Class: Other Macrolides
VA Class: AM200
Chemical Name: [2R - (2R,3S,4R,5R,8R,10R,11R,12S,13S,14R)] - 13 - [2,6,Dideoxy - 3 - C - methyl - 3 - O - methyl - α - L - ribo - hexopyranosyl)oxy) - 2 - ethyl - 3,4,10 - trihydroxy - 3,5,6,8,10,12,14 - heptamethyl - 11 - [[3,4,6,trideoxy - 3 - (dimethylamino) - β - D - xylo - hexopyranosyloxy] - 1 - oxa - 6 - azacyclopentadecan - 15 - one
CAS Number: 83905-01-5
Brands: Zithromax, Zithromax Tri-Paks, Zithromax Z-Pak, Zmax
Introduction
Antibacterial; an azalide, a subclass of macrolide antibiotics.1 3 10 163 196 210 211 302
Uses for Azithromycin
Acute Otitis Media (AOM)
Treatment of AOM caused by H. influenzae, M. catarrhalis, or S. pneumoniae.1 94 106 139 174 175 176 177 179 203 211 294
Not a drug of first choice; considered an alternative for patients with type I penicillin hypersensitivity.203 294 S. pneumoniae resistant to amoxicillin may also be resistant to azithromycin and the drug may not be effective for AOM that fails to respond to amoxicillin.282
Pharyngitis and Tonsillitis
Treatment of pharyngitis or tonsillitis caused by susceptible Streptococcus pyogenes (group A β-hemolytic streptococci) when first-line therapy cannot be used.1 15 29 203 211 Often effective in eradicating susceptible S. pyogenes from the nasopharynx, but efficacy in the prevention of subsequent rheumatic fever has not been established to date.1
CDC, AAP, IDSA, AHA, and others recommend oral penicillin V or IM penicillin G benzathine as treatments of choice;1 6 15 136 137 203 oral cephalosporins and oral macrolides are considered alternatives.6 15 136 137 203 Amoxicillin sometimes used instead of penicillin V, especially for young children.136 203
Consider that strains of S. pyogenes resistant to macrolides are common is some areas of the world (e.g., Japan, Finland) and azithromycin-resistant strains have been reported in the US.1 202 203 309 (See Selection and Use of Anti-infectives under Cautions),
GI Infections
Treatment of symptomatic enteric infections caused by Campylobacter jejuni†.308 Recommended by CDC, NIH,308 IDSA,308 AAP, and others as a drug of choice for empiric treatment.15 142 203 308
Treatment of cryptosporidiosis† in HIV-infected adults, adolescents, or children.256 307 308 Anti-infectives may suppress the infection, but none found to reliably eradicate Cryptosporidium.203 290 307 308 CDC, NIH, IDSA, and others state the most appropriate treatment for cryptosporidiosis in HIV-infected individuals is use of potent antiretroviral agents (to restore immune function) and symptomatic treatment of diarrhea.290 307 308
Treatment of shigellosis† caused by susceptible strains of Shigella dysenteriae, S. boydii, S. flexneri, or S. sonnei.15 142 203 307 316 317 318 Usual drugs of choice are fluoroquinolones (ciprofloxacin, levofloxacin, norfloxacin); alternatives are azithromycin, ampicillin, ceftriaxone, or co-trimoxazole.15 142 203 307 Because of increasing resistance, select anti-infective based on susceptibility patterns of locally circulating Shigella.203 317
Treatment of travelers’ diarrhea†.319 320 359 360 372 Generally self-limited and may resolve within 3–4 days without anti-infective treatment;319 320 336 if diarrhea is moderate or severe, persists >3 days, or is associated with fever or bloody stools, short-term anti-infective therapy (1–3 days) may be indicated.203 319 336 372 Fluoroquinolones (ciprofloxacin, levofloxacin, norfloxacin, ofloxacin) usually recommended.319 320 336 372 Azithromycin is an alternative for those who should not receive fluoroquinolones (children, pregnant women) and may be drug of choice for travelers in areas with high prevalence of fluoroquinolone-resistant Campylobacter (e.g., Thailand, Nepal) or those who have not responded after 48 hours of fluoroquinolone therapy.203 319 320 359 360 372
Treatment of severe diarrhea caused by enterotoxigenic Escherichia coli† (ETEC).203 356 ETEC diarrhea generally is of moderate severity and self-limited, but may be severe.187 203 356 Anti-infectives not usually indicated, but AAP, CDC, and others suggest an anti-infective (e.g., azithromycin, co-trimoxazole, a fluoroquinolone, rifamycin) can be considered in addition to supportive care if diarrhea is severe or intractable and causative organism is susceptible.187 203 356
Treatment of dysentery caused by enteroinvasive E. coli† (EIEC).203 AAP suggests that an oral anti-infective (e.g., azithromycin, ciprofloxacin, co-trimoxazole) can be used; whenever possible, select anti-infective based on in vitro susceptibility testing.203
