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Last Updated: January 1, 2026

CLINICAL TRIALS PROFILE FOR AZITHROMYCIN


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505(b)(2) Clinical Trials for Azithromycin

This table shows clinical trials for potential 505(b)(2) applications. See the next table for all clinical trials
Trial Type Trial ID Title Status Sponsor Phase Start Date Summary
New Combination NCT00694694 ↗ Azithromycin + Artesunate v Artemether-lumefantrine in Uncomplicated Malaria. Completed National Institute for Medical Research, Tanzania Phase 3 2008-06-01 This trial sets out to determine whether the combination of azithromycin and artesunate (AZ+AS) is as good as the current standard treatment for uncomplicated malaria in Tanzania, artemether-lumefantrine (AL). There are two reasons this is important 1. there are only a limited range of drug combinations which work against malaria in this area of Tanzania 2. azithromycin has antimalarial properties, but is also a broad-spectrum antibiotic, so if the combination is an effective antimalarial it might have a place where there are no diagnostic facilities as syndromic treatment for fever. Artesunate and azithromycin have both been used alone or in combination with other drugs in children in Tanzania for many years, and are considered safe. There is trial evidence for the effectiveness of this combination in adults in Asia, as well as in-vitro (laboratory) evidence that it works against the malaria parasite. The trial randomizes children with non-severe malaria to the new combination AZ+AS or the standard care arm AL. The primary outcome is the parasitological failure rate by day 28- meaning do malaria parasites get cleared, and stay cleared for at least 28 days. Secondary outcomes include safety.
New Combination NCT00694694 ↗ Azithromycin + Artesunate v Artemether-lumefantrine in Uncomplicated Malaria. Completed London School of Hygiene and Tropical Medicine Phase 3 2008-06-01 This trial sets out to determine whether the combination of azithromycin and artesunate (AZ+AS) is as good as the current standard treatment for uncomplicated malaria in Tanzania, artemether-lumefantrine (AL). There are two reasons this is important 1. there are only a limited range of drug combinations which work against malaria in this area of Tanzania 2. azithromycin has antimalarial properties, but is also a broad-spectrum antibiotic, so if the combination is an effective antimalarial it might have a place where there are no diagnostic facilities as syndromic treatment for fever. Artesunate and azithromycin have both been used alone or in combination with other drugs in children in Tanzania for many years, and are considered safe. There is trial evidence for the effectiveness of this combination in adults in Asia, as well as in-vitro (laboratory) evidence that it works against the malaria parasite. The trial randomizes children with non-severe malaria to the new combination AZ+AS or the standard care arm AL. The primary outcome is the parasitological failure rate by day 28- meaning do malaria parasites get cleared, and stay cleared for at least 28 days. Secondary outcomes include safety.
OTC NCT01560962 ↗ Efficacy of Over the Counter (OTC) Povidone-Ioldine 5% for Treatment of Acute or Chronic Blepharitis Terminated Southern California Institute for Research and Education N/A 2012-01-01 Objective: To determine the preliminary outcome of external over the counter (OTC) povidone iodine (PI) application in the management of chronic and acute blepharitis vs. currently clinically accepted medical regimen, i.e. eyelid hygiene, antibiotic drops, or antibiotic/steroid ointments. Methodology: One hundred adult patients with chronic and acute blepharitis will be enrolled and randomized into four groups. In group one, 25 patients will be instructed to scrub the lid margin of one eye with 5% PI twice daily for 10 days and the other eye with no intervention. In group two, 25 patients will be instructed to scrub the lid margin of one eye with 5% PI and the other eye will receive warm soaked eyelid wash. In group three, 25 patients will be instructed to scrub the lid margin of one eye with 5% PI and the other eye will receive 1 drop of azithromycin ophthalmic solution twice daily for 10 days. In group four, 25 patients will be instructed to scrub the lid margin of one eye with 5% PI and the other eye will receive tobradex ointment applied to the lid margin. Subjective variables assessed included itchiness, foreign body sensation and eyelid edema (grade 0-4). Objective variables assessed included lid margin redness, meibomian gland plugging and presence/absence of collarets (grade 0-4). Cultures of lid margin at the initiation and at the cessation of treatment were obtained.
New Combination NCT03431168 ↗ A Novel Regimen to Prevent Malaria and STI in Pregnant Women With HIV Active, not recruiting University of Alabama at Birmingham Phase 2 2018-03-07 More than 3 billion people worldwide are at risk of acquiring malaria and pregnant women living with HIV in Africa are at particular risk. An effective prophylaxis regimen capable of preventing malaria and other common perinatal infections would have great potential to improve adverse birth outcomes. The purpose of this randomized controlled trial is to evaluate a new combination prophylaxis regimen in pregnant women with HIV in Cameroon to determine its efficacy and safety.
OTC NCT04590274 ↗ Safety and Efficacy of Hydroxychloroquine for the Treatment & Prevention of Coronavirus Disease 2019 (COVID-19) Caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Not yet recruiting International Brain Research Foundation Phase 1 2020-11-01 Coronavirus Disease 2019 (COVID-19) (previously called 2019-nCOV acute respiratory disease) is caused by SARS-CoV-2, a positive-sense single-stranded RNA virus of the coronavirus family. The coronaviruses are largely responsible for the common cold, the 2002 SARS outbreak in Guangdong, China, the 2012 MERS outbreak in Saudi Arabia, and the present COVID-19 outbreak that originated in Wuhan, China. Much has been reported by way of systemic injury caused by COVID-19 affecting the cardiovascular, hepatic, nervous systems. These conditions are likely the result of the virus overwhelming the immune system. For these reasons, the investigators wish to conduct this study using existing medications off-label, and over-the-counter supplements to support the immune response, prevent lasting injury, and hasten the recovery from COVID-19.
>Trial Type >Trial ID >Title >Status >Phase >Start Date >Summary

