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  • Writer's pictureAlan Frischer, MD, MPH


I think that you’ll find this surprising. One of the most frequent requests I hear from my patients is this: “Doctor, will you give me a Z-Pak?”

Just what is a Z-Pak, and why the constant requests? Let’s start with what is perhaps the most brilliant marketing campaign conducted by any pharmaceutical company, ever. Z-Pak is simply Pfizer’s clever name for a full course of an antibiotic. The name is easy to remember, the marketing to laypeople is effective, it is easy to take with a convenient 5-day course, and it works well for a number of conditions.

Azithromycin is an excellent antibiotic for conditions including bacterial infections of the lungs, sinuses, throat, tonsils, skin, urinary tract, cervix or genitals (including chlamydia and gonorrhea). It does come with side effects, including the potential for serious side effects, though these are rare.

It is important to keep in mind that the Z-Pak has no effect on any viral colds or flu, or on a runny nose or cough caused by allergies. However, it is not always obvious whether an infection is viral or bacterial. There are certain clues, but without lab tests, we often never know for sure. The doctor makes an informed, educated guess.

So, what happens when we become ill? Usually, with time, we get better. When a Z-Pak is taken, we assume that it was the antibiotic that led to our recovery. What we don’t know is whether we would have recovered just as quickly without it, because it is statistically extremely likely that a virus caused the illness in the first place. Studies have been conducted to address this very question, and the data suggests that viruses cause about 81% of respiratory infections.

Due to its overuse, resistance to azithromycin will eventually reach a point where we can no longer count on it to be an effective tool. That resistance level is already around 30-35% in the United States. The problem with any antibiotic is that when it is overused, bacteria eventually figure it out. And, when the full five-day course is not completed, the most resistant bacteria survive. They multiply, leading to a more resistant infection.

So, why do we doctors so frequently comply and prescribe it, even though we are well aware that the odds are that the infection is viral, and that the overuse of the antibiotic will ultimately lead to its end as a viable treatment? If the patient goes home empty-handed and gets sicker, he or she will feel they wasted their time and must return to the doctor. We doctors understand that our patients have taken valuable time away from their jobs, children, or other responsibilities in order to come see us. There is an implied understanding that we will do our best to resolve the issue at hand during that visit. The result? Roughly 60 million prescriptions for Z-Pak are written each year.

Here is the bottom line: If you aren’t running a high fever, or have an underlying medical condition, you will likely feel better in a few days. Take this time to catch up on sleep, eat chicken soup, drink plenty of fluids, and binge watch your favorite shows. If symptoms persist, or get worse, then by all means reach out to your doctor.

It is clear to me that the Z-Pak dilemma will only be solved when both patients and doctors work together to reduce its unnecessary use. Sometimes, the best plan is to be patient, and to stick with over-the-counter medicines for symptom relief.

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