Hello,
I understand you do not wish a reply, but still I would like to clarify my part. Kindly refer http://www.ncbi.nlm.nih.gov/pubmed for reference. This is a world wide trusted database. Wesbites like askpatinet are not trustable in opinion.
Issue 1 : Side effects like Insomnia and Anxiety is indeed very very rare with Azithromycin usage. The reported rate is less that 1% .
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Ref : (for both points)
Foulds G, Shepard RM, and Johnson RB, “The Pharmacokinetics of Azithromycin in Human Serum and Tissues,” J Antimicrob Chemother , 1990, 25(Suppl A):73-82.[PubMed 2154441 ]
Centers for Disease Control and Prevention (CDC), "Update to CDC's Sexually Transmitted Diseases Treatment Guidelines, 2010: Oral Cephalosporins No Longer a Recommended Treatment for Gonococcal Infections”, MMWR Morb Mortal Wkly Rep , 2012, 61(31):590-4. [PubMed 22874837 ]
Coates P, Daniel R, Houston AC, et al, “An Open Study to Compare the Pharmacokinetics, Safety, and Tolerability of a Multiple-Dose Regimen of Azithromycin in Young and Elderly Volunteers,” Eur J Clin Microbiol Infect Dis , 1991, 10(10):850-2. [PubMed 1662630 ]
Foulds G, Shepard RM, and Johnson RB, “The Pharmacokinetics of Azithromycin in Human Serum and Tissues,” J Antimicrob Chemother , 1990, 25(Suppl A):73-82.[PubMed 2154441 ]
Ghanem KG and Workowski KA, “Management of Adult Syphilis,” Clin Infect Dis , 2011, 53(Suppl 3):110-28. [PubMed 22080265 ]
Guay DR, “Pharmacokinetics of the New Macrolides,” Infect Med , 1992, 9:9-13.
Heintz BH, Matzke GR, Dager WE, “Antimicrobial Dosing Concepts and Recommendations for Critically Ill Adult Patients Receiving Continuous Renal Replacement Therapy or Intermittent Hemodialysis,” Pharmacotherapy , 2009, 29(5):562-77. [PubMed 19397464 ]
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Adverse Reactions Significant
>10%: Gastrointestinal: Diarrhea (4% to 9%; high single-dose regimens 12% to 14%), nausea (=7%; high single-dose regimens 18%)
2% to 10%:
Dermatologic: Pruritus, rash
Gastrointestinal: Abdominal pain, anorexia, cramping, vomiting (especially with high single-dose regimens)
Genitourinary: Vaginitis
Local: (with I.V. administration): Injection site pain, inflammation
=1% (Limited to important or life-threatening): Acute renal failure, aggressive behavior agitation, allergic reaction, anaphylaxis, anemia, angioedema, anxiety, arrhythmia (including ventricular tachycardia), arthralgia, bronchospasm, candidiasis, chest pain, cholestatic jaundice, conjunctivitis (pediatric patients), constipation, cough increased, deafness, dehydration, dermatitis (fungal), diaphoresis, dizziness, dyspepsia, eczema, edema, enteritis, erythema multiforme (rare), facial edema, fatigue fever, flatulence, fungal infection, gastritis, headache, hearing disturbance, hearing loss, hepatic failure, hepatic necrosis, hepatitis, hyperactivity, hyperkinesia, hypotension, insomnia, interstitial nephritis, jaundice, leukopenia, LFTs increased, loss of smell, loss of taste, malaise, melena, mucositis, nephritis, nervousness, neutropenia (mild), oral candidiasis, oral moniliasis, pain, palpitation, pancreatitis, paresthesia, pharyngitis, photosensitivity, pleural effusion, pseudomembranous colitis, pyloric stenosis, QT c prolongation (rare), rhinitis, seizure, smell perversion, somnolence, somnolence, Stevens-Johnson syndrome (rare), syncope, taste perversion, thrombocytopenia, tinnitus, tongue discoloration (rare), torsade de pointes (rare), toxic epidermal necrolysis (rare), urticaria, vertigo, vesiculobullous rash, weakness
Contraindications Hypersensitivity to azithromycin, other macrolide (eg, azalide or ketolide) antibiotics, or any component of the formulation; history of cholestatic jaundice/hepatic dysfunction associated with prior azithromycin use
Issue 2 : It is well know than Azithromycin has got a longer half life. But by day 4 the levels will come below threshold levels to induce side effects. I would have agreed to your argument had your other side effects stayed same. (loss of appetite , cramping etc). How come they disappeared and few of the side effects remained ? This proves that the drug levels indeed had gone down and the triggered insomnia and anxiety is persisting.
Hope this clarifies.