Treatment of diarrhea associated with enteroaggregative E. coli† (EAEC).331 A drug of choice, especially in children with severe or persistent illness.331
Role of anti-infectives in treatment of hemorrhagic colitis caused by shiga toxin-producing E. coli† (STEC; formerly known as enterohemorrhagic E. coli [EHEC] or verotoxin-producing E. coli) unclear; most experts do not recommend use of anti-infectives in the treatment of enteritis caused by E. coli 0157:H7 since there is no evidence of benefit from such therapy.142 187 203
Respiratory Tract Infections
Treatment of acute bacterial sinusitis caused by susceptible Haemophilus influenzae, Moraxella catarrhalis, or Streptococcus pneumoniae.1 3 103 179 210 211 302
Treatment of mild to moderate acute bacterial exacerbations of chronic obstructive pulmonary disease (COPD) caused by H. influenzae, M. catarrhalis, or S. pneumoniae.1 3 15 96 97 98 179 210 211
Treatment of mild to moderate community-acquired pneumonia (CAP) caused by susceptible S. pneumoniae, H. influenzae, Mycoplasma pneumoniae, or Chlamydophila pneumoniae (formerly Chlamydia pneumoniae) when oral therapy is indicated.1 3 15 29 91 99 100 101 159 179 203 210 211 302 329
Treatment of CAP caused by susceptible C. pneumoniae, H. influenzae, M. catarrhalis, Legionella pneumophila, M. pneumoniae, Staphylococcus aureus, or S. pneumoniae when initial IV therapy is indicated.196
Select regimen for empiric treatment of CAP based on most likely pathogens and local susceptibility patterns; after pathogen is identified, modify to provide more specific therapy (pathogen-directed therapy).329 Do not use a macrolide alone for empiric treatment of CAP in hospitalized patients.329
For empiric outpatient treatment of CAP in previously healthy adults without risk factors for drug-resistant S. pneumoniae (DRSP), IDSA and ATS recommend monotherapy with a macrolide (azithromycin, clarithromycin, erythromycin) or, alternatively, doxycycline.329 If risk factors for DRSP are present (e.g., chronic heart, lung, liver, or renal disease, diabetes mellitus, alcoholism, malignancy, asplenia, immunosuppression, history of anti-infective treatment within the last 3 months), IDSA and ATS recommend monotherapy with a fluoroquinolone with enhanced activity against S. pneumoniae (gemifloxacin, levofloxacin, moxifloxacin) or, alternatively, a combination regimen that includes a β-lactam active against S. pneumoniae (high-dose amoxicillin or fixed combination of amoxicillin and clavulanic acid or, alternatively, ceftriaxone, cefpodoxime, or cefuroxime) given in conjunction with a macrolide (azithromycin, clarithromycin, erythromycin) or doxycycline.329
For empiric inpatient treatment of CAP when treatment in an intensive care unit (ICU) is not necessary, IDSA and ATS recommend adults receive monotherapy with a fluoroquinolone with enhanced activity against S. pneumoniae (gemifloxacin, levofloxacin, or moxifloxacin) or, alternatively, a combination regimen that includes a β-lactam (usually cefotaxime, ceftriaxone, or ampicillin) given in conjunction with a macrolide (azithromycin, clarithromycin, erythromycin) or doxycycline.329 For empiric inpatient treatment of CAP in ICU patients when Pseudomonas and oxacillin-resistant (methicillin-resistant) S. aureus are not suspected, IDSA and ATS recommend a combination regimen that includes a β-lactam (cefotaxime, ceftriaxone, fixed combination of ampicillin and sulbactam) given in conjunction with either azithromycin or a fluoroquinolone (gemifloxacin, levofloxacin, moxifloxacin).329
For empiric treatment of CAP in adults with risk factors for Ps. aeruginosa, IDSA and ATS recommend a combination regimen that includes an antipneumococcal, antipseudomonal β-lactam (cefepime, imipenem, meropenem, fixed combination of piperacillin and tazobactam) and ciprofloxacin or levofloxacin; one of these β-lactams, an aminoglycoside, and azithromycin; or one of these β-lactams, an aminoglycoside, and an antipneumococcal fluoroquinolone.329
Treatment of infections caused by L. pneumophila (Legionnaires' disease).15 130 168 196 203 232 250 311 312 314 329 330 Drugs of choice are macrolides (usually azithromycin) or fluoroquinolones with or without rifampin.15 203 232 311 312 329 330
Treatment and postexposure prophylaxis of pertussis† caused by Bordetella pertussis.15 28 138 203 324 325 326 329 333 334 (See Pertussis under Uses.)
