# Azithromycin in Nigeria

Azithromycin has 73 active NAFDAC registrations in our October 2026 copy of the register, from 58 registration holders; 68 further listings have lapsed.

- Source: https://ogbogwu.com/drugs/azithromycin/
- Drug class: Macrolide antibiotic (Antibiotics)
- Also known as: Zithromax, Azithro, Z-pack
- Prescription required: yes
- On the WHO Model List of Essential Medicines
- Last updated: October 2026

## Price in Nigeria

As of October 2026, Azithromycin tablets sell for about ₦634 per tablet online in Nigeria (packs ₦1,750–₦13,900; Azilide) at HealthPlus and MedPlus. The online price is roughly unchanged since July 2026. That figure is for Azilide; 72 other azithromycin brands are NAFDAC-registered and generic versions usually cost less. Open-market prices (e.g. Idumota, Ogbogwu) are often lower.

## What is Azithromycin?

Azithromycin is a widely used macrolide antibiotic that has become one of the most popular antibiotics in Nigeria due to its convenient short-course dosing and broad spectrum of activity. It works by binding to the 50S ribosomal subunit of bacteria, blocking their ability to produce proteins essential for growth and survival. Unlike many other antibiotics that need to be taken multiple times daily for a week or longer, azithromycin can often be given as a 3-day course or even a single dose for certain infections, making it particularly practical in a Nigerian healthcare context where adherence to long courses can be challenging.

In Nigeria, azithromycin is available under brand names including Zithromax (Pfizer), Azee (Cipla), and Azithro (Ranbaxy). The 500mg tablet is the most commonly dispensed form. The drug has gained particular importance in the treatment of sexually transmitted infections (STIs), where a single 1g dose can effectively treat chlamydia — one of the most common STIs in Nigeria. It is also widely used for respiratory tract infections, typhoid fever (especially where ciprofloxacin resistance is suspected), and skin infections. Azithromycin's long half-life means it continues working in the body for several days after the last dose is taken.

Beyond individual prescriptions, azithromycin plays a unique public health role in Nigeria. It is used in mass drug administration (MDA) programmes for trachoma elimination, particularly in northern states such as Kebbi, Sokoto, Zamfara, and parts of the North-East, where trachoma — a blinding eye infection — remains endemic. The International Trachoma Initiative, in partnership with Pfizer, has donated hundreds of millions of doses of Zithromax for these programmes across Nigeria and other endemic countries. This large-scale use has been instrumental in reducing trachoma prevalence, though it has also raised concerns about the potential development of antibiotic resistance in treated communities.

## What is Azithromycin used for?

- Upper and lower respiratory tract infections including community-acquired pneumonia, bronchitis, and pharyngitis
- Sexually transmitted infections (STIs) — particularly chlamydia (single dose) and as part of combination therapy for gonorrhoea
- Typhoid fever — increasingly used as an alternative when ciprofloxacin resistance is suspected
- Skin and soft tissue infections including impetigo and erysipelas
- Otitis media (middle ear infections) in children and adults
- Trachoma — used in mass drug administration programmes in endemic areas of Nigeria
- Traveller's diarrhoea
- Mycobacterium avium complex (MAC) prophylaxis in HIV-positive patients
- Pertussis (whooping cough) — treatment and post-exposure prophylaxis

## Dosage

Always follow a doctor's or pharmacist's instructions; this is general reference information.

- Adults: The standard adult dose for most infections is 500mg once daily for 3 days (total course: 1,500mg). Alternatively, some prescribers use a regimen of 500mg on Day 1 followed by 250mg once daily on Days 2 through 5 (total course: 1,500mg). For chlamydia and some other STIs, a single dose of 1g (two 500mg tablets) is effective. For typhoid fever, 500mg to 1g daily for 7 days may be prescribed. Take azithromycin on an empty stomach (1 hour before or 2 hours after meals) for best absorption, although it can be taken with food if stomach upset occurs.
- Children: The paediatric dose is usually 10mg per kilogram on Day 1, followed by 5mg per kilogram on Days 2 through 5, given once daily. For trachoma (mass drug administration), a single dose of 20mg per kilogram (up to a maximum of 1g) is used. Azithromycin suspension (200mg/5ml) is available for children who cannot swallow tablets. Always use the measuring syringe or spoon provided. Shake the suspension well before each dose.

