Azithromycin for Sinusitis, Bronchitis

Azithromycin (Z-pack, Zithromax) is currently recommended by several medical societies for the treatment of community-acquired pneumonia, acute exacerbations of chronic bronchitis, and acute bacterial sinusitis.

Azithromycin for Sinus infection

Azithromycin is used to treat acute sinus infections. It achieves excellent mucosal levels but is considered a second-line choice. Also, azithromycin is not recommended for chronic sinusitis (which lasts more than 3 months).

Azithromycin (Z-Pack) dosage for sinusitis:
Adults: 500 mg once a day for 3 days.
Children aged 6 months and up: the usual dose of suspension is 10 mg/kg given once daily for 3 days.

How long does it take for azithromycin to work? It takes until day 3 before your really start feeling better. Azithromycin concentrations in sinus fluids are maintained up to 120 h, so continues to work 5-6 days after you finish it 2.

How effective is azithromycin? One study found that a 3-day course of azithromycin was as effective as a 10-day course of amoxicillin/clavulanate in treating acute sinusitis 1. However, azithromycin is not likely an optimal choice in sinusitis because of increased Pneumococcal resistance to macrolides.

Azithromycin for Bronchitis

Azithromycin is commonly used in the treatment of acute exacerbations of chronic bronchitis and acute bronchitis4 (a transient inflammation of the trachea and bronchi).

Independent of its potent antimicrobial activity, azithromycin possesses anti-inflammatory properties that contributes to benefits in patients with airway inflammation. Azithromycin can normalize bronchial and nasal mucus secretion, and may reduce bronchial hyperresponsiveness and sputum purulence.

Azithromycin (Z-Pack) dosage for acute bronchitis: 500 mg initially, then 250 mg daily for 4 days.

How quickly does azithromycin begin working? Azithromycin is bacteriostatic. Bacteriostatic antibiotic stops the growth of bacteria and works slower than bactericidal, which kills bacteria. So it takes time to notice the improvement with azithromycin.

Note: Antibiotics are generally not indicated for bronchitis, and should be used only if pertussis is suspected or if the patient is at increased risk of developing pneumonia5.

See also


  • 1. Klapan I, Culig J, Oresković K, Matrapazovski M, Radosević S. Azithromycin versus amoxicillin/clavulanate in the treatment of acute sinusitis. Am J Otolaryngol. 1999 Jan-Feb;20(1):7-11. PubMed
  • 2. Ehnhage A, Rautiainen M, Fang AF, Sanchez SP. Pharmacokinetics of azithromycin in serum and sinus fluid in patients with acute bacterial sinusitis. Int J Antimicrob Agents. 2008 Jun;31(6):561-6.
  • 3. ZITHROMAX® Label Information PDF
  • 4. Panpanich R, Lerttrakarnnon P, Laopaiboon M. Azithromycin for acute lower respiratory tract infections. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD001954.
  • 5. Albert RH. Diagnosis and treatment of acute bronchitis. Am Fam Physician. 2010 Dec 1;82(11):1345-50.
  • 6. Amsden GW, Baird IM, Simon S, Treadway G. Efficacy and safety of azithromycin vs levofloxacin in the outpatient treatment of acute bacterial exacerbations of chronic bronchitis. Chest. 2003 Mar;123(3):772-7. PubMed

Author: OriginalDrugs Team
Last reviewed: February, 2016

Quick facts

zithromax z-pack

  • Five-day course of azithromycin is equivalent to a 7-day course of levofloxacin in the treatment of acute exacerbations of chronic bronchitis6.