Azithromycin: Difference between revisions

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==General==
==General==
*Type: Antibiotic, [[Macrolide]]
*Type: [[Is DrugClass::Macrolide]]
*Dosage Forms: powder for solution, suspension reconstituted, packet, tablet
*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
*Dosage Strengths: powder for solution: 500mg, 2.5g; suspension reconstituted: 100, 200mg/5mL; packet: 1g; tablet: 250, 500, 600mg
*Routes of Administration: PO, IV
*Routes of Administration: PO, IV
*Common Trade Names: [https://azithromycin.net Zithromax], Z-Pak, Zmax
*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]  
===[[Babesiosis]]===
*Bacterial Infections [500mg PO x1 on day 1, then 250mg PO q24h x4 days]
''In combination with Atovaquone''
*[[Strep Pharyngitis]]/tonsillitis   [500mg PO x1 on day 1, then 250mg PO q24h x4 days] Alt: 500mg PO q24h x3 days
*Mild/Moderate: 500mg PO x1 on day 1, then 250mg PO q24h x7-10 days
*[[COPD exacerbation]]   [500mg PO x1 on day 1, then 250mg PO q24h x4 days]  Alt: 500mg PO q24h x3 days
*Severe 500mg IV q24hr for 7 to 10 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]]: 1 g PO x1; (for uncomplicated urethritis, cervicitis, oropharygeal)
===Bacterial Infections===
*[[Gonorrhea]] (initial or recurrent)  [1 g PO x1]
*500mg PO x1 on day 1, then 250mg PO q24h x4 days
*[[Gonorrhea]] (persistent)  [2 g PO x1]
 
*[[PID]] [500mg IV q24h x1-2 days, then 250mg PO q24h x5-6 days]
===[[Strep Pharyngitis]]/tonsillitis===
*[[Urethritis]], non-gonococcal initial infection   [1 g PO x1]
*500mg PO x1 on day 1, then 250mg PO q24h x4 days]
*[[Chancroid]]   [1 g PO x1]
*Alt: 500mg PO q24h x3 days
*MAC (disseminated)  [500-600mg PO q24h]  (not 1st-line agent; use with ethambutol)
 
*MAC (primary prophylaxis)  [1200mg PO qwk]   Alt: 600mg PO 2x/wk
===[[COPD exacerbation]]===
*MAC (secondary prophylaxis)  [500-600mg PO q24h]  (not 1st-line agent; use with ethambutol)
*500mg PO x1 on day 1, then 250mg PO q24h x4 days
*[[Endocarditis]] prophylaxis (dental)   [500mg PO x1]  (Start: 30-60min before procedure)
*Alt: 500mg PO q24h x3 days
*Pertussis [500mg PO on day 1, followed by 250mg q24hr for days 2-5]
 
*Presumptive [[cervicitis ]] [1 g PO x1]
===Community-acquired [[pneumonia]]===
*[[Salmonella]]   [1 g PO q24h x1 day, then 500mg PO q24h x2-6 days]
*500mg PO x1 on day 1, then 250mg PO q24h x4 days
*[[Typhoid fever]] [10mg/kg PO q24h x1wk]
*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)]]
===[[Pneumonia (peds)]]===
**10mg/kg/day PO in a once daily dose on day 1 (max 500mg)
*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
**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: Oral:
===Bacterial sinusitis===
**1-day regimen: 30mg/kg as a single dose (maximum dose: 1,500mg)
*Children ≥6 months: Oral: 10mg/kg PO once daily for 3 days (maximum: 500mg daily)
**3-day regimen: 10mg/kg once daily for 3 days (maximum: 500mg daily)
 
**5-day regimen: 10mg/kg on day 1 (maximum: 500mg daily) followed by 5mg/kg/day once daily on days 2 to 5 (maximum: 250mg daily)
===[[Otitis media]]===
*[[Pharyngitis]] (as an alternative agent in penicillin allergic patients):
*Children ≥6 months:
**Children ≥2 years and Adolescents: Oral: 12mg/kg/dose once daily for 5 days (maximum: 500mg daily)
**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==
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==Adverse Reactions==
==Adverse Reactions==
===Serious===
===Serious===
[[Prolonged QT]], [[torsades]], hepatic necrosis, Eaton-Lambert, [[Myasthenia gravis]], corneal erosion
*[[Prolonged QT]]
*[[Torsades]]
*hepatic necrosis
*Eaton-Lambert
*[[Myasthenia gravis]]
*Corneal erosion


===Common===
===Common===
[[Vomiting]], diarrhea, abdominal pain, headache, vision changes
*[[Vomiting]]
*[[Diarrhea]]
*[[Abdominal pain]]
*[[Headache]]
*Vision changes


==Pharmacology==
==Pharmacology==

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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