Page Synopsis: antibiotic and immunomodulatory, able to suppress the NF-kB transcription factor responsible for the production of pro-inflammatory cytokines, and to cross the blood brain barrier. An important drug in fighting bacterial central nervous system infections, particularly considering HHV can hide in the brain

Skill Level  3

Relevance:2 Technical Level:5


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This page is given low score in that Azithromycin doesn't cure CFS, however, as with all the medicines on this site, it has significantly helped some patients. Considering it is a well tolerated drug, it is deserving of consideration


From: 'Azithromycin (Xithromax)'


Azithromycin (Zithromax) is an antibiotic with immunomodulatory factors used to treat mild to moderate bacterial infections such as bronchitis, pneumonia, sexually transmitted diseases and others (chlamydiae pneumoniae, mycoplasma pneumoniae, streptococcus pneumoniae,etc). It’s ability to suppress the NF-kB transcription factor responsible for the production of pro-inflammatory cytokines indicates it has immuno-modulating properties as well. Azithromycin ability to cross the blood:brain barrier makes it a potentially important drug in fighting bacterial central nervous system infections.


Azithromycin may work in Chronic Fatigue Syndrome (ME/CFS) because it may dampen down an overactive immune system and/or it may fight a bacterial infection. Some chronic fatigue syndrome patients are reported to have chlamydiae and mycoplasma infections and some researchers believe undetected central nervous system infections play an important role in the disease.

Chronic Fatigue Syndrome (ME/CFS) Studies – One small study (10 patients) suggested that azithromycin’s effectiveness was strongly tied to levels of the amino acid acetylcarnitine; 77% of azithromymcin recipients with plasma acetylcarnitine levels lower than 4.1 uM improved, 58% with levels between 4.1 and 6.5 uM and 31% with levels higher than 3.1 uM did. Improvement was assessed as being ‘out of the range of the previous fluctuations of symptoms’. The researchers suggested azithromycin’s efficacy was due either to its antibacterial effects or by reducing immune activity probably in the glial cells that protect the neurons in brain.


Chronic Fatigue Syndrome (ME/CFS) Doctors Report – Dr. DeMeirleir reported that both he and Dr. Nicholson have positive results with Azithromycin.


Side Effects –Azithroymycin (Zithromax) is generally well tolerated. Most side effects are gastrointestinal in nature and include nausea, diarrhea, abdominal pain and diarrhea. Serious allergic reactions and jaundice are rare but can occur.

From: Phoenixrising user A.B. on 'Azithromycin in Chronic Fatigue Syndrome (CFS), an analysis of clinical data'


An older open label study reported a response rate of 59% to azithromycin. Patients did not fully recover but the improvement was substantial, and difficult to explain via placebo effect alone according to the authors.


From: Reviving the Broken Marionette: Treatments for CFS/ME and Fibromyalgia

The macrolide antibiotics are effective against most of the bacteria that have been implicated in CFS/ME. In addition they too have some anti–inflammatory properties and they have been tried in the treatment of e.g. cystic fibrosis.28 The dose used in CFS/ME is usually 500 mg three times a day, though Charles Wheldon prescribes his patients only 250 mg three times a week.29


Fairly impressive results were achieved in a CFS/ME study using azithromycin: 58 out of the 99 patients improved on the drug, though none recovered fully.30 The lack of total recovery and the fact that those with low plasma acetylcarnitine levels were more likely to respond suggests that the benefits were possibly because of the immunomodulatory properties of the drug.


Azithromycin is a safe and well–tolerated drug, though it can sometimes cause stomach upset. Taking it with food markedly hinders the absorption and it should be taken two hours before and after a meal.


This can cause problems with hypoglycemic patients who have to eat often. Azithromycin may increase the effects of oral anticoagulants. It should not be used with ergotamine.


Azithromycin is widely available. It is quite expensive, though the price varies widely between different markets.


Azithromycin works best when paired with


                                 HHV can hide in the brainHidden Herpes Virus May Play Key Role in MS, Other Brain Disorders | URMC Newsroom The Presence of Human Herpesvirus 6 in the Brain in Health and Disease - PMC Herpes Simplex Virus-1 in the Brain: The Dark Side of a Sneaky Infection: Trends in Microbiology Human herpesvirus-6 entry into the central nervous system through the olfactory pathway | PNAS Human Herpesvirus 6 and Neuroinflammation Frontiers | Herpes Simplex Virus Type 1 Infection of the Central Nervous System: Insights Into Proposed Interrelationships With Neurodegenerative Disorders | Cellular Neuroscience Herpes Meningoencephalitis | Johns Hopkins Medicine Human Herpesvirus 7
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