Azithromycin stomach pain: What to expect and how to manage it

In this article:

• Can azithromycin cause stomach pain?
• How long does stomach pain last after taking azithromycin?
• Other possible azithromycin side effects
• Tips for reducing and preventing azithromycin stomach pain
• When to see a healthcare provider about azithromycin stomach pain

In this article

• Can azithromycin cause stomach pain?
• How long does stomach pain last after taking azithromycin?
• Other possible azithromycin side effects
• Tips for reducing and preventing azithromycin stomach pain
• When to see a healthcare provider about azithromycin stomach pain

Azithromycin is an antibiotic that is approved by the Food and Drug Administration (FDA) to treat certain types of bacterial infections, such as ear infections, sinus infections, and bronchitis. It is available in several forms, including the brand name Zithromax, as well as generic azithromycin tablets and oral suspension. Azithromycin is classified in a group of drugs called macrolide antibiotics—it’s in the same drug class as antibiotics like erythromycin and clarithromycin. 

Can azithromycin cause stomach pain?

Yes. Antibiotics often cause stomach-related side effects, and azithromycin is no different. Common side effects of azithromycin include nausea, vomiting, diarrhea, and stomach pain. 

The prescribing information notes that 3%–7% of people typically experience stomach pain from this medicine. Additionally:

• Diarrhea occurs in about 5%–14% of patients taking azithromycin
• Nausea occurs in 3%–18% 
• Vomiting occurs in 2%–7% 

But why are these stomach-related side effects so common with antibiotics? Antibiotics can upset the stomach and cause related issues because they disrupt the gut. While antibiotics are excellent at killing bad bacteria, they also kill the good bacteria in the gut. This causes an imbalance, which results in those dreaded symptoms like stomach pain and diarrhea. 

How long does stomach pain last after taking azithromycin?

Stomach pain typically goes away a few days after you stop taking azithromycin. After the last dose of azithromycin, the medicine stays in your body for a few days. Usually, pain and related stomach symptoms will start to subside at this point. If you have finished your medicine and still have stomach pain a few days later, check in with your healthcare provider. 

In rare cases, though, some people will develop a serious condition called Clostridioides difficile-associated diarrhea (C. diff colitis, or CDAD). This can occur with any antibiotic, while taking it or after you finish it—even up to several months after the last dose. If you have symptoms of CDAD, such as watery or bloody stools, stomach cramps, or fever, call your healthcare provider right away. 

Other possible azithromycin side effects

Other than nausea, vomiting, diarrhea, and abdominal pain, side effects of azithromycin can vary based on the age of the patient, condition being treated, and the dose and duration of azithromycin treatment. 

The following serious side effects, while less common, can be life-threatening and may require immediate medical attention:

• Allergic reactions: Symptoms may include trouble breathing, swelling of the face, lips, tongue, or throat, and skin rash or hives.
• Liver problems: Be alert to symptoms such as weakness, tiredness, loss of appetite, stomach problems, itching, dark urine, and yellowing of the skin or whites of the eyes (jaundice).
• Heart rhythm problems: Symptoms of an irregular heartbeat or heart problems may include dizziness, lightheadedness, chest pain, or feeling like your heart is beating fast or pounding.
• Worsening of myasthenia gravis: Some people may have a worsening of myasthenia gravis while taking antibiotics. Call your healthcare professional right away if you have worsening muscle weakness or breathing problems.

Tips for reducing and preventing azithromycin stomach pain

Here are some tips for reducing and preventing stomach pain and other stomach-related problems while taking azithromycin. 

• Take probiotics: Probiotics may help with stomach cramps and diarrhea, and may even help prevent CDAD. Ask your healthcare provider for medical advice on whether a probiotic would help. You can also eat yogurt that has live and active cultures, which will help you get some probiotics into your diet.
• Take with food: You can take azithromycin with or without food. However, some people tolerate it better and have fewer stomach-related side effects when they take it with food.
• Alter your diet: For an upset stomach, experts used to recommend the BRAT diet: bananas, rice, applesauce, and toast. While these foods are still okay to eat when your stomach isn’t quite right, you don’t have to exclusively stick to those foods. You can also eat other mild foods like dry cereal, oatmeal, boiled potatoes, or crackers—and when you start to feel a little better, you can add in things like eggs, chicken, and cooked vegetables. When your stomach is upset, try to avoid foods that are acidic, spicy, fried, or sugary. Although the probiotics in yogurt may help, you may want to avoid other forms of dairy until your stomach is back to normal. It’s also best to limit or avoid alcohol and caffeine.  

If you tend to reach for an antacid when you have stomach troubles, you’ll want to know that antacids can make azithromycin less effective when taken around the same time. If you need to take an antacid, separate it by at least two hours from the time you take azithromycin to avoid this interaction. (Note: there are also other drug interactions that may occur with azithromycin. Make sure your healthcare provider knows about all the medicines you take, including prescription and over-the-counter drugs, vitamins, and supplements.)   

When to see a healthcare provider about azithromycin stomach pain

Although stomach pain and other symptoms like nausea or diarrhea may be common with azithromycin, some symptoms can be more serious. Call your healthcare provider right away if you have any of the following symptoms:

• Severe stomach pain or cramping, or pain that does not go away
• Watery or bloody diarrhea (with or without stomach cramps and fever)
• Nausea or vomiting that prevents you from eating and drinking

If you have any other concerning symptoms, such as signs of an allergic reaction or side effects not related to the stomach, call your healthcare provider or get emergency medical help if needed.

Bottom line: Azithromycin stomach pain is manageable

Mild stomach pain from azithromycin is usually temporary—and manageable. If you have a sensitive stomach in general, or are concerned about stomach-related side effects, ask your healthcare provider if you should take a probiotic while taking azithromycin, as well as any other precautions you should take. If you are taking azithromycin and experience severe stomach pain, pain that does not go away, or severe diarrhea, call your healthcare provider right away.