pCure Labs
LABS

Search substance info

Azithromycin

Anti-Bacterial Agents
CATEGORIES

Anti-Bacterial Agents, Macrolides


ALIASES

Azasite, Azithromycin 2care4, Azithromycin Actavis, Azithromycin Jubilant, Azithromycin Krka, Azithromycin Mylan, Azithromycin Orifarm, Azithromycin STADA, Azithromycin Sandoz, Azitromax, Azitromycin Ebb, Azitromycin Paranova, Azyter, Zithromax, Zifin, Zithromax, Zitrocin, Zitrotek, Zmax


SUBSTANCES

azithromycin, azithromycin dihydrate, azithromycin monohydrate


ENVIRONMENTAL CONCERN: MODERATE
Azithromycin is a semi-synthetic macrolide antibiotic of the azalide class. Like other macrolide antibiotics, azithromycin inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit of the bacterial 70S ribosome. Binding inhibits peptidyl transferase activity and interferes with amino acid translocation during the process of translation. Its effects may be bacteriostatic or bactericidal depending of the organism and the drug concentration. Its long half life, which enables once daily dosing and shorter administration durations, is a property distinct from other macrolides.

Read More

MODERATE
Azithromycin is on the EU list of substances whose concentrations in surface water should be monitored in the Member States for environmental reasons. May interact in the environment with other macrolide antiobiotics, such as clarithromycin, erythromycin and roxithromycin.

Has been found in Swedish waste water treatment plants in concentrations that might select for antibiotic resistance.

Azithromycin is included in the Stockholm County Council's table of pharmaceuticals with risk for negative environmental impact according to the environmental programme 2017-2021. Measurements in the aquatic environment in Stockholm County are missing during the last five-year period (2012-2016).

Studies have shown that even low concentrations of antibiotics in the environment may trigger antibiotic resistance and therefore measures should be taken to ensure that as little as possible ends up in our environment.

Azithromycin is recommended in the Wise List. Environmental classification of pharmaceuticals is taken into consideration, sometimes with other environmental aspects, when selecting pharmaceuticals for the Wise List. When comparable pharmaceuticals are equivalent to medical effects, safety and pharmaceutical efficacy, environmental impact and price are considered.

Suggestions on how to reduce the release of azithromycin
Concrete proposals on how to work to reduce emissions of environmentally harmful pharmaceuticals on the list have been developed in close cooperation with the Stockholm Drug and Therapeutics Committee's expert advice. The action proposals were developed from an environmental perspective. The patient's best always goes first and several pharmaceuticals on the list are also included in the Wise List. However, for such pharmaceuticals, there may be measures that could reduce the environmental impact.

Concrete proposal for azithromycin:
–  Azithromycin is recommended in the Wise List for the treatment of Mycoplasma genitalium.
– For antibiotics, the general rule is as restrictive use as possible without risking the patient's health. Relevant cultivation is important in order to choose antibiotics that have a good effect with as narrow spectrum as possible.

REFERENCES

  1. Europeiska unionens officiella tidning. Kommissionens genomförandebeslut (EU) 2018/840 av den 5 juni 2018.
  2. European Medicines Agency, EMA: Committee for Medicinal Products for Human Use (CHMP). Guideline on the Environmental Risk Assessment of Medicinal Products for Human Use. 1 June 2006.
  3. Goodpoint. Prioritering av läkemedel med miljörisk inom SLL. Stockholm: Goodpoint; 2016. Rapport LS 2016–0634.
  4. IVL Swedish Environmental Research Institute Ltd. Fick J, Lindberg RH, Kaj L, Brorström-Lundén E. Results from the Swedish National Screening Programme 2010. Subreport 3. Pharmaceuticals.
  5. IVL Swedish Environmental Research Institute Ltd Fick J, Lindberg RH, Fång J, Magnér J, Kaj L, Brorström-Lundén E. Screening 2014. Analysis of pharmaceuticals and hormones in samples from WWTPs and receiving waters. Rapport C 135.
  6. Bengtsson-Palme J, Larsson DG. Concentrations of antibiotics predicted to select for resistant bacteria: Proposed limits for environmental regulation. Environ Int. 2016;86:140-9.
  7. Gullberg E, Cao S, Berg OG, Ilbäck C, Sandegren L, Hughes D et al. Selection of resistant bacteria at very low antibiotic concentrations. PLoS Pathog. 2011;7:e1002158.
  8. Stockholms läns landsting. Förteckning över miljöbelastande läkemedel med åtgärdsförslag framtagen inom ramen för SLL:s miljöprogram 2017–2021.
  9. Fass.se för vårdpersonal
  10. Stockholms läns landsting. Kloka Listan 2018.
  11. Stockholm County Council. The Wise List 2015.
  12. Socialstyrelsen. Statistikdatabas för läkemedel.
  13. Stockholms läns landsting. Janusinfo: Läkemedelsuppföljning