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) StudiesOne 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.

The Phoenix Rising website is compiled by a layman. It is not a substitute for a physician and is for informational uses only. It does not present complete information on this drug. Please discuss any treatments in these pages with your doctor.


Vermeulen, R. and H. Sholte. 2006. Azithromycin in chronic fatigue syndrome (CFS): an analysis of clinical data. Journal of Translational Medicine 4: 43.

James April 19, 2012 at 1:24 am

I tried Azithromycin and I subsequently had a improved health for a number of months. I hope to repeat this test to see if the same thing happens again. I would like to give my GP some evidence or guidance about using Azithromycin to treat CFS, to help them justify it and to help us find the best dose to test. Do you know of any research relating to his or of any other evidence we can use to guide us?

Fantastic website.
Thanks for any help you can offer.

Cort April 19, 2012 at 6:05 am

Its an interesting drug :). I’ve found one study below. Its a free paper you can print the whole thing out if you want:

J Transl Med. 2006 Aug 15;4:34.
Azithromycin in chronic fatigue syndrome (CFS), an analysis of clinical data.
Vermeulen RC, Scholte HR.
CFS and Pain Research Center Amsterdam, Waalstraat 25-31, 1078 BR Amsterdam, The Netherlands.

CFS is a clinical state with defined symptoms, but undefined cause. The patients may show a chronic state of immune activation and treatment with an antibiotic in this subgroup has been suggested.
In a retrospective study, the response of CFS patients to azithromycin, an antibiotic and immunomodulating drug, has been scored from the patients records and compared with clinical and laboratory data. Azithromycin was not the first choice therapy, but offered when the effect of counseling and L-carnitine was considered insufficient by the patient and the clinician.
Of the 99 patients investigated, 58 reported a decrease in the symptoms by the use of azithromycin. These responding patients had lower levels of plasma acetylcarnitine.
The efficacy of azithromycin in the responsive patients could be explained by the modulating effect on a chronic primed state of the immune cells of the brain, or the activated peripheral immune system. Their lower acetylcarnitine levels may reflect a decreased antioxidant defense and/or an increased consumption of acetylcarnitine caused by oxidative stress.

Paula Carnes October 10, 2012 at 5:55 pm

I did very well on Zithromax for several years. Then I got was seemed to be fungal meningitis. After that I have responded to nothing – have constant headache and vertigo and brain fog for 8 years and counting….

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