Skin and Skin Structure Infections
Treatment of uncomplicated skin and skin structure infections caused by susceptible S. aureus, S. pyogenes, or S. agalactiae (group B streptococci).1 3 210 211
Babesiosis
Treatment of babesiosis† caused by Babesia microti.125 203 288 337
Regimens of choice for babesiosis are atovaquone in conjunction with azithromycin or quinine in conjunction with clindamycin.125 288 337 The clindamycin and quinine regimen may be preferred for severe babesiosis;288 in those with mild or moderate illness, the atovaquone and azithromycin regimen may be as effective and better tolerated than the quinine and clindamycin regimen.125 337 Also consider exchange transfusions in severely ill patients with high levels of parasitemia (>10%), substantial hemolysis, or compromised renal, hepatic, or pulmonary function.125 203 288
Bartonella Infections
Treatment of infections caused by B. henselae† (e.g., cat scratch disease, bacillary angiomatosis, peliosis hepatitis).15 203 261 310 Cat scratch disease generally self-limited in immunocompetent individuals and may resolve spontaneously in 2–4 months; some clinicians suggest that anti-infectives be considered for acutely or severely ill patients with systemic symptoms, particularly those with hepatosplenomegaly or painful lymphadenopathy, and such therapy probably is indicated in immunocompromised patients.203 261 310 Anti-infectives also indicated in patients with B. henselae infections who develop bacillary angiomatosis, neuroretinitis, or Parinaud’s oculoglandular syndrome.203 Optimum regimens have not been identified; some clinicians recommend azithromycin, ciprofloxacin, erythromycin, doxycycline, rifampin, co-trimoxazole, gentamicin, or third generation cephalosporins.15 203 261 310
Treatment of bacteremia caused by Bartonella quintana†;15 257 261 used in conjunction with ceftriaxone.257 261 307 Optimum anti-infective regimens have not been identified.257 259 260 307 310
Chancroid
Treatment of chancroid (genital ulcers caused by Haemophilus ducreyi).1 8 10 15 157 159 181 203 242
CDC and others recommend azithromycin, ceftriaxone, ciprofloxacin, or erythromycin for treatment of chancroid.8 15 159 181 203 242
Safety and efficacy of azithromycin established in men (not women),1 but has been effective for and is recommended by CDC for treatment of chancroid in women†.8 157 159 181 203 262
HIV-infected patients and uncircumcised males may not respond to treatment as well as those who are HIV-negative or circumcised.242 CDC recommends that single-dose azithromycin or ceftriaxone regimens be used in HIV patients only if follow-up can be ensured.242
Chlamydial Infections
Treatment of uncomplicated urethritis or cervicitis caused by C. trachomatis.1 7 8 10 15 92 109 110 111 112 114 179 184 185 203 211 242 CDC and others recommend azithromycin or doxycycline as drug of choice for nongonococcal urethritis (NGU) or cervicitis.8 242 For recurrent or persistent urethritis in patients with NGU who have already been treated with a recommended regimen, CDC recommends metronidazole or tinidazole used in conjunction with azithromycin.242
A drug of choice for presumptive treatment of coexisting chlamydial infection in patients being treated for gonorrhea.8 242
A drug of choice for treatment of urogenital chlamydial infections in pregnant women.8 203 242
Treatment of ocular trachoma† caused by C. trachomatis.15 29 112 114 189 203 217 301 354 370 373 374 375 376 A drug of choice;15 353 354 370 376 recommended for use in mass treatment programs.354 370 375 376
Treatment of chlamydial pneumonia in infants203 or chlamydial conjunctivitis in neonates (ophthalmia neonatorum caused by C. trachomatis).8 203 242
Alternative to tetracyclines for treatment of psittacosis† caused by Chlamydophila psittaci (formerly Chlamydia psittaci),15 203 329 especially in children <8 years of age who should not receive tetracyclines.203
Treatment of lymphogranuloma venereum caused by C. trachomatis.203 242 CDC recommends doxycycline as drug of choice and erythromycin as an alternative; some experts suggest that azithromycin may be effective, but clinical data are lacking.203 242
Has been used to treat adults with CAD who have elevated anti-C. pneumoniae antibody titers† (a possible risk factor for MI or CAD) in an attempt to reduce recurrent ischemic events;231 297 298 efficacy not proven to date.297 298
Cholera
Treatment of cholera† caused by Vibrio cholerae 01 or 0139.350 351 352
