Please check your internet connection and try again.
# Azithromycin (Azitgro)
## Overview
Azithromycin is a macrolide antibiotic that inhibits bacterial protein synthesis. It has broad-spectrum activity against many Gram-positive, Gram-negative, and atypical pathogens.
## Primary Indications
* **Respiratory Tract Infections:** Community-acquired pneumonia, acute exacerbations of chronic obstructive pulmonary disease (COPD), acute bacterial sinusitis.
* **Skin and Soft Tissue Infections:** Uncomplicated skin and skin structure infections.
* **Genital Ulcer Disease:** Chancroid.
* **Sexually Transmitted Infections:** Cervicitis and urethritis due to *Chlamydia trachomatis*, and *Neisseria gonorrhoeae* (as part of combination therapy).
* **Prophylaxis:** Prevention of MAC infection in patients with advanced HIV.
## Adult Dosing
* **Community-Acquired Pneumonia:** 500 mg on day 1, followed by 250 mg once daily on days 2-5.
* **Acute Bacterial Sinusitis:** 500 mg once daily for 3 days.
* **Acute Exacerbations of COPD:** 500 mg once daily for 3 days. *Dosing for COPD exacerbations may vary based on local guidelines and pathogen susceptibility.*
* **Uncomplicated Skin and Skin Structure Infections:** 500 mg on day 1, followed by 250 mg once daily on days 2-5.
* **Chancroid:** Single dose of 1 gram orally.
* **Cervicitis/Urethritis due to *Chlamydia trachomatis*:** Single dose of 1 gram orally.
* **Disseminated MAC Prophylaxis:** 1200 mg orally once weekly.
* **Adjunctive treatment for Pertussis:** 500 mg once daily for 7 days, or 1 gram on day 1 followed by 500 mg once daily for 4 days.
## Pediatric Dosing
Pediatric dosing is highly dependent on the indication, weight, and age. Dosing recommendations vary significantly. Consult specific guidelines or product labeling for precise pediatric dosing. For example:
* **Acute Otitis Media:** 10 mg/kg on day 1 (not to exceed 500 mg), followed by 5 mg/kg once daily on days 2-5 (not to exceed 250 mg/day).
* **Community-Acquired Pneumonia:** 10 mg/kg on day 1 (not to exceed 500 mg), followed by 5 mg/kg once daily on days 2-5 (not to exceed 250 mg/day).
## Dose Adjustments
No dose adjustment is generally required for patients with renal or hepatic impairment. However, caution is advised in severe hepatic impairment.
## Contraindications
* Hypersensitivity to azithromycin, erythromycin, any macrolide antibiotic, or any component of the formulation.
* History of cholestatic jaundice or hepatic dysfunction with prior azithromycin use.
## Adverse Effects
* **Common:** Diarrhea, nausea, abdominal pain, vomiting.
* **Serious:** *Clostridioides difficile*-associated diarrhea, hepatotoxicity (including cholestatic hepatitis and liver failure), QT interval prolongation and torsades de pointes, hypersensitivity reactions (including anaphylaxis and angioedema).
## Key Drug Interactions
* **Antacids containing magnesium or aluminum:** May decrease azithromycin absorption. Administer azithromycin at least 1 hour before or 2 hours after antacids.
* **CYP3A4 Substrates (e.g., carbamazepine, cyclosporine, digoxin, theophylline, warfarin):** Azithromycin can inhibit CYP3A4, potentially increasing serum concentrations of concomitant drugs metabolized by this enzyme. Monitor for toxicities of co-administered drugs.
* **Ergot alkaloids:** Avoid co-administration due to potential for ergotism.
* **Nirmatrelvir/ritonavir:** Ritonavir can increase azithromycin exposure. Monitor for azithromycin-related adverse effects.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for signs and symptoms of *Clostridioides difficile*-associated diarrhea.
* Monitor liver function tests in patients with pre-existing liver disease or those on prolonged therapy.
* Consider ECG monitoring for patients with known risk factors for QT prolongation or those receiving other QT-prolonging medications.
## Clinical Pearls
* Azithromycin has a long half-life, allowing for once-daily dosing and shorter treatment courses for some infections.
* It can be taken with or without food.
* Ensure adequate hydration, especially when experiencing diarrhea.
* Resistance can occur; optimal use requires knowledge of local susceptibility patterns.
***
**Disclaimer:** This information is intended as a quick reference. Always consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions.
