RESUMO
Azithromycin is one of the most commonly prescribed antibiotic. It is also considered as one of the safest antibiotic withadvantage of once a day dosage. It is also available as over-the-counter medicine. Most commonly encountered adverseeffect of azithromycin is gastrointestinal, mostly nausea, diarrhea, bloating, and indigestion. We present the case of a youngmale patient who presented with symptoms of upper respiratory tract infection and was prescribed tablet azithromycin 500 mgfor 4 days. On taking first dose of azithromycin 500 mg, the patient noticed sudden-onset acute confusional state within 2 hof ingestion. He had vivid thoughts, confusion, disorientation, and blurring of vision which lasted for 20–30 min. This episodesubsided spontaneously without any intervention. Such episode with azithromycin is exceedingly rare and hardly noticed infour patients till date. Knowledge of such azithromycin-induced neuropsychiatric manifestation is necessary and should bekept in mind.