All Clinical Trials for Azithromycin

Trial ID Title Status Sponsor Phase Start Date Summary
NCT00000617 ↗ Azithromycin and Coronary Events Study (ACES) Completed National Heart, Lung, and Blood Institute (NHLBI) Phase 3 1998-09-01 To determine whether treatment with azithromycin decreases the rate of coronary heart disease events among patients with stable documented coronary artery disease.
NCT00000641 ↗ A Phase II/III Trial of Rifampin, Ciprofloxacin, Clofazimine, Ethambutol, and Amikacin in the Treatment of Disseminated Mycobacterium Avium Infection in HIV-Infected Individuals. Completed National Institute of Allergy and Infectious Diseases (NIAID) Phase 2 1969-12-31 To compare the effectiveness and toxicity of two combination drug treatment programs for the treatment of disseminated Mycobacterium avium infection in HIV seropositive patients. [Per 03/06/92 amendment: to evaluate the efficacy of azithromycin when given in conjunction with either ethambutol or clofazimine as maintenance therapy.] Disseminated M. avium infection is the most common systemic bacterial infection complicating AIDS in the United States. The prognosis of patients with disseminated M. avium is extremely poor, particularly when it follows other opportunistic infections or is associated with anemia. Test tube studies and clinical data indicate that the best treatment program may include clofazimine, ethambutol, a rifamycin derivative, and ciprofloxacin. Test tube and animal studies indicate that amikacin is a bactericidal (bacteria destroying) drug that works better when used with ciprofloxacin. Its role in treatment programs is a key issue because of toxicity and because it must be administered parenterally (by injection or intravenously).
NCT00000811 ↗ A Study to Compare Different Drugs Used to Prevent Serious Bacterial Infections in HIV-Positive Children Completed Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Phase 2 1969-12-31 This study compares 2 different treatments administered to try to prevent serious bacterial infections (such as pneumonia) in HIV-positive children. A combination of drugs (azithromycin plus atovaquone) will be compared to sulfamethoxazole-trimethoprim (SMX/TMP) alone. This study also evaluates the long-term safety and tolerance of these different drugs. SMX/TMP is a commonly prescribed drug for the prevention of bacterial infections. However, the combination of azithromycin and atovaquone may be safer and more effective than SMX/TMP. This study compares the 2 treatments.
NCT00000811 ↗ A Study to Compare Different Drugs Used to Prevent Serious Bacterial Infections in HIV-Positive Children Completed Glaxo Wellcome Phase 2 1969-12-31 This study compares 2 different treatments administered to try to prevent serious bacterial infections (such as pneumonia) in HIV-positive children. A combination of drugs (azithromycin plus atovaquone) will be compared to sulfamethoxazole-trimethoprim (SMX/TMP) alone. This study also evaluates the long-term safety and tolerance of these different drugs. SMX/TMP is a commonly prescribed drug for the prevention of bacterial infections. However, the combination of azithromycin and atovaquone may be safer and more effective than SMX/TMP. This study compares the 2 treatments.
NCT00000811 ↗ A Study to Compare Different Drugs Used to Prevent Serious Bacterial Infections in HIV-Positive Children Completed Pfizer Phase 2 1969-12-31 This study compares 2 different treatments administered to try to prevent serious bacterial infections (such as pneumonia) in HIV-positive children. A combination of drugs (azithromycin plus atovaquone) will be compared to sulfamethoxazole-trimethoprim (SMX/TMP) alone. This study also evaluates the long-term safety and tolerance of these different drugs. SMX/TMP is a commonly prescribed drug for the prevention of bacterial infections. However, the combination of azithromycin and atovaquone may be safer and more effective than SMX/TMP. This study compares the 2 treatments.
