or without fever, severe watery or bloody diarrhoea, yellowing of the skin or eyes, hives, or wheezing or trouble breathing or swallowing.

Because dizziness, drowsiness, convulsions and visual or auditory impairment have been reported, the UK SmPC describes a moderate influence on the ability to drive and use machines, and the NHS says that if you feel dizzy you should not drive, cycle or use machinery. In an overdose the effects are similar to those at normal doses, mainly nausea, vomiting, diarrhoea and abdominal pain, and treatment is symptomatic and supportive.

Who should not take it, and interactions

Azithromycin is contraindicated in people who are allergic to it or to other macrolides, and it has to be used with care alongside several common medicines.

Contraindications

• Known hypersensitivity to azithromycin, erythromycin, any macrolide or ketolide (US label and UK SmPC).
• A history of cholestatic jaundice or hepatic dysfunction associated with previous azithromycin use (US label).
• Hypersensitivity to any excipient (UK SmPC). The UK tablet contains lactose and is not for people with rare galactose intolerance, lactase deficiency or glucose-galactose malabsorption; the UK suspension contains sucrose 3.9 g per 5 mL, glucose and benzyl alcohol 0.35 microgram per 5 mL, which may cause allergic reactions.

Tell your doctor before taking it if you have

• Heart rhythm problems or heart failure, or low potassium or magnesium.
• Liver problems.
• Severe diarrhoea after other antibiotics.
• Myasthenia gravis.
• A prescription for ergot derivatives; the UK SmPC says ergot derivatives and azithromycin should not be given together.

Key interactions

• Warfarin: post-marketing reports of potentiated anticoagulation, although prothrombin time was unchanged in the dedicated study, so prothrombin time should be monitored.
• Nelfinavir raises azithromycin levels; no dose change is required, but liver enzymes and hearing should be monitored.
• Digoxin and colchicine: azithromycin inhibits P-glycoprotein, so exposure to these drugs may rise; the UK SmPC records a 57% rise in colchicine AUC. Careful monitoring is advised with digoxin, colchicine and phenytoin.
• Ciclosporin, dabigatran (haemorrhage reports) and statins (rhabdomyolysis reports) need caution or monitoring.
• QT-prolonging medicines to use with caution include class IA antiarrhythmics such as quinidine and procainamide, class III agents such as dofetilide, amiodarone and sotalol, and also pimozide, citalopram, moxifloxacin, levofloxacin, cisapride, chloroquine and hydroxychloroquine.
• The US label found no need for dosage adjustment with atorvastatin, carbamazepine, cetirizine, didanosine, efavirenz, fluconazole, indinavir, midazolam, sildenafil, theophylline and others tested.

Pregnancy and breastfeeding

In pregnancy, the US label reports that published data and decades of post-marketing experience have not identified drug-associated risks of major birth defects, miscarriage, or adverse maternal or fetal outcomes, and animal studies found no malformations. The UK SmPC states that over 7,000 exposed pregnancies in observational studies do not suggest an increased risk of malformations, the evidence on miscarriage is inconclusive, and the medicine should be used only if clinically needed. The decision always belongs to your doctor.

In breastfeeding, the US label reports that azithromycin is present in human milk, with non-serious reactions reported in breastfed infants; the infant should be monitored for diarrhoea, vomiting or rash, and the drug was detected in milk up to 4 weeks after a single 2 g dose given in labour in 20 women. The UK SmPC says it is excreted in milk to a substantial extent and the benefit of breastfeeding should be weighed against the treatment, while the NHS says it passes into milk in small amounts and may be suitable if the baby is healthy, after talking to a doctor or pharmacist.

Alcohol and contraception

The NHS states that you can drink alcohol with azithromycin, but not if the medicine makes you dizzy; the US label, the UK SmPC and the MedlinePlus page make no statement about alcohol. Azithromycin does not stop any type of contraception working, but vomiting or severe and prolonged diarrhoea can make contraceptive pills less reliable.

Notes on sexually transmitted infections

The US label says azithromycin should not be relied on to treat syphilis, and antibiotics given for sexually transmitted infections may mask incubating syphilis. The UK SmPC states that Neisseria gonorrhoeae is very likely to be macrolide-resistant, so azithromycin is not recommended for uncomplicated gonorrhoea or pelvic inflammatory disease unless susceptibility is confirmed.

