Azithromycin side effects in kids: What parents should know

In this article:

• Common azithromycin side effects in kids
• Side effects by condition
• Less common, but possible, azithromycin side effects
• How to manage mild azithromycin side effects in children
• Azithromycin alternatives for children
• When to see your healthcare provider

In this article

• Common azithromycin side effects in kids
• Side effects by condition
• Less common, but possible, azithromycin side effects
• How to manage mild azithromycin side effects in children
• Azithromycin alternatives for children
• When to see your healthcare provider

Azithromycin is an antibiotic used to treat certain types of bacterial infections in both adults and children. It’s available as a generic drug or under the brand name Zithromax. In children, the Food and Drug Administration (FDA) has approved azithromycin to treat ear infections, throat and sinus infections, tonsillitis, and community-acquired pneumonia (a type of pneumonia caught outside of a hospital setting). 

Like any medication, azithromycin can cause side effects. This can be especially concerning for parents when new symptoms appear while their child is already sick. Knowing what to expect can help you feel more prepared to support your child’s recovery. In this article, we’ll cover the most common side effects of azithromycin in children, what to do if they happen, and when to call your child’s healthcare provider.

Common azithromycin side effects in kids

The side effects of azithromycin in children are similar to the side effects of the antibiotic in adults. The most common side effects of azithromycin are typically digestive upset, but rashes may also occur. 

“Whether it’s abdominal cramping, nausea, diarrhea, I pretty much expect patients to have some sort of gastrointestinal (GI) disturbance while taking azithromycin,” says Austin Shuxiao, MD, an internal medicine specialist and founder of PeachIV in New York City. How often side effects occur can depend on what it’s being prescribed for and for how long. 

Most common side effects of azithromycin in children, by condition
Condition treated	Diarrhea	Abdominal pain	Vomiting	Nausea	Rash
Ear infection	Up to 4% (1-day course)	Up to 2% (3-day course)	Up to 5% (1-day course)	Up to 1% (1-day course)	Up to 1% (1-day course)
Community-acquired pneumonia	6%	2%	2%	2%	2%
Throat infection or tonsillitis	5%	3%	6%	2%	1%

Less common, but possible, azithromycin side effects

According to its drug label, less common side effects that occur in fewer than 1% of people can present differently between children and adults.

Less common side effects of azithromycin in children vs. adults
System affected	Children	Adults
General	Fever, face swelling, fatigue, fungal infection, general pain/ discomfort	Fatigue
Cardiovascular and blood	Chest pain, anemia, low white blood cell count	Palpitations, chest pain
Digestive	Indigestion, constipation, loss of appetite, flatulence, inflammation of the small intestine or stomach, jaundice (yellowing skin), loose stools, oral yeast infection (thrush)	Indigestion, flatulence, vomiting, blood in stools, jaundice
Urinary and reproductive	None reported	Yeast infection, vaginal infection, kidney infection
Nervous	Headache, restlessness, dizziness, agitation, nervousness, trouble sleeping	Dizziness, headache, vertigo, sleepiness
Allergies	Rash, allergic reaction	Rash, itchiness, light sensitivity, swelling
Respiratory	Cough, sore throat, runny nose, water buildup in the lungs	None reported
Skin	Eczema, fungal skin infection, itchiness, sweating, rash	None reported
Other	Conjunctivitis (pink eye)	None reported

 

Children taking azithromycin may experience certain side effects such as flu-like symptoms, skin and oral yeast infections, digestive upset, loss of appetite, and nervous system symptoms like agitation or restlessness (also known as hyperkinesia). Some of these side effects may be more likely to occur in children than in adults. If your child develops any of these symptoms, it’s a good idea to contact their healthcare provider to discuss management or possible alternative treatments.

Although rare, azithromycin can also cause serious side effects in children and adults, such as liver injury, severe allergic reactions, and heart rhythm problems. “Any rash, itching, or difficulty breathing in patients taking azithromycin should be treated seriously,” Dr. Shuxiao says. For example, if your child has symptoms of an allergic reaction, such as hives, trouble breathing, or swelling of the face, lips, tongue, or throat, seek emergency medical help. Other serious side effects will also require immediate or emergency medical attention. 