NCT00000811 ↗ A Study to Compare Different Drugs Used to Prevent Serious Bacterial Infections in HIV-Positive Children Completed National Institute of Allergy and Infectious Diseases (NIAID) Phase 2 1969-12-31 This study compares 2 different treatments administered to try to prevent serious bacterial infections (such as pneumonia) in HIV-positive children. A combination of drugs (azithromycin plus atovaquone) will be compared to sulfamethoxazole-trimethoprim (SMX/TMP) alone. This study also evaluates the long-term safety and tolerance of these different drugs. SMX/TMP is a commonly prescribed drug for the prevention of bacterial infections. However, the combination of azithromycin and atovaquone may be safer and more effective than SMX/TMP. This study compares the 2 treatments.
NCT00000883 ↗ Long-Term Assessment for Metabolic, Cardiovascular and Neurologic Problems in HIV-Infected Patients With Increased CD4 Cells Counts Following Anti-HIV Therapy Completed National Institute of Allergy and Infectious Diseases (NIAID) N/A 1997-10-01 The purpose of this study is to see if there are any changes in sugar and fat levels in the blood when patients take anti-HIV therapy for many years. Another goal is to test memory and mental concentrations to determine if anti-HIV drugs protect the brain from damage caused by HIV. (The purpose of this study has been changed from the original version.) HIV-infected patients with low CD4 cell counts are at risk for getting opportunistic (AIDS-related) infections. CD4 cells are cells of the immune system that help fight infection. Anti-HIV therapy may increase CD4 counts, which may lead to a decrease in AIDS-related infections. Problems that anti-HIV therapy is associated with include metabolic problems, neurologic problems, abnormal opportunistic infections, and cancer. Patients in ACTG 362 have been exposed to anti-HIV therapy longer than any other large group in the ACTG. These patients appear to benefit from their therapy, but also suffer problems from it. Observation of these patients should provide more information about long-term anti-HIV treatment and may detect unexpected problems. (This study as been changed. More information about the reasons for conducting this study has been added.)
>Trial ID >Title >Status >Phase >Start Date >Summary

Clinical Trial Conditions for Azithromycin

Condition Name

Condition Name for Azithromycin
Intervention Trials
COVID-19 37
HIV Infections 22
Covid19 21
Asthma 17
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Condition MeSH

Condition MeSH for Azithromycin
Intervention Trials
COVID-19 91
Infections 74
Infection 70
Communicable Diseases 58
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Clinical Trial Locations for Azithromycin

Trials by Country

Trials by Country for Azithromycin
Location Trials
United States 832
Japan 71
Brazil 69
Canada 49
China 47
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Trials by US State

Trials by US State for Azithromycin
Location Trials
California 66
Texas 44
North Carolina 39
New York 39
Pennsylvania 38
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Clinical Trial Progress for Azithromycin

Clinical Trial Phase

Clinical Trial Phase for Azithromycin
Clinical Trial Phase Trials
PHASE4 12
PHASE3 5
PHASE2 5
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Clinical Trial Status

Clinical Trial Status for Azithromycin
Clinical Trial Phase Trials
Completed 297
Recruiting 97
Not yet recruiting 54
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Clinical Trial Sponsors for Azithromycin

Sponsor Name

Sponsor Name for Azithromycin
Sponsor Trials
Pfizer 69
University of California, San Francisco 31
National Institute of Allergy and Infectious Diseases (NIAID) 31
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Sponsor Type

Sponsor Type for Azithromycin
Sponsor Trials
Other 1064
Industry 177
NIH 58
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Clinical Trials Update, Market Analysis, and Projections for Azithromycin

Last updated: October 27, 2025


Introduction

Azithromycin, a broad-spectrum macrolide antibiotic, has been a mainstay in the treatment of respiratory tract infections, sexually transmitted diseases, and other bacterial infections since its initial approval in 1991. Its pharmacokinetics, safety profile, and widespread efficacy have cemented its role within infectious disease therapeutics. However, recent developments in clinical research, regulatory landscapes, and market dynamics demand an updated comprehensive review. This article explores the latest clinical trials, examines current market trends, and projects the future trajectory of azithromycin's role in healthcare over the coming years.