Rules in India

In India, azithromycin is a Schedule H antibiotic that can be sold by retail only on the prescription of a Registered Medical Practitioner, and the NPPA fixes ceiling prices for its tablet, capsule, liquid and injection forms.

Schedule H and the Red Line campaign

Under the Drugs and Cosmetics Rules, 1945 (CDSCO consolidated text amended up to 31 December 2016), Schedule H item 32 is "Antibiotics", and the rule 97 label carries the Rx symbol and the words "Schedule H drug - Warning: To be sold by retail on the prescription of a Registered Medical Practitioner only". A Press Information Bureau release of a Lok Sabha reply dated 10 February 2023 confirms that antibiotics are included in Schedule H and H1 and are sold only under a Registered Medical Practitioner's prescription, that Schedule H1 supplies are recorded in a separate register kept for three years, and that CDSCO has placed 24 high-end antimicrobials under Schedule H1.

In that same consolidated text, azithromycin is not named in the Schedule H1 list of 46 drugs, which includes cefixime, cefpodoxime, ceftriaxone, levofloxacin, moxifloxacin, meropenem and rifampicin. The Ministry of Health and Family Welfare has also run a Red Line awareness campaign on antimicrobial resistance, urging people not to use medicines marked with a red vertical line, including antibiotics, without a doctor's prescription.

NLEM 2022 and NPPA ceiling prices

The National List of Essential Medicines 2022, notified as Schedule-I of the DPCO 2013 by S.O. 5249(E) dated 11 November 2022, lists azithromycin for Primary, Secondary and Tertiary care as tablet 250 mg, tablet 500 mg, oral liquid 200 mg/5 mL and powder for injection 500 mg, plus tablet 1000 mg for the syndromic management of sexually transmitted infections. As checked on 9 October 2026, the ceiling prices come from order S.O. 1575(E) dated 25 March 2026 (Gazette of India Extraordinary No. 1510), effective 1 April 2026, with a Wholesale Price Index uplift of 0.64956%, and are exclusive of Goods and Services Tax; orders issued after 7 October 2026 were not verified for this page.

WHO AWaRe group

In the WHO AWaRe classification of antibiotics 2025, published on 5 September 2025, azithromycin (macrolides, ATC J01FA10) is placed in the WATCH group, which carries a higher resistance potential and is a key target of stewardship programmes and monitoring. It also appears on the WHO Model List of Essential Medicines 2025 (24th list) and on the Children's list (10th).

Azithromycin brands listed on PharmEasy

The brands shown in the table at the top of this article were seen on the PharmEasy marketplace on 9 October 2026, and the table is a marketplace listing, not a sales ranking. There is no published sales ranking for azithromycin brands in India in the sources consulted for this page, and no brand is described here as a best seller. The 500 mg, 5-tablet strips cluster around ₹126 to ₹127 per strip, which works out to about ₹25.3 per tablet, a little above the NPPA ceiling price of ₹24.14 per tablet that is exclusive of GST. Azithral and Azee are also listed with 500 mg injection vials at about ₹218.69 and ₹218.67, and Azee, Azithral and Zithrox suspensions of 200 mg/5 mL in 15 mL bottles at about ₹54.95 to ₹54.97. Product labels support no claim that one brand is better than another, so ask your prescriber or pharmacist about the product that is dispensed.

The Vibcare range

Vibcare Pharma markets 15 azithromycin products in 5 compositions: 200 mg oral liquids (suspension and syrup) in 15 mL bottles, tablets of 250 mg and 500 mg in blister packs, and tablets combining azithromycin 250 mg or 500 mg with Lactic Acid Bacillus 60 million spores. These are sold under the Azivib (Prima), Everazi (Evermed), Jemazi (Auspin) and Norazi (Medanor) names.

The range is available to Vibcare PCD franchise partners, who are appointed one per district with monopoly rights confirmed in writing.

Frequently asked questions

Sources

Related reading

• PCD pharma franchise with Vibcare
• Browse the Vibcare product range