Azithromycin: Difference between revisions

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==General==
==General==
*Type:  
*Type: [[Is DrugClass::Macrolide]]
*Dosage Forms:
*Dosage Forms: powder for solution, suspension reconstituted, packet, tablet
*Common Trade Names:  
*Dosage Strengths: powder for solution: 500mg, 2.5g; suspension reconstituted: 100, 200mg/5mL; packet: 1g; tablet: 250, 500, 600mg
*Routes of Administration: PO, IV
*Common Trade Names: Zithromax, Z-Pak, Zmax


==Adult Dosing==
==Adult Dosing==
===[[Babesiosis]]===
''In combination with Atovaquone''
*Mild/Moderate: 500mg PO x1 on day 1, then 250mg PO q24h x7-10 days
*Severe 500mg IV q24hr for 7 to 10 days]
===Bacterial Infections===
*500mg PO x1 on day 1, then 250mg PO q24h x4 days
===[[Strep Pharyngitis]]/tonsillitis===
*500mg PO x1 on day 1, then 250mg PO q24h x4 days]
*Alt: 500mg PO q24h x3 days
===[[COPD exacerbation]]===
*500mg PO x1 on day 1, then 250mg PO q24h x4 days
*Alt: 500mg PO q24h x3 days
===Community-acquired [[pneumonia]]===
*500mg PO x1 on day 1, then 250mg PO q24h x4 days
*Alt: 500mg IV q24h x2 or more days, then 500mg PO q24h to complete 7-10 day course
===[[Chlamydia]]  (uncomplicated urethritis, cervicitis, oropharygeal)===
*1 g PO x1
===[[Gonorrhea]]===
*Initial or recurrent: 1 g PO x1
*Persistent: 2 g PO x1
===[[PID]]===
*500mg IV q24h x1-2 days, then 250mg PO q24h x5-6 days
===[[Urethritis]], non-gonococcal initial infection===
*1 g PO x1
===[[Chancroid]]===
*1 g PO x1
===MAC===
*Disseminated: 500-600mg PO q24h (not 1st-line agent; use with ethambutol)
*Primary prophylaxis: 1200mg PO qwk  Alt: 600mg PO 2x/wk
*Secondary prophylaxis: 500-600mg PO q24h (not 1st-line agent; use with ethambutol)
===[[Endocarditis]] prophylaxis (dental)===
*500mg PO x1 (Start: 30-60min before procedure)
===Pertussis===
*500mg PO on day 1, followed by 250mg q24hr for days 2-5
===Presumptive [[cervicitis]]===
*1 g PO x1
===[[Salmonella]]===
*1 g PO q24h x1 day, then 500mg PO q24h x2-6 days
===[[Typhoid fever]]===
*10mg/kg PO q24h x1wk


==Pediatric Dosing==
==Pediatric Dosing==
===[[Pneumonia (peds)]]===
*10mg/kg/day PO in a once daily dose on day 1 (max 500mg)
**Followed by 5mg/kg/day PO once daily on days 2-5
===Bacterial sinusitis===
*Children ≥6 months: Oral: 10mg/kg PO once daily for 3 days (maximum: 500mg daily)
===[[Otitis media]]===
*Children ≥6 months:
**1-day regimen: 30mg/kg PO a single dose (maximum dose: 1,500mg)
**3-day regimen: 10mg/kg PO once daily for 3 days (maximum: 500mg daily)
**5-day regimen: 10mg/kg PO on day 1 (maximum: 500mg daily) followed by 5mg/kg/day once daily on days 2 to 5 (maximum: 250mg daily)
===[[Pharyngitis]] (as an alternative agent in penicillin allergic patients)===
*Children ≥2 years and Adolescents: Oral: 12mg/kg/dose once daily for 5 days (maximum: 500mg daily)


