Z-Pack: What is it and how is it used?

Published March 28th, 2020 by Bridget Reed
Fact Checked by
Chris Riley
Updated Date: Apr 16th, 2021

Antibiotics, including the well-known Z-Pack, sometimes get a bad rap these days. After decades of the prescription drug, Z-Pack being prescribed for seemingly everything, including viral infections that they couldn’t successfully treat, some bacteria have become resistant to the more common forms of antibiotics. Antibiotic resistance is an important issue that should not be overlooked, but there are many cases where just a few doses of common antibiotics, like azithromycin (the generic name for Z-Pack) and zithromax, can be used to quickly and effectively treat bacterial infections. When used correctly and prescribed for the right conditions, the Z-Pack is an easy-to-use, FDA-approved and an affordable treatment option.

What is a Z-Pack?

Z-Packs might sound like something sold over the counter, but they’re actually an antibiotic, known as azithromycin, used to treat many types of infections. Azithromycin belongs to the macrolide-type family of antibiotics and works by stopping the growth of bacteria. Z-Packs include a specific amount of the antibiotic conveniently divided into daily doses, and they get their name from the packaging. Z-Packs are available in three-day and five-day packs, depending on the condition they are being used to treat, and come in both a name-brand and generic formula. In order to provide relief more efficiently, your doctor may give an injection of azithromycin and then have you follow up with the oral form of the antibiotic. 

What are Z-Packs used to treat?

Z-Packs are effective at fighting a number of different bacterial infections. Unfortunately, they’re sometimes incorrectly prescribed for sinus infections caused by viruses, which won’t respond to antibiotics. When used correctly, Z-Packs, which are sometimes referred to as z-pak, are commonly used to treat the following conditions:

  • Strep throat: Strep throat is commonly caused by a bacterial infection, and Z-Packs are a great choice for treatment if you’re allergic to penicillin (the preferred course of treatment). Up to 20 percent of the bacteria causing strep throat may not respond to Z-Packs, but they’re still a good choice overall.
  • Skin and soft tissue infections: Infections of the skin or soft tissues that are caused by Staphylococcus and Streptococcus bacteria usually respond well to Z-Packs.
  • Community-acquired pneumonia: If you acquire mild to moderate pneumonia outside of a hospital setting, a Z-Pack may be a good choice for treatment. Pneumonia picked up in a hospital is more likely to be drug resistant and should not be treated with Z-Packs.
  • Acute bacterial bronchitis: Although Z-Packs will not cure chronic bronchitis or treat underlying lung disease, it can be used to treat acute bacterial bronchitis.
  • Chlamydia: Chlamydia is a sexually transmitted disease that can be treated with one dose of azithromyacin. You won’t even need the whole Z-Pack!
  • Traveler’s diarrhea: If you’ve ever been out of the country and eaten something you shouldn’t have or drank tap water that wasn’t clean, you’ve probably experienced traveler’s diarrhea. Nothing puts a damper on your trip faster! Diarrhea caused by the Shigella and Campylobacter bacteria can be effectively treated with a Z-Pack. Tell your doctor about your upcoming international travel and ask for a Z-Pack just in case, especially if you’ll be visiting a developing country. 
  • Nongonococcal urethritis in men: Although Z-Packs aren’t recommended for curing urethra infections for women, they work great for men. You’ll just need a single dose, rather than the entire pack.
  • Chronic lung disease: Z-Packs won’t cure chronic lung disease, but it can improve symptoms and quality of life for those with chronic bronchiectasis or COPD when used daily. 
  • Cystic fibrosis in kids: Again, it’s not a cure, but Z-Packs help mitigate symptoms and improve lung function for kids with cystic fibrosis.
  • Preventing infection in HIV/AIDS patients: HIV and AIDS patients are particularly susceptible to infections due to their immuno-compromised status. Z-Packs can treat and prevent infections caused by M. avium-intracellulare in these patients.

Z-Packs are approved for use in children and are commonly used to treat ear infections, bacterial sinus infections, community-acquired pneumonia, and strep throat in children ages six months and older. The medication can be used off-label to treat walking pneumonia and pertussis.

What are the benefits of using a Z-Pack?

