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British Lung Foundation
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Azithromycin and acid reflux?

Hi all - has anyone who takes 3 x week azithromycin found that their acid reflux has got worse? I have with lots of burping and a bit of regurging which I hardly ever had before. Ive looked on the patient leaflet, and various websites and they don't mention this - the nearest Ive found is one site which mentioned "full feeling" and I do have this. I certainly feel more upward pressure. I have had some stress issues lately which could have contributed but then Ive had similar stress in the past with no problem. Ive not had any other changes in medication.

I've been taking azithromycin for a few months with no problems at all so it may well be something else but I thought I'd ask to see if any of you have had a similar experience.

Enjoy the evening everyone :)

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No Pete doesn’t have that problem with Azithromycin O2. Hope you feel better soon.

Have a good weekend. Xxxx

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Im glad Pete finds azith ok Carol. Im thinking of trying twice a week rather than the standard three times and see if that helps. Heaven knows what my GP would say! You both take care xx

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See how it goes and good luck. Xxxx

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Thanks :) :) xx

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Some abs can do that, Doxy is quite common to make reflux worse. Not sure about azrithromycin though, but I not see why not.

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That's what I though Shancock, but I couldnt find anything about it in the list of side effects in the patient information.

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Hello, I was diagnosed with a reflux problems many years before I had even heard of Azith. In fact I had not even been near a doctor about my breathing.

I had felt that my reflux had increased and had mentioned this to my GP. He thought about this for 30 sec as he ran his eyes down the list of current medication that I was taking. He the suggested that instead of taking two Lansoprazol once per day, I could try taking one in the morning and one at bedtime and ring him if it did not improve. It has substantially improved my reflux.

Unfortunately it has not done anything about the huge swollen belly that I have grown over the last decade or so. As I eat very little and don't drink booze or pop. In-hospital investigations have only come to the conclusion that it is gas. The put a tube into my stomach via my nose in the hope of syphoning some fluid to test the acids. They only got gas in the capture system. Which they drew off measured amounts periodically. They got 21 litres over the 24 hrs. My tummy went down to the size that I had not been for years. As soon as the tune came out the belly soon went back up. We still have no idea why.

Kindest wishes, Rib

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You might have fungus infection ... I use to suffer terrible acid reflux NOT that doctors was interested I took antacids gavascon etc and they did nothing.

Was only when I went on nystan anti fungus stuff my acid reflux stopped.

This bacteria that makes loves acid also causes over population AND it’s that that causes reflux in some cases.

What surprised me I was on antibiotics when had acid reflux ... I would a thought antibiotics might stoped bacteria causing acid and reflux but the never.

Thought would give mention as anti fungus stuff cured me of acid and reflux

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Generally it's thought that ABs make your stomach more acid Jeff. Interesting though that nystan seemed to stop your reflux. Ive not heard of that.

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I asked my doctor how long would I be on NYSTAN hu he said probably rest of my life

Said this loads on it LIKE forever

Might be worth doing post n asking who else is on it and suffers acid or reflux.

I know it’s pits and hope you get it sorted

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Thanks Jeff :)

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I am on my 6th day of Azithromycin and suffering with stomach problems having to take Gaviscon but with clearer mucus they seem to be helping. Not shifting my barking cough though . Don't have any prednisolone and GP says should only take for exacerbation which the antibiotics should prevent happening. I too not eating as much. Hope they work well for you 🤞

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Ive been on them a few months Joyce and it's been fine til now. It might be something else causing the problem, not sure. Hope the azith works for you too.

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Thank you can't blame the stomach problems on the tablets I get problems from time to time. I'm hopeful they are working mucus definitely clearer now x

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Hi O2Trees .... an interesting thought as this drug is implicated in enhanced oesphageal motility and accelerated gastric emptying which can cause a little more burping. However, here is an extract on Azithromycin (AZI) is a macrolide antibiotic that improves lung function in lung transplant recipients (LTx). The rejection is general Obliterative Bronchiolitis ( which I suffer from, but don't have a LTx) so my consultant put me on Azithromycin.