A tetracycline or, alternatively, a fluoroquinolone or co-trimoxazole generally used for treatment of cholera in conjunction with fluid and electrolyte replacement therapy.15 142 203 Although further study is needed, azithromycin may be an alternative, especially for treatment of cholera in children or infections caused by V. cholerae resistant to tetracyclines and fluoroquinolones.350 351 352
Gonorrhea
Treatment of uncomplicated urethritis or cervicitis caused by susceptible Neisseria gonorrhoeae.1 179 182 183 190 191 242 303 305
Not recommended for routine treatment of gonorrhea.179 182 183 242 250 CDC and others state azithromycin can be used as an alternative for treatment of uncomplicated gonorrhea when preferred drugs cannot be used (e.g., in patients hypersensitive to cephalosporins when spectinomycin is unavailable and desensitization to cephalosporins is not an option).303 306 371 Although azithromycin is effective, CDC recommends the drug be used only when necessary because of concerns related to emerging resistance to macrolides.371
Granuloma Inguinale (Donovanosis)
Alternative for treatment of granuloma inguinale† (donovanosis) caused by Klebsiella granulomatis (formerly Calymmatobacterium granulomatis).221 242 CDC recommends doxycycline as the drug of choice and azithromycin, ciprofloxacin, erythromycin, or co-trimoxazole as alternatives.242
Leptospirosis
Alternative for treatment of leptospirosis caused by Leptospira†.363 365 Penicillin G is drug of choice for severe infections; tetracyclines (usually doxycycline) or ceftriaxone are recommended as alternatives for less severe infections.15 203 Azithromycin also has been effective.363 365
Lyme Disease
Alternative for treatment of early disseminated Lyme disease† associated with erythema migrans, in the absence of neurologic involvement or third-degree AV heart block, when first-line agents cannot be used.15 124 179 211 226 227 288 IDSA, AAP, and others recommend oral doxycycline, oral amoxicillin, or oral cefuroxime as first-line therapy for treatment of early localized or early disseminated Lyme disease when oral therapy is appropriate;15 203 289 226 288 macrolides generally have been less effective than first-line agents.203 226 288 289
Malaria
Although further study is needed, has been used in conjunction with an antimalarial (e.g., chloroquine, quinine, artesunate [not commercially available in the US]) for treatment of uncomplicated malaria† caused by Plasmodium falciparum, including multidrug-resistant strains.341 342 343 Should not be used alone as monotherapy for treatment of malaria.341 342
Although further study is needed, has been used for treatment or prevention of P. vivax malaria†.344 345 When used for treatment, the rate of resolution of parasitemia reported for azithromycin was considerably slower than that reported for chloroquine.345
Mycobacterium avium Complex (MAC) Infections
Primary prevention (primary prophylaxis) of disseminated MAC infection in adults, adolescents, and children† with advanced HIV infection.10 12 203 234 Recommended as a drug of choice for primary prevention of MAC in HIV-infected patients;234 usually used alone but has been used in conjunction with rifabutin.10 234
Treatment of disseminated MAC disease, including in HIV-infected adults, adolescents, and children.10 117 203 233 234 307 308 ATS, IDSA, CDC, NIH, and others recommend a regimen of clarithromycin (or azithromycin) and ethambutol with or without rifabutin.233 234 307 308 Clarithromycin usually the preferred macrolide for initial treatment; azithromycin can be substituted if clarithromycin cannot be used because of drug interactions or intolerance and is preferred in pregnant women.233 307 308
Prevention of recurrence (secondary prophylaxis) of disseminated MAC infection in HIV-infected adults, adolescents, and children†.10 117 203 233 234 ATS, CDC, NIH, and IDSA recommend a macrolide (clarithromycin or azithromycin) given with ethambutol (with or without rifabutin).233 234 307 308
Treatment of pulmonary MAC infections† in conjunction with other antimycobacterials.233 313 315 For initial treatment of nodular/bronchiectatic pulmonary disease caused by macrolide-susceptible MAC, ATS and IDSA recommend a 3-times-weekly regimen of clarithromycin (or azithromycin), ethambutol, and rifampin in most patients.233 For initial treatment of fibrocavitary or severe nodular/bronchiectatic pulmonary disease caused by macrolide-susceptible MAC, ATS and IDSA recommend a daily regimen of clarithromycin (or azithromycin), ethambutol, and rifampin (or rifabutin) and state that consideration can be given to adding amikacin or streptomycin during the first 2–3 months of treatment for extensive (especially fibrocavitary) disease or when previous therapy has failed.233 Although a 2-drug regimen of clarithromycin (or azithromycin) and ethambutol may be adequate for treatment of nodular/bronchiectatic MAC disease in some patients, such regimens should not be used in fibrocavitary disease because of the risk of emergence of macrolide resistance.233
