Azithromycin overview and therapeutic potential of natural products in the management of its toxicity

Azithromycin is a macrolide antibiotic that is extensively used in the treatment of bacterial infection with broad spectrum activity. Unlike other macrolide members, Azithromycin is preferred due to its high tissue penetration and low side effects that promote long-term patient compliance which makes it a great choice in the treatment of bacterial infection. Moreover, Azithromycin has notable in-vitro and in-vivo antiviral effect against many viruses. Recently, Azithromycin was used to treat severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection due to its antiviral and immune-modulatory activity. After COVID, the world gained awareness about Azithromycin adverse drug reactions (ADRs) including cardiotoxicity, hepatotoxicity, and nephrotoxicity due to its extensive use in COVID protocol regimen. Azithromycin toxicity is due to free radicals which can cause oxidation, inflammation and necrosis of tissue. Many studies showed potential protection of various natural products against Azithromycin toxicity due to their anti-inflammatory, anti-apoptotic and antioxidant properties. This article presents collective studies on Azithromycin properties, therapeutic effects and toxicity, as well as the natural products which are used in the management of azithromycin-induced toxicity, in addition to their mechanisms that are used to elucidate Azithromycin's negative impacts.