There are many reasons to consider using a Z-Pack to treat a bacterial infection. Although antibiotic resistance has increased in bacteria over the years, Z-Packs are still effective treatments for many infections and work on a large number of bacteria. Some of the main benefits of Z-Packs include:

  • Ease of use: It doesn’t get much easier to use than a Z-Pack! The medication comes in a package of three or five pills, and you take one a day. That’s it!
  • Inexpensive: Z-Packs can be purchased for about ten dollars, and sometimes even less. That comes out to about two dollars per day if you are using a five tablet pack.
  • Effective: Part of the reason that Z-Packs are so effective is that they are well-absorbed when taken orally. The medication easily enters your tissues and stays active for a long time, helping it to effectively fight and kill disease-causing bacteria.
  • Few interactions: Although there are some medications that should not be taken with Z-Packs, the drug mostly does not interfere with common medications, making it safe for people with a large number of medical conditions to take.
  • Broadly applicable: Z-Packs can be used to treat many different infections caused by a variety of bacteria.  

What are the dosing instructions for a Z-Pack?

Z-Pack comes in an injectable form, an oral tablet, and a liquid suspension. Your doctor may choose to give you an injection of azithromycin prior to the beginning of the oral treatment regimen. When used in the oral tablet form, you will take one tablet per day. The medication can be taken with or without food and should be taken at the same time each day. If you experience an upset stomach when taking your Z-Pack, try taking the medication with food. The liquid version of the medication should be measured using a dosing syringe or medical spoon to ensure that you get the correct dose.
Although Z-Packs are known to cause stomach upset, you should not take antacids containing aluminum or magnesium within two hours before or after you take your medication, as this can reduce its effectiveness. Antacids such as Tums, which contain calcium carbonate, are ok to take with azithromycin.
Azithromycin may make you more sensitive to sun exposure and can cause you to sunburn more easily. You should wear protective clothing and use sunblock an SPF of 30 or higher when outdoors.
One of the most important instructions for using a Z-Pack is that you must take the medication for the fully prescribed length of time, even if you start to feel better. One of the ways that bacteria become resistant to antibiotics is when they are exposed to a medication for a short period of time but not completely eradicated. This offers the surviving bacteria the opportunity to adapt and mutate and form resistance to the drug. Be sure to finish your entire Z-Pack. 

Do Z-Packs come with any side effects?

Like many antibiotics, Z-Packs can be hard on your stomach. To help prevent and minimize these side effects, consider taking your medication with food. Common side effects associated with Z-Packs include:

  • Nausea
  • Vomiting
  • Stomach pain

Some people may have a severe reaction to azithromycin. Seek medical treatment if you experience any of the following symptoms, as these could be a sign of a severe reaction:

  • Skin rash
  • Fever
  • Swollen glands
  • Muscle aches
  • Severe weakness
  • Unusual bruising
  • Yellowing of the skin or eyes
  • Severe stomach pain
  • Diarrhea that is watery or bloody
  • Fast or pounding heartbeats
  • Fluttering in your chest
  • Shortness of breath
  • Sudden dizziness/feeling like you may pass out
  • Liver problems, including nausea, vomiting, loss of appetite, stomach pain on the upper right side of your abdomen, tiredness, itching, dark urine, clay-colored stools, or jaundice

Allergic reactions to azithromycin, just like amoxicillin, can be serious. Seek emergency medical help if you have any of the following signs of an allergic reaction or severe skin reaction to Z-Packs:

  • Hives
  • Difficulty breathing
  • Swelling in your face or throat
  • Fever
  • Sore throat
  • Burning in your eyes
  • Skin pain
  • Red or purple skin rash that spreads and causes blistering

Who should not take Z-Packs?

Prior to taking Z-Pack, make sure to give your doctor your complete medical history for accurate medical advice, especially if you have experienced heart disease, liver disease, kidney disease, or myasthenia gravis. Azithromycin can affect the heart rhythm, sometimes resulting in a serious, but rarely fatal, fast or irregular heartbeat called ventricular arrythmia and other symptoms that need immediate medical attention. Individuals with a personal or family history of heart problems may be especially at risk. Low levels of potassium or magnesium in the body can also enhance your risk for heart issues.
Pregnant women should not take Z-Packs unless there is a clearly established need for the medication. Azithromycin is known to pass through breast milk, so nursing mothers should speak with their doctors prior to use. 
Certain live vaccines, such as typhoid, may not be as effective if administered while you are taking azithromycin. You should not receive any immunizations or vaccinations while being treated with a Z-Pack.

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