==Special Populations==
==Special Populations==
*Pregnancy:
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: B
*Lactation:
*[[Lactation risk categories|Lactation risk]]: Excreted in low amounts of breast milk and may lead to rash, somnolence, and diarrhea in nursing infants
*Renal Dosing
*Renal Dosing: Caution in patients with GFR <10 mL/minute, though primarily elimated through hepatic metabolism
**Adult
*Hepatic Dosing:  Caution is indicated for potential hepatotoxicity though it is rare, and there are no specific dosage adjustments indicated for patients with liver failure
**Pediatric
*Hepatic Dosing
**Adult
**Pediatric


==Contraindications==
==Contraindications==
*Allergy to class/drug
*Hypersensitivity to azithromycin or other macrolides or any component of the formulation
*History of cholestatic jaundice/hepatic dysfunction with prior Azithromycin use


==Adverse Reactions==
==Adverse Reactions==
===Serious===
===Serious===
*[[Prolonged QT]]
*[[Torsades]]
*hepatic necrosis
*Eaton-Lambert
*[[Myasthenia gravis]]
*Corneal erosion


===Common===
===Common===
*[[Vomiting]]
*[[Diarrhea]]
*[[Abdominal pain]]
*[[Headache]]
*Vision changes


==Pharmacology==
==Pharmacology==
*Half-life:  
*Half-life: 68 hrs
*Metabolism:  
*Metabolism: Hepatic
*Excretion:  
*Excretion: Biliary
*Mechanism of Action:
*Mechanism of Action:Binds 50S ribosomal subunit interfering with microbial protein synthesis
 
==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==
{| class="wikitable"
| align="center" style="background:#f0f0f0;"|'''Group'''
| align="center" style="background:#f0f0f0;"|'''Organism'''
| align="center" style="background:#f0f0f0;"|'''Sensitivity'''
|-
| Gram Positive||[[Strep. Group A, B, C, G]]||I
|-
| ||[[Strep. Pneumoniae]]||I
|-
| ||[[Viridans strep]]||X1
|-
| ||Strep. anginosus gp||X1
|-
| ||[[Enterococcus faecalis]]||R
|-
| ||[[Enterococcus faecium]]||R
|-
| ||[[MSSA]]||'''S'''
|-
| ||[[MRSA]]||R
|-
| ||[[CA-MRSA]]||I
|-
| ||[[Staph. Epidermidis]]||R
|-
| ||[[C. jeikeium]]||R
|-
| ||[[L. monocytogenes]]||'''S'''
|-
| Gram Negatives||[[N. gonorrhoeae]]||I
|-
| ||[[N. meningitidis]]||X2
|-
| ||[[Moraxella catarrhalis]]||'''S'''
|-
| ||[[H. influenzae]]||'''S'''
|-
| ||[[E. coli]]||R
|-
| ||[[Klebsiella]] sp||R
|-
| ||E. coli/Klebsiella ESBL+||R
|-
| ||E coli/Klebsiella KPC+||R
|-
| ||[[Enterobacter]] sp, AmpC neg||R
|-
| ||[[Enterobacter]] sp, AmpC pos||R
|-
| ||[[Serratia]] sp||X1
|-
| ||Serratia marcescens||R
|-
| ||[[Salmonella]] sp||I
|-
| ||[[Shigella]] sp||I
|-
| ||[[Proteus mirabilis]]||X1
|-
| ||[[Proteus vulgaris]]||R
|-
| ||[[Providencia sp.]]||X1
|-
| ||[[Morganella sp.]]||X1
|-
| ||[[Citrobacter freundii]]||X1
|-
| ||[[Citrobacter diversus]]||X1
|-
| ||[[Citrobacter sp.]]||X1
|-
| ||[[Aeromonas sp]]||X1
|-
| ||[[Acinetobacter sp.]]||R
|-
| ||[[Pseudomonas aeruginosa]]||R
|-
| ||[[Burkholderia cepacia]]||R
|-
| ||[[Stenotrophomonas maltophilia]]||R
|-
| ||[[Yersinia enterocolitica]]||R
|-
| ||[[Francisella tularensis]]||X1
|-
| ||[[Brucella sp.]]||R
|-
| ||[[Legionella sp.]]||'''S'''
|-
| ||[[Pasteurella multocida]]||X1
|-
| ||[[Haemophilus ducreyi]]||'''S'''
|-
| ||[[Vibrio vulnificus]]||X1
|-
| Misc||[[Chlamydophila sp]]||'''S'''
|-
| ||[[Mycoplasm pneumoniae]]||'''S'''
|-
| ||[[Rickettsia sp]]||X1
|-
| ||[[Mycobacterium avium]]||'''S'''
|-
| Anaerobes||[[Actinomyces]]||'''S'''
|-
| ||[[Bacteroides fragilis]]||R
|-
| ||[[Prevotella melaninogenica]]||'''S'''
|-
| ||[[Clostridium difficile]]||X1
|-
| ||[[Clostridium (not difficile)]]||'''S'''
|-
| ||[[Fusobacterium necrophorum]]||R
|-
| ||[[Peptostreptococcus sp.]]||'''S'''
|}
 
