Class: Macrolide Antibiotic
Dosage Forms. Tablet: 250 mg, 500 mg, 600 mg; Microspheres for Suspension: 2 g/bottle; Powder for Oral Suspension: 100 mg/5 mL, 200 mg/5 mL, 1 g packet
Common FDA Label Indication, Dosing, and Titration.
1. Acute infective exacerbation of COPD, skin or tissue infection: 500 mg po daily × 3 d or 500 mg po × 1 dose, then 250 mg po daily × 2-5 d
2. Bacterial sinusitis: Adults, 500 mg po daily × 3 d; Children, 10 mg/kg po daily × 3 d, or 2 g po × 1 dose
3. Chancroid, nongonococcal cervicitis, nongonococcal urethritis: 1000 mg po × 1 dose
4. Community acquired pneumonia: 500 mg po daily × 3 d or 500 mg po × 1, then 250 mg po daily × 2-5 d; Children 6 mo and older, tablets and immediate-release suspension, 10 mg/kg po on day 1, then 5 mg/kg po daily × 2-5 d or extended-release suspension, <34 kg, 60 mg/kg po × 1; > 34 kg, 2 g po × 1 dose
5. Gonorrhea, urethritis, or cervicitis: 2 g po × 1 dose
6. Streptococcal pharyngitis: 500 mg po × 1 dose, then 250 mg po daily × 2-5 d; Children, 12 mg/kg po daily × 5 d
1. Traveler’s diarrhea: Adults, 1000 mg po × 1 dose, or 500 mg po daily × 3 d; Children, 10 mg/kg po daily × 3 d
2. Bacterial endocarditis, Prophylaxis: Adults, 500 mg po 30-60 min prior to procedure; Children, 15 mg/kg po 30-60 min prior to procedure
MOA. Azithromycin is a macrolide antibiotic that is slightly less active than erythromycin against Gram-positive bacteria but substantially more active against Moraxella (Branhamella) catarrhalis, Haemophilus sp., Legionella sp., Neisseria sp., Bordetella sp., Mycoplasma spp., and Chlamydia trachomatis.
Drug Characteristics: Azithromycin
Medication Safety Issues: Azithromycin
Drug Interactions: Azithromycin
Adverse Reactions: Azithromycin
Efficacy Monitoring Parameters. Resolution of signs and symptoms of infection.
Toxicity Monitoring Parameters. Seek medical attention if chest pain, blistering skin rash, or extreme fatigue.
Key Patient Counseling Points. Complete full course of therapy. Avoid mixing suspension with food or beverages, but food can be taken afterward. Symptoms should improve within 2-3 d; if they worsen, seek follow-up with healthcare practitioner. Take extended-release suspension on empty stomach. Avoid concurrent use of aluminum or magnesium containing antacids.
Clinical Pearls. Use with caution in severe renal, hepatic, or cardiac disease. Pediatric use of extended-release tablets is restricted to community acquired pneumonia. Max dose in children is 500 mg. There is a small absolute increase in the risk of cardiovascular death during a 5-d course of oral azithromycin.