Azithromycin 500mg Tablets

How does Azithromycin treat travellers' diarrhoea?

Azithromycin is a first-line antibiotic treatment for traveller’s diarrhoea (TD) caused by common bacterial infections. It is an antibiotic that kills diarrhoea-causing bacteria and reduces the symptoms and duration of this illness, especially when taken with loperamide - a treatment to help reabsorb water from the large intestine. The dose of Azithromycin is one tablet daily for three days. Begin taking Azithromycin as soon as you develop diarrhoea, not before. It cannot be used as a preventative measure. You can also take an anti-sickness tablet, such as Avomine, to minimize fluid loss and discomfort.

What countries is Azithromycin recommended for use in TD?

Azithromycin is the preferred antibiotic for treating travellers' diarrhoea in South Asia (India, Pakistan) or South East Asia (Thailand, Laos, Cambodia, Vietnam etc.). In other parts of the world, the antibiotic Ciprofloxacin is preferred.

What is travellers' diarrhoea?

Travellers' diarrhoea is a common condition affecting 20-50% of international travellers. It usually occurs during the first two weeks of travel to a foreign country, especially in the developing world where it can affect up to 60% of travellers. Symptoms include passing three or more unformed stools within 24 hours, often accompanied by nausea, stomach pain, bloating, vomiting and/or fever.

The illness can be contracted when the body is exposed to unfamiliar bacteria. Bacterial infections normally account for around 85% of cases. For the local population, these bacteria are often harmless but for a foreign traveller, they may result in infection. Viruses and parasites may also account for a minority of travellers’ diarrhoea.

It is important to take the suggested dosage of Azithromycin before symptoms become any worse. The organisms that cause traveller's diarrhoea include bacteria such as E. coli and Salmonella, parasites such as Giardia and viruses like norovirus.

How can I avoid travellers' diarrhoea?

The organisms that cause TD can be contracted through contaminated food and beverages as well as contact with dirty hands and plates. Avoiding contaminated foods is the most effective way to prevent Traveller's Diarrhoea.

Basic precautions include:

• Drink only safe water and beverages that have been boiled, bottled or distilled. Avoid tap water and hot drinks which have not been boiled.
• Avoid ice cubes as they may be made with contaminated tap water.
• Avoid ice cream and other frozen desserts as many developing countries experience frequent power cuts which means these products can defrost and refreeze at unsafe temperatures.
• Avoid raw fruit and vegetables that you have not peeled.
• Avoid salads as they may have been washed with contaminated water.
• Wash your hands before eating.

Standby treatment is recommended for the following travellers:

• Travellers who often experience diarrhoea while travelling abroad
• Travellers with bowel conditions such as IBS.
• Travellers to destinations far from medical help.
• Travellers who have conditions which may be aggravated by severe dehydration/diarrhoea.

OTC (over the counter medication) alternative for Travellers' Diarrhoea

In some more simple cases, travellers' diarrhoea can be treated with over-the-counter medicines. These medicines include Loperamide (Imodium) and rehydration sachets (Dioralyte). Using these products together will help ease the symptoms, and this will help as your body is trying to fight off the infection. You must also ensure you remain hydrated so take on as much fluids as possible during this time, as dehydration is the most dangerous consequence of Travellers' diarrhoea.

Warnings

Do not take Azithromycin tablets if:

• You have liver, kidney, or heart problems.
• You have low levels of potassium or magnesium.
• You develop symptoms of another infection.
• You take any derivatives of ergot such as ergotamine (for migraines).
• You have muscle weakness, myasthenia gravis.
• You have neurological or psychiatric problems.

Consult your doctor or pharmacist if you are taking any of the following medicines:

• Antacids - Azithromycin should be taken at least 1 hour before or 2 hours after the antacid.
• Ergotamine (for migraine treatment). It should not be taken with Azithromycin as the combination may cause serious side effects such as numbness or tingling in the limbs, headaches, muscle cramps, convulsions, chest or abdominal pain.
• Cholesterol-lowering tablets (statins).
• Warfarin or similar medicines (blood thinners). Azithromycin can further thin the blood.
• Cisapride (for stomach problems). This medication should not be taken with Azithromycin as severe heart problems may result.
• Terfenadine (for hay fever). When taken with Azithromycin, severe heart problems may develop.
• Zidovudine or Nelfinavir (for HIV treatment). Taking nelfinavir with Azithromycin may make you susceptible to more of the side effects listed in this leaflet.
• Rifabutin (for tuberculosis treatment).
• Quinidine (for treatment of heart rhythm problems).
• Cyclosporine (for preventing organ-rejection). Your doctor will regularly check your blood levels of cyclosporine and may change your dose.

Please read all packaging and the Product Information Leaflet before taking any new medications. Inform your doctor about any medications you take or intend to take.

If you notice blood in your stools or vomit, or you suffer from fever, chills, or severe headache your infection may be more serious and you should see a doctor as soon as possible.

Dosage

How to take Azithromycin tablets for TD (antibiotics)

• Take one tablet a day for 3 days.
• Continue the course until it is complete unless a doctor directs otherwise.
• Start taking Azithromycin as soon as symptoms of traveller’s diarrhoea occur. These include diarrhoea, sickness, nausea and stomach cramps.

How to take Loperamide capsules (anti-diarrhoeal)

• Take two capsules at the onset of diarrhoea, followed by a further capsule after each loose bowel movement.
• You should never take more than 8 capsules in 24 hours.

How to take Dioralyte sachets (rehydration sachets)

• Dissolve the contents of one sachet in roughly 200ML of fresh drinking water. Where fresh drinking water is unavailable, you should use water that has been freshly boiled and cooled.
• The solution should be made up immediately before use and consumed within one hour. If it is possible to refrigerate the mixture it can be stored for up to 24 hours.

Ingredients

Azithromycin 500mg tablets contain:

Active ingredient: azithromycin 500mg.

Inactive ingredients: croscarmellose sodium (E468), magnesium stearate (E572), silicium dioxide (E551), microcrystalline cellulose (E460), poloxamer, povidone (E1201), talc waterfree lactose.

Coating: hypromellose (E464), hydroxypropyl cellulose, macrogol, titanium dioxide (E171).

Side effects

Side effects can include:

Mild allergic reactions (serious reactions are rare). If you develop any of the following symptoms, contact your doctor immediately.

• Sudden difficulty in speaking, breathing and swallowing
• Swollen lips, face, tongue and neck
• Extreme dizziness or fainting
• Severe or itchy skin rash, especially if it includes blistering and the eyes, mouth or genital organs become sore.

Contact your doctor as soon as possible if you develop any of the following symptoms:

• Diarrhoea that lasts a long time, is serious or has blood, accompanied by stomach pain or fever. This can signal a rare but serious bowel inflammation.
• Yellowing of the whites of the eyes or skin as this can signal liver problems.
• Severe pain in the abdomen and back which can indicate inflammation of the pancreas.
• Reduced or increased urine output, or traces of blood in the urine
• Skin rash caused by photosensitivity
• Unusual bruises or bleeding
• Irregular heartbeat.

Other common side effects:

• Diarrhoea
• Abdominal pain
• Nausea
• Flatulence
• Lack of appetite
• Feeling dizzy
• Headache
• Tingly sensation or numbness
• Changes in your sense of taste
• Vision impairment
• Deafness
• Vomiting, stomach pain or cramps, digestion problems
• Skin rashes and itching
• Joint pain
• Fatigue
• Change in the concentration of bicarbonate in the blood and the quantity of the white blood cells.

If you are concerned about these effects, or if the product affects you in a different way, stop using Azithromycin and talk to your doctor or pharmacist.