Azithromycin continues working in the body for about 5 days after the last dose due to its long tissue half-life. This is why a 3-day course is as effective as longer courses of other antibiotics. Do not take antacids containing aluminium or magnesium at the same time as azithromycin. Complete the full prescribed course even if you feel better after 1 or 2 days.

## Side effects

Common: Diarrhoea and loose stools; Nausea and abdominal pain; Vomiting; Headache; Dizziness.

Serious (seek medical help immediately): QT prolongation and cardiac arrhythmias — can cause dangerous irregular heartbeat, especially in patients with pre-existing heart conditions; Severe allergic reactions including anaphylaxis — swelling, difficulty breathing, widespread rash; Liver damage — jaundice, dark urine, severe abdominal pain; cholestatic hepatitis has been reported; Clostridium difficile-associated diarrhoea — persistent, severe diarrhoea; Hearing loss — usually reversible but can be permanent at high doses; Stevens-Johnson syndrome and toxic epidermal necrolysis — severe blistering skin reactions.

When to see a doctor: Seek immediate medical attention if you develop an irregular or rapid heartbeat, difficulty breathing, swelling of the face or throat, severe or bloody diarrhoea, yellowing of the eyes or skin, or a blistering skin rash. If you experience sudden hearing loss or ringing in the ears, stop the medication and consult your doctor promptly. In Nigeria, go to the nearest hospital emergency department — do not wait for symptoms to resolve on their own, particularly if you experience chest symptoms or difficulty breathing.

## Warnings

Do not take if: Known allergy to azithromycin, erythromycin, or any other macrolide or ketolide antibiotic; History of cholestatic jaundice or liver dysfunction associated with prior azithromycin use; Severe liver disease; Known QT prolongation or concurrent use of drugs that prolong the QT interval; Myasthenia gravis — azithromycin may worsen symptoms.

Interactions: Antacids containing aluminium or magnesium — take azithromycin at least 1 hour before or 2 hours after antacids; Warfarin — azithromycin may enhance the anticoagulant effect; monitor INR closely; Digoxin — azithromycin can increase digoxin levels by altering gut bacteria that metabolise digoxin; Ergot alkaloids (ergotamine) — risk of dangerous ergot toxicity; concurrent use is not recommended; Cyclosporine — azithromycin may increase cyclosporine levels; Statins (atorvastatin, simvastatin) — potential increased risk of muscle damage (rhabdomyolysis); Drugs that prolong QT interval (e.g., haloperidol, chloroquine, hydroxychloroquine) — increased risk of dangerous heart rhythm abnormalities.

Pregnancy & breastfeeding: Azithromycin is generally considered acceptable for use during pregnancy when the benefits outweigh the risks. Animal studies have not shown harmful effects on the foetus, and it is commonly used in pregnant women in Nigeria for chlamydia and other susceptible infections when alternatives are not suitable. Azithromycin is excreted in breast milk in small amounts but is generally considered compatible with breastfeeding. However, the infant should be monitored for diarrhoea and thrush. Always consult your doctor or pharmacist before taking any medication during pregnancy or while breastfeeding.

## Brands in Nigeria

Well-known NAFDAC-registered brands: Zithromax (Pfizer, made in USA); Azee (Cipla, made in India); Zentiva Azithromycin (Zentiva, made in Czech Republic); Zetro (Getz Pharma, made in Pakistan); Azilide (Geneith Pharmaceuticals Limited, made in India).
Full searchable brand list: https://ogbogwu.com/drugs/azithromycin/brands/

## How to verify it is genuine

1. Check for a valid NAFDAC registration number on the packaging. All genuine azithromycin products sold in Nigeria must be NAFDAC-registered.
2. Use the NAFDAC Mobile Authentication Service (MAS): scratch the security panel on the product and send the code via SMS to 38353 to verify authenticity.
3. Purchase only from registered pharmacies. Be especially cautious of azithromycin sold at significantly discounted prices in open markets or from street vendors.
4. Examine the packaging carefully for print quality, correct spelling, proper holographic features (if applicable), and intact seals.
5. Verify the expiry date and storage conditions — azithromycin should be stored below 30°C, which is important in Nigeria's hot climate.
6. If in doubt, ask your pharmacist to show you the purchase invoice from a NAFDAC-approved distributor.

