Azithromycin

General

Type: Antibiotic, 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

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 (initial or recurrent) [1 g PO x1]
Gonorrhea (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)
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]

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: Oral:
- 1-day regimen: 30mg/kg as a single dose (maximum dose: 1,500mg)
- 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)
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)

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

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

Prolonged QT, torsades, hepatic necrosis, Eaton-Lambert, Myasthenia gravis, corneal erosion

Vomiting, diarrhea, abdominal pain, headache, vision changes

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

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

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

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