II. Indications
- Activity Spectrum
- Spectrum includes organisms covered by Erythromycin
- Increasing Macrolide resistance for most indications
- HaemophilusInfluenzae
- Moraxella catarrhalis
- Toxoplasmosis gondii
- Mycobacterium Avium Complex (Clarithromycin better)
- Borrelia Burgdorferi
- Conditions
- Single dose Chlamydia trachomatis treatment
- Non-tuberculous Mycobacterial infections
- Helicobacter infections
- Community Acquired Pneumonia
- Limit to suspected Mycoplasma pneumonia or Legionella pneumonia
- Macrolide resistant pneumococcus is common
- Consider Doxycycline as alternative
- Streptococcal Pharyngitis (second line agent)
- Macrolides are only indicated in significant allergy to beta-lactams
- Original indications that have fallen out of favor due to Antibiotic Resistance
- Otitis Media
- Not recommended due to increased resistance rates
- Acute Sinusitis
- Not recommended due to growing resistance rates
- Otitis Media
- References
- (2013) Presc Lett 20(8): 44
III. Medications
- Intravenous
- Tablets: 250, 500, 600 mg
- Oral suspension: 100 ro 200 mg per 5 ml
- Take on an empty Stomach
- Packs
- Z-Pak: 500 mg day 1, 250 mg days 2 to 5
- Tri-Pak: 500 mg tabs x3
- Packet containing 1000 mg
IV. Dosing
- See Pertussis
- See Chlamydia trachomatis
- Take more than 1 hour before or 2 hours after food
-
General Dosing
- Adult
- Day 1: 500 mg orally daily
- Day 2 to 5: 250 mg orally daily
- Child
- Day 1: 10 mg/kg orally daily (maximum: 500 mg)
- Day 2 to 5: 5 mg/kg orally daily (maximum: 250 mg)
- Infant under age 6 months
- 10 mg/kg/day for 5 days
- Adult
-
Group A Streptococcal Pharyngitis (second line agent in beta lactam allergy)
- Take 12 mg/kg up to 500 mg orally daily for 5 days
-
Acute Exacerbation of Chronic Bronchitis
- Adult: Take 500 mg orally daily for 3 days
-
Chlamydia, Chancroid or Nongonococcal Urethritis
- Adult: Take 1 gram orally once
- Doxycycline for 7 days is preferred
-
Mycobacterium Avium Complex Disease (e.g. AIDS)
- Adult: Take 1200 mg orally once weekly
- Active disease is treated with at least 2 drugs
V. Pharmacokinetics
- Half Life: 68 hours
VI. Adverse Effects
- See Macrolide
-
Hypertrophic Pyloric Stenosis
- Infants age <45 days
-
QT Prolongation with Azithromycin
- Class effect with Macrolides
- Three fold increased risk of Sudden Cardiac Death while on Azithromycin
- Higher risk with known QTc Prolongation, Hypokalemia, Hypomagnesemia, Class IA or III Antiarrhythmics
- Ray (2013) N Engl J Med 366(20): 1881-90 [PubMed]
VII. Safety
- Considered safe in Lactation
- Pregnancy Category C
- Macrolides in general (including Azithromycin) may increase heart defects with first trimester exposure of 5-7 days
- Previously only Clarithromycin was considered a potential Teratogen (Cleft Lip association)
- Fan (2020) BMJ 368: m331 +PMID:32075790 [PubMed]
VIII. Drug Interactions
-
Drug-Induced QTc Prolongation
- Avoid combining with other agents that prolong QTc
-
Warfarin
- May increase INR
- Aluminum or MagnesiumAntacids
- May interfere with Azithromycin absorption
IX. Resources
- Azithromycin Tablet (DailyMed)
Images: Related links to external sites (from Bing)
Related Studies
| azithromycin (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| AZITHROMYCIN 1 GM PWD PACKET | Generic | $19.97 each |
| AZITHROMYCIN 100 MG/5 ML SUSP | Generic | $0.48 per ml |
| AZITHROMYCIN 200 MG/5 ML SUSP | Generic | $0.41 per ml |
| AZITHROMYCIN 250 MG TABLET | Generic | $0.33 each |
| AZITHROMYCIN 500 MG TABLET | Generic | $0.64 each |
| AZITHROMYCIN 600 MG TABLET | Generic | $1.29 each |
| zithromax (on 2/23/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| ZITHROMAX 250 MG TABLET | Generic | $0.33 each |
| ZITHROMAX 250 MG Z-PAK TABLET | Generic | $0.33 each |