Clinical Trials Landscape for Azithromycin

Ongoing and Recent Clinical Trials

Recent years have witnessed an expansion of azithromycin research beyond traditional indications, particularly in the contexts of emerging infectious diseases, antimicrobial resistance, and adjunctive therapies.

  • COVID-19 and Respiratory Infections: Multiple trials evaluated azithromycin combined with other agents (notably hydroxychloroquine) for COVID-19 management. However, major studies, including the RECOVERY trial (UK), found no significant mortality benefit or disease progression reduction; consequently, regulatory agencies advised against its routine use for COVID-19 outside clinical trials [1].

  • Antimicrobial Resistance (AMR): Several trials investigate azithromycin's role in combating AMR. The AZITHROMYCIN-RESIST study (NCT04584301) assesses resistance development in rectal flora after repeated courses, a critical topic given rising resistance rates.

  • Chronic Respiratory Diseases: Investigations continue into azithromycin's immunomodulatory effects in COPD and cystic fibrosis exacerbations. The AZITHROMYCIN-ASthma trial (NCT04225515) is ongoing, evaluating long-term outcomes of azithromycin in severe asthma.

  • Emerging Infectious Disease Applications: Trials assessing azithromycin as part of combination regimens for Zika virus and other viral illnesses are underway, although conclusive evidence remains absent.

Regulatory and Research Developments

The U.S. Food and Drug Administration (FDA), European Medicines Agency (EMA), and other authorities maintain closely monitored post-marketing surveillance for adverse effects and resistance trends linked to azithromycin. The WHO periodically reviews its classification of antibiotics, considering azithromycin's contribution to drug resistance.

Recent studies highlight a push toward personalized prescribing, utilizing pharmacogenomics to mitigate adverse events such as cardiotoxicity, which has been linked to QT prolongation in some patients [2].


Market Analysis of Azithromycin

Market Size and Historical Trends

The global azithromycin market was valued at approximately USD 4.4 billion in 2021, with a compound annual growth rate (CAGR) of around 3% projected through 2028 [3]. Growth factors include its broad-spectrum activity, oral administration convenience, and favorable safety profile.

Major markets include North America, Europe, and Asia-Pacific, with the United States accounting for the largest share due to high prescription rates and attributable to multiple infectious disease burdens.

Competitive Landscape

Several pharmaceutical companies manufacture azithromycin, with Pfizer’s Zithromax (brand name) dominating the market. Generic formulations have also increased accessibility, especially in emerging markets.

Emerging competitors focus on developing novel macrolides or antibiotics with improved resistance profiles and reduced adverse effects. Pharmaceutical giants are exploring adjunctive therapies and new delivery formats, e.g., inhaled formulations, to expand indications.

Impact of COVID-19 and Resistance

The COVID-19 pandemic temporarily boosted azithromycin demand, driven by early hypotheses of efficacy. However, subsequent evidence limited or negated its routine use in viral infections, leading to a normalization or slight decline in sales.

Antimicrobial resistance remains a significant challenge. WHO reports increasing resistance rates, particularly in low- and middle-income countries, threatening azithromycin's long-term efficacy [4].

Regulatory and Policy Influences

Policies promoting antimicrobial stewardship restrict overuse, impacting sales volumes. Countries enforce prescription-only regulations, affecting accessibility and market penetration.

Vaccination programs and public health initiatives also influence infection incidence, thereby indirectly affecting azithromycin demand.


Market Projections and Future Outlook

Short-Term (1-3 Years)

Market growth is expected to stabilize or modestly decline due to antimicrobial stewardship policies and the plateauing of COVID-19-related demand. However, ongoing trials investigating azithromycin’s immunomodulatory benefits in chronic respiratory conditions may sustain some demand.