===Key===
{{Template:Antibacterial Spectra Key}}


==See Also==
==See Also==
*[[Antibiotics (Main)]]
*[[Antibiotics (Main)]]


==Source==
==References==
<references/>
[[Category:Pharmacology]] [[Category:ID]]


<references/>
*Epocrates
[[Category:Drugs]]
*Micromedex

Latest revision as of 19:53, 28 January 2026

General

  • Type: Macrolide
  • Dosage Forms: powder for solution, suspension reconstituted, packet, tablet
  • Dosage Strengths: powder for solution: 500mg, 2.5g; suspension reconstituted: 100, 200mg/5mL; packet: 1g; tablet: 250, 500, 600mg
  • Routes of Administration: PO, IV
  • Common Trade Names: Zithromax, Z-Pak, Zmax

Adult Dosing

Babesiosis

In combination with Atovaquone

  • Mild/Moderate: 500mg PO x1 on day 1, then 250mg PO q24h x7-10 days
  • Severe 500mg IV q24hr for 7 to 10 days]

Bacterial Infections

  • 500mg PO x1 on day 1, then 250mg PO q24h x4 days

Strep Pharyngitis/tonsillitis

  • 500mg PO x1 on day 1, then 250mg PO q24h x4 days]
  • Alt: 500mg PO q24h x3 days

COPD exacerbation

  • 500mg PO x1 on day 1, then 250mg PO q24h x4 days
  • Alt: 500mg PO q24h x3 days

Community-acquired pneumonia

  • 500mg PO x1 on day 1, then 250mg PO q24h x4 days
  • Alt: 500mg IV q24h x2 or more days, then 500mg PO q24h to complete 7-10 day course

Chlamydia (uncomplicated urethritis, cervicitis, oropharygeal)

  • 1 g PO x1

Gonorrhea

  • Initial or recurrent: 1 g PO x1
  • Persistent: 2 g PO x1

PID

  • 500mg IV q24h x1-2 days, then 250mg PO q24h x5-6 days

Urethritis, non-gonococcal initial infection

  • 1 g PO x1

Chancroid

  • 1 g PO x1

MAC

  • Disseminated: 500-600mg PO q24h (not 1st-line agent; use with ethambutol)
  • Primary prophylaxis: 1200mg PO qwk Alt: 600mg PO 2x/wk
  • Secondary prophylaxis: 500-600mg PO q24h (not 1st-line agent; use with ethambutol)

Endocarditis prophylaxis (dental)

  • 500mg PO x1 (Start: 30-60min before procedure)

Pertussis

  • 500mg PO on day 1, followed by 250mg q24hr for days 2-5

Presumptive cervicitis

  • 1 g PO x1

Salmonella

  • 1 g PO q24h x1 day, then 500mg PO q24h x2-6 days

Typhoid fever

  • 10mg/kg PO q24h x1wk

Pediatric Dosing

Pneumonia (peds)

