Abstract

AZITHROMYCIN: A COMPREHENSIVE REVIEW OF PHARMACOLOGY, CLINICAL APPLICATIONS, ANTIMICROBIAL RESISTANCE, AND PUBLIC HEALTH IMPACT

Aaryan Mishra*, Umesh Parekh, Manoj Goyal

ABSTRACT

Azithromycin, a semi-synthetic second-generation macrolide antibiotic derived from erythromycin, has played a transformative role in global clinical medicine since its approval. Characterized by its unique 15-membered lactone ring containing a nitrogen atom, azithromycin exhibits superior pharmacokinetic and pharmacodynamic properties compared to its predecessor, including enhanced acid stability, extensive tissue penetration, and an exceptionally long elimination half-life. This comprehensive review evaluates the historical development, chemical structure, and molecular mechanism of action of azithromycin, which primarily involves binding to the 50S ribosomal subunit of susceptible microorganisms to inhibit protein synthesis. We systematically discuss its diverse clinical applications, ranging from community-acquired respiratory tract infections and sexually transmitted infections to its criticalrole in mass drug administration programs for the elimination of endemic trachoma and yaws. Furthermore, this paper highlights its secondary immune modulatory and anti-inflammatory properties, which have generated significant therapeutic interest in chronic pulmonary disorders like cystic fibrosis and chronic obstructive pulmonary disease. Crucially, the review addresses the escalating global threat of antimicrobial resistance (AMR), detailing the molecular mechanisms of resistance—such as target site modification mediated by erm genes and active efflux pumps encoded by mef genes—and examines current public health challenges, stewardship strategies, and future perspectives. Special focus is directed toward insights from the Indian clinical landscape, emphasizing the imperative balance between therapeutic access and stringent antimicrobial stewardship.

Keywords: Azithromycin, Macrolides, Pharmacokinetics, Antimicrobial Resistance, Public Health, Pharmacodynamics.