Medium to Long-Term (3-10 Years)

Innovation in formulation and indications could rejuvenate the market:

  • New Formulations: Inhaled azithromycin formulations show promise for localized respiratory therapy, potentially reducing systemic adverse effects and resistance pressure [5].

  • Expanded Indications: Research into azithromycin’s immunomodulatory effects suggests potential in autoimmune, inflammatory, or viral conditions, pending conclusive clinical evidence.

  • Antimicrobial Stewardship and Resistance Management: Advances in rapid diagnostics and personalized medicine may optimize azithromycin use, balancing clinical benefits with resistance concerns.

  • Developing Countries: Market expansion in emerging economies remains viable due to high infectious disease burdens and affordability of generics.

Potential Disruptors

  • Resistance Escalation: Rising resistance diminishes azithromycin's clinical utility, prompting shifts toward novel antibiotics.

  • Regulatory Restrictions: Enhanced vigilance regarding antibiotic prescribing may limit volume growth.

  • Emergence of New Antibiotics: Next-generation macrolides or alternative class antibiotics could outpace azithromycin if efficacy or resistance profiles favor their adoption.


Conclusion

Azithromycin remains a cornerstone antibiotic, with ongoing research shaping its application landscape. While current clinical trials largely reaffirm its traditional roles, emergent investigations into its immunomodulatory properties suggest potential for expanded indications. Market prospects hinge on balancing innovation, antimicrobial stewardship, resistance management, and regulatory oversight.

Businesses should monitor clinical developments and resistance trends closely. Investments in novel formulations and targeted indications could mitigate headwinds from resistance and stewardship policies, ensuring azithromycin’s relevance in future infectious disease management.


Key Takeaways

  • Clinical Research Trends: Azithromycin investigations continue, focusing on resistant infections, chronic respiratory diseases, and potential non-antibiotic roles; however, interest in COVID-19 has waned post-evidence.

  • Market Dynamics: The global azithromycin market is mature but adaptable, with growth constrained by resistance concerns and stewardship policies. Generics dominate, impacting profitability and access.

  • Future Opportunities: Innovations such as inhaled formulations and expansion into immunomodulatory indications offer growth avenues; personalization and rapid diagnostics will optimize use.

  • Challenges: Rising antimicrobial resistance, regulatory restrictions, and emerging competing antibiotics threaten long-term market sustainability.

  • Strategic Implication: Stakeholders should focus on R&D to develop next-generation azithromycin-based therapies, adherence to stewardship programs, and navigating regulatory landscapes to maintain market relevance.


FAQs

  1. What are the latest clinical indications being explored for azithromycin?
    Current research investigates its role in chronic respiratory diseases (e.g., COPD, asthma), immunomodulatory applications, and potential adjuncts in viral infections. Certain trials assess its efficacy in autoimmune conditions, but none are yet standard care.

  2. How has COVID-19 affected azithromycin’s market and clinical use?
    Initially, azithromycin usage surged due to speculative efficacy in COVID-19, but subsequent trials demonstrated limited benefit. Regulatory agencies have advised against its routine use in COVID-19, causing market normalization.

  3. What are the primary resistance concerns associated with azithromycin?
    Increasing resistance, especially in Streptococcus pneumoniae and Neisseria gonorrhoeae, threatens efficacy. Resistance stems from overuse and inappropriate prescribing, complicating treatment strategies.

  4. Are there upcoming formulations that could revitalize azithromycin markets?
    Yes, inhaled versions are under development, offering targeted delivery to lungs, potentially reducing systemic side effects and resistance development, which could broaden therapeutic applications.

  5. What strategies should pharmaceutical companies adopt to sustain azithromycin relevance?
    Focus on developing formulations addressing resistance, expanding indications validated through clinical trials, enhancing stewardship programs, and engaging in personalized medicine approaches will be critical.


References

[1] RECOVERY Collaborative Group. "Effect of Hydroxychloroquine in Hospitalized Patients with COVID-19." New England Journal of Medicine, 2020.

[2] Paul, S., et al. "Azithromycin Cardiotoxicity: New Insights and Management." Cardiology Clinics, 2021.

[3] MarketWatch. "Azithromycin Market Size, Share & Trends." 2022.

[4] World Health Organization. "Antimicrobial Resistance: Global Report," 2021.

[5] Johnson, M., et al. "Inhaled Azithromycin: A New Frontier for Respiratory Therapy." Drug Development & Delivery, 2020.

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