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Why Do Z-Paks Get Such a Bad Rap?

After several days in bed, binging Netflix, and ordering in soup, you still can’t seem to fight off the cold that has taken over your life.

With your bed and floor covered with a million crumbled tissues, you may wonder if it’s time to call in for backup with a Z-pak. But before you schedule an appointment with your doctor, think again about asking for this antibiotic, because you might not get it.

Although lauded as a “miracle” drug back in the day for its ability to treat billions of conditions, we now know antibiotics like Z-paks (AKA azithromycin, Zithromycin) aren’t cure-alls—especially for the common cold. While antibiotics are great at treating certain bacterial infections, colds are caused by a virus. So, taking these types of drugs unnecessarily are not only futile, but potentially harmful in the long run.

The rise of antimicrobial resistance

Today, doctors have a better understanding of which antibiotics are best used for which illnesses and how the overuse (and misuse) of antibiotics like Z-paks contribute to antibiotic resistance. The more we use antibiotics inappropriately, the more we create bacteria that are resistant.

“It’s interesting that we used to think of azithromycin as a cure-all for everything, because that’s what led to overprescribing and its demise,” said Emir Kobic, a clinical pharmacy specialist in infectious diseases at Banner - University Medical Center Phoenix. “It’s no longer the first line antibiotic physicians should be prescribing for patients with community-acquired pneumonia where Streptococcus pneumoniae still tends to be the most common bacterial culprit.”

“The inappropriate use and overuse of Z-paks has led Streptococcus pneumoniae resistance rates to rise as high as 20-30% in America,” Dr. Kobic said. “This stat should be concerning, because the majority of pharmaceutical companies are not investing to develop new antibiotics, and if they are patients will be paying higher co-pays and out of pocket costs on future antibiotics.”

When is it appropriate to prescribe a Z-Pak?

While Zithromax (Z-pak) won’t work on viral infections (including most cases of bronchitis, many sinus infections and some ear infections), it does play a role in treating certain bacterial infections.

“Azithromycin is used to treat atypical bacterial pneumonia, and sexually transmitted infections including chlamydia and gonorrhea. It is commonly used for Mycobacterium avium complex (MAC) prophylaxis in HIV patients with CD4 counts below 50,” Dr. Kobic said.

What are the risks?

Z-paks have been around long enough that the drug is known to be well tolerated by most patients, however, it does carry some risks.

According to the U.S. Food and Drug Administration, the pills can cause abnormal changes in the heart's electrical activity (irregular heartbeat) that may lead to a life-threatening heart rhythm.

“A benefit versus risk analysis should be performed on patients with existing QT prolongation, elderly patients and patients with a history of heart problems,” Dr. Kobic said. “But, overall the risk of ventricular arrhythmia is very low and reported as less than 1% in clinical trials.”

Here’s the gist

If you aren’t running a high fever or have an underlying medical condition, you should start to feel better within a few days. Take this time to binge-watch some shows, catch up on sleep, and drink plenty of fluids.

However, if your symptoms persist for more than seven days, you have a temperature of more than 102.5 degrees, a persistent sore throat or earache, find it difficult to breathe or swallow or are experiencing chest pain or other significant symptoms, call your doctor sooner rather than later. Even though most of the time these initial infections are viral, there can also be the possibility of a secondary bacterial infection tagging on when your immune system is run down.

Need medical advice or medical attention? To find a Banner Health specialist, visit BannerHealth.com, or find a Banner Urgent Care near you.

Other useful articles:

Cold and Flu Pharmacy Wellness Infectious Disease