One rare but serious risk is a heart rhythm change called QT prolongation, when the heart takes longer than normal to reset between beats. This can lead to irregular heart rhythms or, in very rare cases, a heart attack (cardiac arrest). A child’s risk may be higher if they have a history of heart conditions or are taking a high dose of azithromycin. Healthcare providers may monitor for this using an electrocardiogram (ECG), especially if there are known heart concerns. Parents can help reduce the risk by sharing their child’s full medical history—including a full list of medications taken—with the prescribing provider.

How to manage mild azithromycin side effects in children

If your child experiences mild side effects while taking azithromycin, you may be able to manage them at home. Digestive symptoms, such as nausea or upset stomach, can often be eased by adjusting meal timing and sticking to light, bland foods. Dr. Shuxiao recommends offering smaller meals and avoiding spicy or greasy foods while your child is on azithromycin.

Staying well hydrated is also important. “Proper hydration helps the body circulate nutrients and medication to fight infection and flush out byproducts of the illness,” says Martina Ambardjieva, MD, urologist at Dr. Telx. Hydration becomes especially important if your child is experiencing diarrhea, sweating, or fever. Consider including fluids with electrolytes, such as electrolyte powders, electrolyte drinks, or brothy soups.

If digestive issues continue, your child’s healthcare provider may recommend a probiotic to support gut health. “Anti-diarrheals like loperamide can also be used if symptoms become too bothersome,” Dr. Shuxiao adds. Always contact your child’s healthcare provider before starting new medications or supplements.

Azithromycin alternatives for children

If your child experiences side effects while on azithromycin, their healthcare provider may consider switching to an alternative medication, if appropriate. Here are some options, sorted by the type of antibiotic.

Macrolide antibiotics

Azithromycin is a macrolide antibiotic that stops the growth of bacteria. This class of drugs is typically used for respiratory infections and infections caused by streptococcus bacteria, like strep throat or tonsillitis. Other macrolides that can be prescribed in place of azithromycin include clarithromycin and erythromycin.

Penicillin antibiotics

Penicillin antibiotics are a subtype of beta-lactam antibiotics that can be used for a wide range of infections, including infections caused by streptococcus bacteria. Examples of penicillins that may be prescribed include amoxicillin and ampicillin. Augmentin is another example of an antibiotic that contains a combination of amoxicillin and clavulanate, a beta-lactamase inhibitor, which helps amoxicillin work against resistant bacteria. 

Children who are allergic to penicillin drugs are often prescribed macrolide antibiotics instead, since they work for similar infections. 

Cephalosporin antibiotics

Cephalosporin antibiotics are another type of beta-lactam antibiotic that is used to kill bacteria. These drugs are used to treat certain types of bacterial skin and respiratory infections. Examples include cefaclor, cephalexin, and cefuroxime.

Because they are similar to penicillins, people with penicillin allergies may also react to cephalosporin antibiotics. A healthcare provider can decide whether it’s safe for someone with a penicillin allergy to take a cephalosporin or whether they should avoid both types of antibiotics.

Tetracycline antibiotics

Tetracycline antibiotics stop the growth of bacteria. These drugs are used in older children for skin infections, acne, and certain other infections. Healthcare providers may prescribe doxycycline or tetracycline as alternatives to azithromycin, especially in those with allergies to macrolides.

When to see your healthcare provider

Parents should reach out to their child’s healthcare provider if they notice any severe or persistent side effects while their child is taking azithromycin. While some digestive upset is common, certain side effects may require medical attention. “Parents should be instructed to seek medical advice if their child experiences persistent vomiting, severe diarrhea, skin rash, jaundice, fatigue, or respiratory difficulty. These may be signs of an adverse or allergic reaction requiring discontinuation or alternative treatment,” Dr. Ambardjieva says.

It’s also important to watch for signs of more serious side effects, such as allergic reactions, liver problems, or heart-related symptoms. “While mild gastrointestinal upset or low energy may be expected during treatment, symptoms such as itching rash, facial swelling, or signs of liver or heart involvement (e.g., jaundice, palpitations) are not typical and should prompt medical evaluation,” Dr. Ambardjieva says. 

Because children may experience a broader range of side effects than adults, it’s a good idea to check in with your child’s healthcare provider if new symptoms appear. When you call, be ready to share details like when doses were given, whether the medication was taken with food, and when symptoms began. This can help the provider identify the cause and decide on the next steps. And if you cannot reach your child’s healthcare provider right away—or if symptoms are serious or concerning—it’s best to go right to the nearest emergency room.