Azithromycin and Pregnancy: What You Need to Know About Safety and Risks

When you're pregnant and sick, choosing the right medicine isn't just about feeling better—it's about keeping your baby safe. azithromycin, a commonly prescribed macrolide antibiotic used for bacterial infections like pneumonia, chlamydia, and sinusitis. Also known as Zithromax, it's one of the most frequently prescribed antibiotics during pregnancy because it doesn't cross the placenta as aggressively as some others. But is it truly safe? Many women worry about taking any drug while pregnant, and that’s completely normal.

pregnancy, the biological process of carrying a developing fetus. Also known as gestation, it's a time when even harmless-seeming medications can raise red flags. The key isn’t avoiding all drugs—it’s choosing the right ones at the right time. Studies tracking over 100,000 pregnant women who took azithromycin show no increase in major birth defects compared to those who didn’t. The CDC and the American College of Obstetricians and Gynecologists both list it as a preferred option for treating chlamydia during pregnancy, which is critical because untreated chlamydia can lead to premature birth, low birth weight, or eye and lung infections in newborns.

antibiotic safety during pregnancy, the practice of selecting antimicrobial drugs that minimize risk to the developing fetus while effectively treating infection. Not all antibiotics are created equal. Tetracyclines can stain baby teeth, and fluoroquinolones may affect joint development—so doctors avoid those. Azithromycin, on the other hand, has been studied across multiple trimesters with consistent results: low risk. But safety doesn’t mean zero risk. Some women report mild stomach upset or diarrhea, which is common with any antibiotic. Rare cases of liver enzyme changes have been noted, but these are usually temporary and don’t harm the baby.

What you should do: If your doctor prescribes azithromycin, ask why—especially if you’re being treated for something like a cold or flu. Antibiotics don’t work on viruses. If it’s for a confirmed bacterial infection, ask if there are alternatives, but don’t refuse a needed treatment out of fear. The bigger danger is leaving an infection untreated. Many women who take azithromycin during pregnancy go on to have perfectly healthy babies. The real question isn’t whether azithromycin is safe—it’s whether you need it, and if so, whether the benefit outweighs the small known risks.

Always tell your provider you’re pregnant before taking any medication—even over-the-counter ones. Keep a list of all drugs you’re using, including supplements. And if you’re unsure about a prescription, talk to your pharmacist. They’re trained to spot interactions and can explain what’s safe in plain language. You’re not alone in this. Thousands of pregnant women take azithromycin every year, and most do so without a single issue.

Below, you’ll find real patient questions and clinical insights about antibiotics during pregnancy, how azithromycin compares to other options, and what to watch for if you’re prescribed it. No fluff. Just facts you can use.