Nutritional Considerations

• Antibiotics kill sensitive bacteria, including beneficial flora in the gut, which could affect digestion and/or elimination. Take probiotics - such as Lactobacillus casei, Lactobacillus acidophilus, Bifidobacterium longum, or Saccharomyces boulardii species - to help prevent common side effects of antibiotic therapy, such as diarrhea or yeast infections (Candida albicans) in the vagina or intestines.

  1. Bengmark S & Gianotti L: Nutritional support to prevent and treat multiple organ failure. World J Surg, 1996 May, 20:4, 474-81.
  2. Fuller R. Probiotics in human medicine. Gut 1991;32:439-42 [review].
  3. Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents. A neglected modality for the treatment and prevention of selected intestinal and vaginal infections. JAMA 1996;275:870-76.
  4. Cummings JH, Macfarlane G: Role of intestinal bacteria in nutrient metabolism, JPEN J Parenter Enteral Nutr, 1997, 21(6): 357-65.
  5. Gorbach SL: Bengt E. Gustafsson Memorial Lecture, Function of the Normal Human Microflora, Scand J Infect Dis Suppl, 1986, 49:17-30.

• Taking supplements and zithromax together may affect the absorption of both the medication and the supplementation. Therefore, zithromax should be taken at least 2 hours apart from supplementation with calcium, magnesium, zinc, and iron.

  1. Watson, A. et al: Severe hypomagnesaemia and hypocalcaemia following gentamicin therapy. Irish Med. J. 1983, 76: 381-383.
  2. Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer Company, 2000
  3. Foulds G, Hilligoss DM, Henry EB, Gerber N. The effects of an antacid or cimetidine on the serum concentrations of azithromycin. J Clin Pharmacol 1991; 31:164-67.

• Vitamin K - Zithromax may interfere with the absorption of vitamin K, which can cause excessive bleeding. Take 100 mcg of vitamin K per day to avoid depletion, or eat more leafy green vegetables while taking the drug.

  1. Suzuki K, Fukushima T, Meguro K, et al. Intracranial hemorrhage in an infant owing to vitamin K deficiency despite prophylaxis. Childs Nerv Syst 1999;15:292-4
  2. Huilgol VR, Markus SL, Vakil NB. Antibiotic-induced iatrogenic hemobilia. Am J Gastroenterol 1997;92:706-7
  3. Bandrowsky T, Vorono AA, Borris TJ, Marcantoni HW. Amoxicllin-related postextraction bleeding in an anticoagulated patient with tranexamic acid rinses. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;82:610-2
  4. Kaiser CW, McAuliffe JD, Barth RJ, Lynch JA. Hypoprothrombinemia and hemorrhage in a surgical patient treated with cefotetan. Arch Surg 1991;126:524-5

• Magnesium- and aluminum-containing antacids were reported to interfere with Zithromax absorption in a study of ten healthy people. People can avoid this interaction by taking Zithromax two hours before or after any aluminum/magnesium-containing antacids. No studies have yet shown that magnesium nutritional supplements negatively affect absorption of this drug.

  1. Foulds G, Hilligoss DM, Henry EB, Gerber N. The effects of an antacid or cimetidine on the serum concentrations of azithromycin. J Clin Pharmacol 1991; 31:164-7