How it Works: The Infamous Z-Pak

By Jarrod Beachum, PA-C

We have all been to the doctor’s office at some point in our lives with some of the following symptoms: cough, nasal congestion, sore throat, maybe even a low-grade fever, aka “the crud”. You would often go home with a decongestant, possibly a steroid pack, or maybe a Z-pak. We often tend to take these meds without question, sometimes even requesting them before the office visit even starts because we just want some relief or have become so conditioned to that scenario. In this How It Works entry, I would like to discuss what the Z-Pak is, does, and doesn’t do, and why maybe next time you’re getting treated for a cold you can feel empowered to ask: what bacteria are you treating with this?

So, what is a Z-pack actually? Unfortunately, many patients don’t know or aren’t told that the “Z” in Z-pak stands for azithromycin, which is a powerful macrolide antibiotic. All medicines in this class work by stopping bacteria reproduction, eventually killing the population, and curing the infection. Since this is an antibiotic, it has no use for any viral disease. We commonly use it to treat strep throat, skin infections, community-acquired pneumonia, some sexually transmitted infections, and more. What it will not treat is the common cold, allergies, the flu, Covid-19, or any other viral infection (it does treat the parasite that causes malaria, which is neither a bacterium nor a virus).

One of the most common reasons for an urgent care visit is for the common cold. In the US, over 90% percent of all colds are caused by a virus. Common symptoms overlap with non-viral infections, including fever, cough, drainage, sneezing, congestion, nausea/vomiting/diarrhea. To make it even trickier, sometimes you can have infections by different organisms at the same time! Fun Fact of the Day: the color of your mucous does not absolutely differentiate between viral and bacterial infections. So how do we know what we are treating? By taking the time to get a good and accurate history and physical, supported by labs and testing if necessary. We don’t get it right by running a cough and cold assembly line.

Practicing medicine is as much an art as is it a science. We don’t always get it right, but that doesn’t mean we should just accept that and prescribe antibiotics without a good reason. The CDC reported studies that found 30-50% of antibiotics prescribed in hospitals are unnecessary. 50% is half in my book, and that is way too many in anybody’s book. What if every other time you went to dinner they gave you the wrong food or half the time you put gas in your car this year it was water? Overprescribing is not just limited to hospitals by any means. The rates reported for urgent care nationwide was 45%, ER’s at 24%, down to about 17% at medical offices and retail clinics. The most common cause for inappropriate antibiotic use overall? Acute respiratory infections like the one described above. This incorrect use of antibiotics has led to skyrocketing resistance rates in many bacteria, leading to the formation of superbugs that are next to impossible to treat. Before the advent of antibiotics, people used to die in much higher numbers from bacterial infections. Experts predict that staying on the current trends, within my lifetime we may go from 700,000 deaths a year from untreatable bacterial infections to 10 MILLION a year by 2050. We are literally overusing our way back into the time before antibiotics even existed…

So why does this happen? A survey of medical providers in different practices had one very common reason cited: patient satisfaction. How many times have you heard someone say “I went to the doctor for my cold and they didn’t do anything”? Now, they may have been told to rest for 2-3 days, increase water intake, take Tylenol/ibuprofen as needed, use a decongestant, etc. That’s not doing anything. That is using experience and training to make an informed decision that weighs the risks and benefits of treatment vs non-treatment. We all have to get out of the mindset that when we see a provider we have to leave with something, get poked, or pee in a cup to feel we got our money’s worth. As a patient, you are your number one advocate. You should never be afraid to question your treatment plan. Ask us those questions. Ask me why I am doing one thing versus another. Ask me why I ordered a test or x-ray, and how it will affect my treatment plan. Some providers do get bristled when they may want to just move on to the next patient, but we (providers) should view it as an opportunity to educate and inform, not feel like our judgment is being challenged. When we can openly communicate and make decisions as a team, everybody wins. Just ask: what bacteria are you treating?