Verify any NAFDAC number free (no login): https://ogbogwu.com/nafdac-checker/

## Compared with

### Azithromycin vs Amoxicillin: three-day pack or the classic course — which antibiotic when?

These are different tools, not rungs on a strength ladder. Amoxicillin remains first choice for ear, throat, and many chest infections. Azithromycin's three-day convenience is real, but its best roles are specific: penicillin allergy, 'atypical' chest infections, typhoid, and certain STIs — ideally chosen by a clinician, because casual use is burning through its usefulness.

When Azithromycin fits:

- You're genuinely allergic to penicillins
- A clinician suspects atypical pneumonia, typhoid, or an STI indication
- Adherence to a week-long course has failed you before — and a clinician agrees

When Amoxicillin fits:

- Standard ear, throat, dental, or chest infection
- A child's infection (familiar dosing, syrups everywhere)
- First-line treatment where no allergy exists

Amoxicillin guide: https://ogbogwu.com/drugs/amoxicillin/

## FAQs

### Can I take azithromycin for gonorrhoea?

Azithromycin is used as part of combination therapy for gonorrhoea, usually given alongside ceftriaxone injection. A single 1g or 2g oral dose of azithromycin is combined with a 250mg to 500mg intramuscular injection of ceftriaxone. Azithromycin alone is no longer recommended for gonorrhoea treatment due to rising resistance. If you suspect you have gonorrhoea, visit a hospital or sexual health clinic for proper testing and treatment rather than self-medicating. Incomplete treatment can lead to resistant strains and complications.

### Why is azithromycin given as a 3-day course while other antibiotics take 7 days?

Azithromycin has a uniquely long half-life compared to other antibiotics. After you take the last dose on Day 3, the drug continues to remain active in your body tissues at effective levels for about 5 more days. This means a 3-day course of azithromycin provides roughly 10 days of antibacterial activity. This is a major advantage in Nigeria and other settings where patients may struggle to complete longer courses of antibiotics, whether due to cost, forgetfulness, or the perception that they have recovered before the course is finished.

### Can azithromycin be used for typhoid fever?

Yes, azithromycin is increasingly used for typhoid fever in Nigeria, particularly when ciprofloxacin resistance is suspected or confirmed. Studies have shown that azithromycin is effective against both drug-sensitive and multidrug-resistant Salmonella typhi. The typical dose for typhoid is 500mg to 1g once daily for 7 days, though some doctors may use different regimens. A proper diagnosis should be confirmed ideally with blood culture before starting treatment. Azithromycin is especially useful for treating typhoid in children and pregnant women, for whom ciprofloxacin is generally not recommended.

### What is the trachoma programme using azithromycin in Nigeria?

Trachoma is a bacterial eye infection caused by Chlamydia trachomatis that can lead to blindness if left untreated. It is endemic in parts of northern Nigeria, particularly in rural areas with limited access to clean water and sanitation. The Nigerian government, in collaboration with international partners and Pfizer's International Trachoma Initiative, conducts mass drug administration (MDA) of azithromycin in affected communities. Entire communities receive a single dose of azithromycin once a year as part of the SAFE strategy (Surgery, Antibiotics, Facial cleanliness, Environmental improvement). This programme has significantly reduced trachoma prevalence in treated areas.

### Does azithromycin affect the heart?

Azithromycin can cause QT prolongation — a change in the electrical activity of the heart that can lead to dangerous irregular heartbeats (arrhythmias). This risk is higher in patients who already have heart disease, low potassium or magnesium levels, a slow heart rate, or who are taking other medications that also prolong the QT interval (such as certain antimalarials like chloroquine). If you have a known heart condition, inform your doctor before taking azithromycin. Seek immediate medical help if you experience palpitations, dizziness, or fainting during treatment.

### Is azithromycin stronger because it's only three tablets?

No — the short course reflects how long the drug lingers in tissue, not extra power. Against the bacteria amoxicillin covers well, amoxicillin is at least as effective. 'Stronger' isn't a useful antibiotic concept; 'right spectrum for this infection' is.

### Which one treats typhoid?

Azithromycin is one of the current oral options for uncomplicated typhoid — but typhoid should be confirmed (ideally by culture, not Widal alone) and treated at proper doses for the full duration. Guessing 'typhoid' for every lingering fever and buying three tablets is how both the diagnosis and the drug get devalued.

## Sources

- NAFDAC Greenbook (official register of approved products in Nigeria)
- WHO Model List of Essential Medicines
- British National Formulary (BNF)
- Nigerian Standard Treatment Guidelines (Federal Ministry of Health)