  • 10mg/kg/day PO in a once daily dose on day 1 (max 500mg)
    • Followed by 5mg/kg/day PO once daily on days 2-5

Bacterial sinusitis

  • Children ≥6 months: Oral: 10mg/kg PO once daily for 3 days (maximum: 500mg daily)

Otitis media

  • Children ≥6 months:
    • 1-day regimen: 30mg/kg PO a single dose (maximum dose: 1,500mg)
    • 3-day regimen: 10mg/kg PO once daily for 3 days (maximum: 500mg daily)
    • 5-day regimen: 10mg/kg PO on day 1 (maximum: 500mg daily) followed by 5mg/kg/day once daily on days 2 to 5 (maximum: 250mg daily)

Pharyngitis (as an alternative agent in penicillin allergic patients)

  • Children ≥2 years and Adolescents: Oral: 12mg/kg/dose once daily for 5 days (maximum: 500mg daily)

Special Populations

  • Pregnancy Rating: B
  • Lactation risk: Excreted in low amounts of breast milk and may lead to rash, somnolence, and diarrhea in nursing infants
  • Renal Dosing: Caution in patients with GFR <10 mL/minute, though primarily elimated through hepatic metabolism
  • Hepatic Dosing: Caution is indicated for potential hepatotoxicity though it is rare, and there are no specific dosage adjustments indicated for patients with liver failure

Contraindications

  • Hypersensitivity to azithromycin or other macrolides or any component of the formulation
  • History of cholestatic jaundice/hepatic dysfunction with prior Azithromycin use

Adverse Reactions

Serious

Common

Pharmacology

  • Half-life: 68 hrs
  • Metabolism: Hepatic
  • Excretion: Biliary
  • Mechanism of Action:Binds 50S ribosomal subunit interfering with microbial protein synthesis

Antibiotic Sensitivities[1]

Group Organism Sensitivity
Gram Positive Strep. Group A, B, C, G I
Strep. Pneumoniae I
Viridans strep X1
Strep. anginosus gp X1
Enterococcus faecalis R
Enterococcus faecium R
MSSA S
MRSA R
CA-MRSA I
Staph. Epidermidis R
C. jeikeium R
L. monocytogenes S
Gram Negatives N. gonorrhoeae I
N. meningitidis X2
Moraxella catarrhalis S
H. influenzae S
E. coli R
Klebsiella sp R
E. coli/Klebsiella ESBL+ R
E coli/Klebsiella KPC+ R
Enterobacter sp, AmpC neg R
Enterobacter sp, AmpC pos R
Serratia sp X1
Serratia marcescens R
Salmonella sp I
Shigella sp I
Proteus mirabilis X1
Proteus vulgaris R
Providencia sp. X1
Morganella sp. X1
Citrobacter freundii X1
Citrobacter diversus X1
Citrobacter sp. X1
Aeromonas sp X1
Acinetobacter sp. R
Pseudomonas aeruginosa R
Burkholderia cepacia R
Stenotrophomonas maltophilia R
Yersinia enterocolitica R
Francisella tularensis X1
Brucella sp. R
Legionella sp. S
Pasteurella multocida X1
Haemophilus ducreyi S
Vibrio vulnificus X1
Misc Chlamydophila sp S
Mycoplasm pneumoniae S
Rickettsia sp X1
Mycobacterium avium S
Anaerobes Actinomyces S
Bacteroides fragilis R
Prevotella melaninogenica S
Clostridium difficile X1
Clostridium (not difficile) S
Fusobacterium necrophorum R
Peptostreptococcus sp. S

Key

  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

See Also

References

  1. ↑ Sanford Guide to Antimicrobial Therapy 2014
  • Epocrates
  • Micromedex
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