Azithromycin in acute bacterial upper respiratory tract infections: Observational multicentric study from Bosnia and Herzegovina

Gorana Krstović, Anita Kovačević, Lina Rayan-Duranović, Tarik Čatić, Belma Kapo, Meliha Mehić, Anela Šehić-Lihovac, Esad Alibašić


Objectives: The primary objective of the study was to examine the effectiveness of azithromycin in the treatment of acute tonsillitis, pharyngitis, tonsillopharyngitis in adults (reduction or withdrawal of clinical symptoms), and the secondary objective of the study was to examine the tolerability of the administered treatment and patient compliance during the study.

Methods: This multi-centric, non-interventional study included 297 subjects with acute tonsillitis, pharyngitis or tonsillopharyngitis. Patients were administered film-coated tablets - azithromycin 500 mg (Azomex®) and followed-up 4 to 5 days. The patients were observed at 2 time points; baseline and one additional assessment. At both time points, we examined physical findings, general condition of the patient to establish severity of the disease. We also measured the tolerability and patient compliance. In the test lists of subjects, the physician, assessed the effectiveness of azithromycin according to the Likert’s scale.

Results: A total of 297 patients were included in the study. The median of symptom improvement was 3 (2.0-4.0) days, with 60 (28.1%) patients who had improvement after 2 days of administration, 135 patients (45.8%) after 3 days of administration, while the 77 patients (26.1%) experienced symptoms improvement within the period of 4 to 6 days after the start of treatment. The treatment outcome was successful in 260 (89.0%) patients, while in 32 (11.0%) the treatment outcome was unsuccessful, which was a significant difference in the successfulness of treatment with azithromycin (X2=159.0; p<0.001). Tolerability of azithromycin was reported to be very good by 235 patients (80.8%), good by 32 (11.0%) and unsatisfactory reported by 8 (2.7%) patients.

Conclusion: The effectiveness and tolerability of the drug azithromycin (Azomex®) film-tablets in the treatment of acute tonsillitis, pharyngitis, tonsillopharyngitis, was found to be good with a small percentage of reported mild side effects.

Keywords: azithromycin, upper respiratory tract infection, tonsillitis, pharyngitis, drug effectiveness

Full Text:



Tewfik TL, Al Garni M. Tonsillopharyngitis: Clinical Highlights. J Otolaryngol. 2005; 34(1): 45-49.

Budimir D, Curić I, Curić S. Acute Tonsillopharyngitis in a Family Practice in Mostar, Bosnia and Herzegovina. Coll Antropol. 2009; 33(1): 289–292.

Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G, et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis. 2012; 55:1279-1282.

Donde S, Mishra A, Kochhar P. Azithromycin in Acute Bacterial Upper Respiratory Tract Infections: An Indian Non-Interventional Study. Indian J Otolaryngol Head Neck Surg. 2014; 66(1): 225–230.

A Guideline on Summary of Product Characteristics, SmPC; 22.04.2016.

Francetić I. Farmakokinetika azitromicina. Medicus. 2008; 13(1): 9-14.

Markotić A. Protuupalno djelovanje azitromicina u respiratornim infekcijama. Medicus. 2014:23(1):63-68.

Logan LK, McAuley JB, Shulman ST. Macrolide treatment failure in streptococcal pharyngitis resulting in acute rheumatic fever. Pediatrics. 2012; 129:798-802.

Penezić A, Gašparić M, Kolumbić-Lakoš A, Matrapazovski-Kukuruzović M, Kovačić D, Baršić B. Effectiveness and safety of azithromycin in the treatment of upper respiratory tract infections. Croatian Journal of Infection. 2015;35 (1): 17–25.

Carbon C, Hotton JM, Pépin LF, Wohlhuter C, Souétre E, Hardens M, et al. Economic analysis of antibiotic regimens used in the treatment pharyngitis: a prospective comparison of azithromycin versus roxithromycin. J Antimicrob Chemother. 1996; 37(C): 151-161.

Kardas P. Comparison of patient compliance with once-daily and twice-daily antibiotic regimens in respiratory tract infections: results of a randomized trial. J Antimicrob Chemother. 2007; 59: 531–536.

Kardas P. Patient compliance with antibiotic treatment for respiratory tract infections. J Antimicrob Chemother. 2002; 49: 897–903.


  • There are currently no refbacks.