Azithromycin: Difference between revisions
(Remove disease-specific entries now covered by AntibioticDose (8 sections))
 
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*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]


===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]]===
*1 g PO x1; (for uncomplicated urethritis, cervicitis, oropharygeal)


===[[Gonorrhea]]===
===Indications by Disease===
*[[Gonorrhea]] (initial or recurrent)  [1 g PO x1]
{{#ask: [[Has DrugName::Azithromycin]] [[Has Population::Adult]]
*[[Gonorrhea]] (persistent)  [2 g PO x1]
|?Treats disease=Disease
|?Has Dose=Dose
|?Has Context=Context
|format=table
|limit=50
|mainlabel=-
|headers=show
|sort=Treats disease
}}


===[[PID]]===
==Pediatric Dosing==
*[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===
*MAC (disseminated)  [500-600mg PO q24h]  (not 1st-line agent; use with ethambutol)
*MAC (primary prophylaxis)  [1200mg PO qwk]  Alt: 600mg PO 2x/wk
*MAC (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==
===Indications by Disease===
*[[Pneumonia (peds)]]
{{#ask: [[Has DrugName::Azithromycin]] [[Has Population::Pediatric]]
**10mg/kg/day PO in a once daily dose on day 1 (max 500mg)
|?Treats disease=Disease
***Followed by 5mg/kg/day PO once daily on days 2-5
|?Has Dose=Dose
*Bacterial sinusitis: Children ≥6 months: Oral: 10mg/kg PO once daily for 3 days (maximum: 500mg daily)
|?Has Context=Context
*[[Otitis media]]: Children ≥6 months: Oral:
|format=table
**1-day regimen: 30mg/kg as a single dose (maximum dose: 1,500mg)
|limit=50
**3-day regimen: 10mg/kg once daily for 3 days (maximum: 500mg daily)
|mainlabel=-
**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)
|headers=show
*[[Pharyngitis]] (as an alternative agent in penicillin allergic patients):
|sort=Treats disease
**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 11:07, 20 March 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

Indications by Disease

DiseaseDoseContext
Acute diarrhea500mg PO once daily x 5 daysCampylobacter
Acute diarrhea500mg PO daily x 5 daysShigella
Acute diarrhea20mg/kg (1g) PO onceVibrio cholerae
Babesiosis500-1000mg day 1 then 250-1000mg daily x 10 daysMild parasitemia less than 4 percent option 1 with Atovaquone
Bacterial conjunctivitis1% ophthalmic solution 1 drop BID for 2 days THEN 1 drop daily for 5 daysBacterial Conjunctivitis, Topical
COPD exacerbation500mg PO x1 on day 1, then 250mg PO q24h x4 days; Alt: 500mg PO q24h x3 daysCOPD exacerbation
Cervicitis1 g PO x 1GC/Chlamydia, Pregnant
Chancroid1 g PO x1Chancroid
Endocarditis500mg (15mg/kg) PODental Procedure Prophylaxis
Gonorrheal conjunctivitis1g (20mg/kg) PO one time doseChlamydial Conjunctivitis
Gonorrheal conjunctivitis1g PO one doseGonococcal Conjunctivitis
Infectious tenosynovitis1g PO onceGonococcal
Lymphogranuloma venereum1g PO weekly for 3 weeksPregnancy Alternative
Mastitis500mg PO x1 day 1, then 250mg PO daily days 2-5PCN allergy alternative
Mycobacterium avium complex1200mg PO weekly (Alt: 600mg PO twice weekly)Primary prophylaxis
Mycobacterium avium complex500-600mg PO daily (use with ethambutol; not 1st-line)Treatment, disseminated
Mycobacterium avium complex500-600mg PO daily (use with ethambutol; not 1st-line)Secondary prophylaxis
Pelvic inflammatory disease500mg IV q24h x1-2 days, then 250mg PO q24h x5-6 daysPID
Pertussis500mg PO once daily for day #1 then 250mg PO once daily for days #2-5Adults
Pneumonia (main)500mg IV dailyICU, Risk of Pseudomonas
Pneumonia (main)500mg IVICU, Low Risk
Pneumonia (main)500 mg dailyInpatient, CAP Non-ICU
Pneumonia (main)500 mg on first day then 250 mg dailyOutpatient, Unhealthy
Pneumonia (main)500 mg on first day then 250 mg dailyOutpatient, Healthy
Salmonella1 g PO q24h x1 day, then 500mg PO q24h x2-6 daysSalmonella
Streptococcal pharyngitis12 mg/kg PO once (maximum = 500 mg), then 6 mg/kg (max=250 mg) once daily for the next 4 daysPenicillin Allergy (anaphylaxis)
Toxoplasmosis1200mg PO q24hrsImmunosuppressed alt
Traveler's diarrhea500mg PO q24h x 3 days OR 1000mg PO x 1Traveler's Diarrhea
Typhoid fever1 g PO daily x 5 daysQuinolone Resistant, Oral
Urethritis in men1 g PO x1Urethritis, non-gonococcal initial infection

Pediatric Dosing

Indications by Disease

DiseaseDoseContext
Acute diarrhea10mg/kg/day once daily x 3 daysPediatric travelers diarrhea
Acute diarrhea10mg/kg PO day 1 (max 500mg), then 5mg/kg/day x 4 daysPediatric Shigella
Acute diarrhea10mg/kg PO day 1, then 5mg/kg/day x 4 daysPediatric Salmonella
Acute diarrhea10mg/kg PO daily x 3 days (max 500mg)Pediatric Campylobacter
Acute diarrhea10mg/kg/day once daily x 3 daysPediatric travelers diarrhea
Diarrhea aguda10mg/kg/day once daily x 3 daysPediatric travelers diarrhea
Acute otitis media10mg/kg/day x 1 day and 5mg/kg/day x 4 remaining daysPenicillin Allergy
Bacterial conjunctivitis1% ophthalmic solution 1 drop BID x 2 days then daily x 5 daysPediatric
Endocarditis15mg/kg PO (max 500mg)Pediatric Dental Prophylaxis, PCN Allergy
Gonorrheal conjunctivitis20mg/kg PO once daily x 3 daysChlamydial Conjunctivitis, Newborn
Neonatal conjunctivitis20mg/kg PO once daily x 3 daysChlamydial conjunctivitis
Pertussis10mg/kg (max 500mg/day) daily x 5 days>1 month old
Pertussis10mg/kg (max 500mg/day) daily x 5 days<1 month old
PharyngitisChildren ≥2 years and Adolescents: Oral: 12mg/kg/dose once daily for 5 days (maximum: 500mg daily)Pharyngitis (as an alternative agent in penicillin allergic patients)
Pneumonia (peds)2.5mg/kg q12hrs1-3 month afebrile pneumonitis
SinusitisChildren ≥6 months: Oral: 10mg/kg PO once daily for 3 days (maximum: 500mg daily)Bacterial sinusitis
Streptococcal pharyngitis12mg/kg PO day 1 (max 500mg), then 6mg/kg daily x 4 days (max 250mg)Pediatric PCN Allergy (severe)
Traveler's diarrhea10mg/kg/day once daily x 3 daysPediatric travelers diarrhea
Typhoid fever10-20mg/kg PO daily x 5-7 days (max 1g)Pediatric, Oral

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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