BACKGROUND:
Acne vulgaris (or simply acne) is a long-term skin condition characterized by areas of blackheads, whiteheads, pimples, greasy skin, and possibly scarring. The resulting appearance may lead to anxiety, reduced self-esteem, and in extreme cases, depression or thoughts of suicide.
Acne develops as a result of blockages in the skin's follicles. These blockages are thought to occur as a result of the following four abnormal processes: a higher than normal amount of sebum production (influenced by androgens), excessive keratin deposition leading to comedone (blackheads) formation, colonization of the follicle by Propionibacterium acnes bacteria, and the local release of pro-inflammatory chemicals in the skin.
Azithromycin is an antibiotic. Antibiotics work by suppressing the growth of bacteria that contribute to acne symptoms.
Overall, Azithromycin is rated as a mediocre treatment for acne. Users report that, Azithromycin is somewhat effective for improving acne symptoms and that this medication tends to have mild side effects.
Although there is a lot of research supporting the use of azithromycin to treat acne, it is not commonly used for this purpose. Numerous studies have shown that azithromycin can produce a significant improvement of acne symptoms for some patients.
The major limitation of the use of azithromycin to treat acne are the increasing levels of azithromycin resistant bacteria. The research data about the antibiotic susceptibility of Propionibacterium acnes bacteria indicates that resistance to all of the macrolide family antibiotics (especially azithromycin, erythromycin and clarithromycin) is becoming more common. Recent testing of P. acnes bacteria isolated from acne patients has indicated that a significant percentage of these bacteria are resistant to azithromycin, as well as the related erythromycin and clarithromycin.
Erythromycin and clindamycin, which are closely related to azithromycin, are two of the most popular topical antibiotics for the treatment of acne vulgaris, which further contributes to the problem of macrolide resistance.
AZYTHROMYCIN:
Generic name: Azithromycin
Brand name: Macrobac, Azomax, Zithromax, Zmax
Chemical formula: C38 H72 N2 O12
Antibiotic Family: Macrolide
Azithromycin was first made in 1980. It is on the World Health Organization's List of Essential Medicines, the most important medications needed in a basic health system.
Azithromycin belongs to macrolide family of antibiotics.

USES:
It is a wide spectrum antibiotic. Azithromycin is an antibiotic useful for the treatment of a number of bacterial infections. This includes middle ear infections, strep throat, pneumonia, traveler's diarrhea, urethritis, genital ulcer disease in men, acute sinusitis and certain other intestinal infections. It is also used for uncomplicated skin and skin structure infections due to bacteria. It may also be used for a number of sexually transmitted infections including chlamydia and gonorrhea infections.
ADVERSE EFFECT:
Most common side effects are diarrhea (5%), nausea (3%), abdominal pain (3%), and vomiting.
Other reported adverse effects include heart burn, chest pain, dizziness, headache, vertigo, sleepiness, fatigue, weakness, rash, and photosensitivity.
Less than 1% of patients stop taking the drug due to side effects.
MECHANISM OF ACTION:
The antibiotic accumulates in white blood cells and is actively transported to the site of infection. It can also accumulate in sebum, a feature which makes it an attractive antibiotic for the treatment of acne.
Azithromycin prevents bacteria from growing by interfering with their protein synthesis. It binds to the 50S subunit of the bacterial ribosome, thus inhibiting translation of mRNA. Nucleic acid synthesis is not affected.

PHARMACOKINETICS:
Azithromycin is an acid-stable antibiotic, so it can be taken orally with no need of protection from gastric acids. It is readily absorbed, but absorption is greater on an empty stomach. Time to peak plasma concentration (Tmax) in adults is 2.1 to 3.2 hours for oral dosage forms. Due to its high concentration in phagocytes, azithromycin is actively transported to the site of infection. During active phagocytosis, large concentrations are released. The concentration of azithromycin in the tissues can be over 50 times higher than in plasma due to ion trapping and its high lipid solubility (volume of distribution is too high).
The terminal elimination half-life is 68 hours. The prolonged terminal half-life is thought to be due to extensive uptake and subsequent release of drug from tissues.
Azithromycin's half-life allows a large single dose to be administered and yet maintain bacteriostatic levels in the infected tissue for several days.
Biliary excretion of azithromycin, predominantly as unchanged drug, is a major route of elimination. Over the course of the week, approximately 6% of the administered dose appears as unchanged drug in urine.
CONRAINDICATIONS:
Hypersensitivity
Azithromycin is contraindicated in patients with known hypersensitivity to azithromycin, erythromycin, any macrolide, or ketolide drug.
Hepatic Dysfunction
Azithromycin is contraindicated in patients with a history of cholesteric jaundice/hepatic dysfunction associated with prior use of azithromycin.

RESULTS:
Other than the reported side effects, the subjects experienced conditions like dry skin, itchy/irritated skin, inflamed/red skin, dry throat, frequent nose bleeds, hyperpigmentation and scarring of skin.
PREVIOUSLY NOT REPORTED ADVERSE EVENTS
Among the reported adverse effects most common was nausea, vomiting, diarrhea, rash, photosensitivity and fatigue. REPORTED ADVERSE EFFECTS

DISCUSSION: We prepared a questionnaire for people using Macrobac or Azomax (azithromycin) as an acne medication, enquiring about the conditions they’ve experienced while on this drug, and how much are they satisfied with its use. According to our observations, nausea and vomiting were commonly experiential. After these conditions, diarrhea, photosensitivity, rash and fatigue were prevalent. All these interpretations were similar to those already reported.

Although we considered a small number of subjects for this survey, we came to observe some other conditions which were probably caused by the usage of this drug or by contraindication of other drugs. These previously non-reported conditions include epistaxis (nose bleeds), erythema (red/inflamed skin), xerosis (dryness of skin), pruritus (itchy skin), xerostomia (dryness of mouth) and hyperpigmentation of effected area skin.

Acne is common in people in their teens and early 20s as a result of Puberty, which causes hormone levels to rise (especially testosterone), environmental factors, life styles and vice versa. This is why our subjects are mostly in their early 20s and their side effects are comparable. According to our outcomes dosage and duration of the drug had no significant effect on the conditions.That is even the person with minimum dosage and duration suffered from the same adverse effect as the person with maximum dosage and duration.
In a nutshell, there is no association found between dosage, duration and the adverse effects.
SATISFACTION POINTS

When asked to score the drug on a scale of 1-10 (10 being the highest), most people scored 7. Maximum being 10 and minimum being 5. This indicate that the drug is effective in treating acne vulgaris and most people are satisfied with it’s results.
CONCLUSION:
We can conclude that azythromycin is effective in treating acne vulgaris. There are many more adverse effects than reported and research should be conducted in this area.