Gastroesophageal reflux (GER) has been implicated in the pathogenesis of chronic rejection after LTx. Macrolide antibiotics may affect GER by modifying esophageal and gastric motility. The purpose of this study was to evaluate the effect of AZI on GER and gastric aspiration after LTx. Acid and weakly acidic GER was measured with 24-h pH-impedance monitoring in 47 LTx patients (12 patients “on” AZI). Gastric aspiration was assessed in a separate group of 30 LTx patients before and after AZI by measurements of pepsin and bile acid in bronchoalveolar lavage fluid (BALF). Patients “on” AZI had a significant lower total number of reflux events [41 (30–61) vs. 22.5 (7–37.5)], number of acid reflux events [24 (16–41) vs. 8 (4–18)], esophageal acid exposure [2.9% (0.7–7.3) vs. 0.2% (0.1–2.0)], bolus exposure [0.73% (0.5–1.4) vs. 0.21% (0.12–0.92)], and proximal extent of reflux [14 (9–24) vs. 5 (2–7)]. AZI reduced the concentration of bile acids in BALF without affecting levels of pepsin. LTx patients “on” AZI have less GER and bile acids aspiration. This effect might be due to enhanced esophageal motility and accelerated gastric emptying.

I have learnt that since being on this drug, I need to chew and chew the food as the saliva needs to bind with the food which seems to help the process. Also I take it the time of day I am not going to eat for another couple of hours. in my case around 2.30pm lunch is out of the way and evening meal is yet to come. This allows me to be able to take Gavison Advance after eating and before bed. Hopefully causing less reflux. Hope this helps.

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Yes, very helpful ledge. So if Im reading this right, patients on azith have less GERD, not more. I always chew my food very well - it takes me longer to finish a meal than it does my friends and partner. I havent needed to use Gaviscon for quite a while as the reflux has been very well controlled with just 15mg lansoprazole a day and hour before bed. Is that the only reason you take the azith between meals, so you can take the gaviscon without it interfering with absorption of the azith? Thanks for your reply.

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Yes, that's my understanding regarding the absorption of the azith. Also, in terms of the reflux, It is not that reflux doesn't happen, it is just that it, in theory, happens less, and is, therefore, is less damaging. I happen to have severe reflux too, and this seems to have precipitated my lung damage- but as a side to this, I run a Essex group for reflux and Barretts oesophagus sufferers, and over a period of time in our meetings its been found by general consensus of all the vast majority of our members that reflux worsens with stress and stress worsens with reflux. Jolly ole life isn't it!

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Ain't it just ledge?! No way out then :(

Sorry if Im repeating but I also have Barretts which is the main reason Im worried. Maybe I should cross the Dartford Bridge and come to your group - don't think there's a Barretts group over here in East Kent.

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pm me and I will send you my email address for the group

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Hi Jean

Yes it aggravates my acid reflux. All antibiotics do.

Check with the respiratory specialist for advice.

Take care xx

Fran

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Thanks Fran xx

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Watch out for mycobacterium in sputum as well, I think I got that as a result of all my antibiotics treatment.

Take care Jean xx

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Oh not nice Fran. Sorry you have that on top of everything else.

You take care too xxx

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Yes I have been having a similar experience but was not sure it was Azithromycin as I take so many other meds. Do you experience worse symptoms on the days you take it or most of the time?

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Im trying to work that out hallentine47. Thinking of trying to take it twice a week instead of 3 times. I left out Friday's dose so as to have a longer gap and I think it is ever so slightly better but hard to tell and could be my imagination! Generally I have symptoms most of the time but until recently I had hardly any as it was so well controlled. Ive been taking azith for about 4 months now but this has only come on in the last ten days approx.

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Difficult to identify precisely I know. Different foods and changes in diet or time of day when eating and so on....curiously enough, I have an appointment with my GP next week to discuss this very subject. I will let you know if he provides any new info.

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Look forward to hearing, good luck :)

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Well, trip to GP offered little more than I knew already. I am on max daily Lansoprazole and so we were left talking about diet and times of day I eat such as dairy products especially even small amounts of cheese. He did suggest I lie in bed slightly more elevated which allows gravity to help matters!! His suggestion not mine. Sorry I cannot be more of help. It seems that it just yet another aspect of the illness that goes with the landscape. I am left with trial and error as usual.

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It's actually a bit better hallentine - ive started on a very small amount of Mirtazipine for anxiety and I am feeling better and digestion less stressed.

Have you tried not only raising bed, or wedge pillow, but also sleeping on your left hand side? The stomach isnt symetrical, the entrance from the oesophagus is a little down on the right hand side so keeping your right side above by sleeping on the left is a further way gravity can help keep acid and other stuff in the stomach. Do hope trial and error produces something helpful.

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Thank you. I have tried 1/2 mg Lorazepam before sleeping and that seems to have helped which suggests I too may have been effected by stress or anxiety which again seems to go with my condition. Pleased you are feeling better and thank you for the tips.

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I’ve been on them for about eighteen months but don’t get acid reflux.

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