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Side effect of azithromycin

Question
My daughter, 6 years, CF, takes for about 2 years azithromycin permanent antibiotic treatment, every 2nd day 250mg.
Can hair loss be a consequence? One has only to pull her hair slightly, then one has little bunches in the hand.
Can I do something about it?
Thanks!!
Answer
Hello,
you report that your daughter takes for about 2 years azithromycin at a dosage of 250mg every 2nd day and you observe that your daughter has increased hair loss. You ask, if the increased hair loss probably has a connection to the long-term therapy with azithromycin.
Intensive search of the literature as well as a request to the producing company of the azithromycin preparation you mentioned, revealed that there are no scientifically proven publications which prove a direct connection of increased hair loss and the therapy with azithromycin. The producing company has very infrequent reports of patients in which a time connection between a therapy with azithromycin and increased hair loss had been observed without that a direct causal connection could be proven.
In general it can be said that in children increased hair loss can be observed due to very different reasons.
We would like to recommend the following approach:
First of all you should visit a dermatologist and get counselled there. In case he should confirm, that there is an unusual severe hair loss, the usual causes of hair loss should be clarified with him.
In case the situation remains unclear, you should discuss with your CF-center, if an interruption of the azithromycin therapy on trial would be possible.
Independent of these measures your CF-physician in charge should send a report about an unwanted drug side effect to the producing company. This is important, as a long-term therapy with azithromycin is done out of the licensing policies.
Yours sincerely,
Dr. H.-G. Posselt
13.02.2011