Treatment of MAC infections is complicated and should be directed by clinicians familiar with mycobacterial diseases; consultation with a specialist is particularly important when the patient cannot tolerate first-line drugs or when the infection has not responded to prior therapy or is caused by macrolide-resistant MAC.233
Mycobacterium abscessus, M. kansasii, and M. marinum Infections
Treatment of infections caused by M. abscessus†.233 For serious skin, soft tissue, and bone infections, ATS and IDSA recommend a multiple-drug regimen of clarithromycin (or azithromycin) used in conjunction with a parenteral anti-infective (e.g., amikacin, cefoxitin, imipenem);233 surgery usually indicated for extensive disease, abscess formation, and when drug therapy is difficult.233 This multiple-drug regimen also has been used in the treatment of M. abscessus lung disease; anti-infectives may control symptoms and disease progression, but generally cannot produce long-term sputum conversion.233 Curative therapy may be possible in those with focal infections and limited lung disease if surgical resection is used in conjunction with a multiple-drug treatment regimen.233
Treatment of rifampin-resistant M. kansasii† infections in conjunction with other antimycobacterials.233 ATS and IDSA recommend a 3-drug regimen based on results of in vitro susceptibility testing, including clarithromycin (or azithromycin), moxifloxacin, ethambutol, sulfamethoxazole, or streptomycin.233
Treatment of M. marinum† infections.233 A regimen of clarithromycin and ethambutol has been used; based on experience in other mycobacterial infections, a regimen of azithromycin and ethambutol may be an alternative.233
Neisseria meningitidis Infections
Elimination of nasopharyngeal carriage of N. meningitidis†.346 347 349
CDC and AAP consider rifampin, ceftriaxone, or ciprofloxacin the drugs of choice to eliminate nasopharyngeal carriage of N. meningitidis and for postexposure prophylaxis in household or other close contacts of patients with invasive meningococcal disease.203 349 Although further study is needed,349 CDC suggests azithromycin can be used as an alternative in areas where ciprofloxacin-resistant N. meningitidis have been reported (e.g., Minnesota, North Dakota).347
Pelvic Inflammatory Disease
Treatment of acute pelvic inflammatory disease (PID) caused by C. trachomatis, Mycoplasma hominis, or N. gonorrhoeae when initial IV therapy is considered necessary.196 197 If anaerobic bacteria are suspected, an anti-infective active against anaerobes should be used in conjunction with azithromycin.196 Although azithromycin is not included in CDC's recommended or alternative regimens for treatment of PID,242 371 CDC states a regimen of amoxicillin and clavulanic acid, azithromycin, and metronidazole has demonstrated short-term clinical cure when used in outpatients.371
Pertussis
Treatment of pertussis† caused by Bordetella pertussis and postexposure prophylaxis of pertussis† in household and other close contacts of an individual with pertussis.15 28 138 203 324 325 326 333 334
Macrolides (azithromycin, clarithromycin, erythromycin) are the drugs of choice.15 138 203 326 333 334 Although erythromycin traditionally has been considered the drug of choice for treatment and postexposure prophylaxis of pertussis,15 138 203 326 333 334 azithromycin and clarithromycin appear to be as effective and may be associated with better compliance because shorter regimens are required and the drugs are better tolerated.203 324 333 334
For treatment and postexposure prophylaxis of pertussis in adults and children ≥1 month of age, CDC and AAP recommend azithromycin, clarithromycin, or erythromycin as drug of choice;203 334 co-trimoxazole is an alternative for those ≥2 months of age when a macrolide cannot be used.203 334 AAP and CDC state azithromycin is the preferred macrolide for treatment of pertussis in infants <1 month of age; however, safety and efficacy not established in this age group and only limited data are available.203 334
If given during the catarrhal stage of pertussis (approximately 1–2 weeks of nasal congestion, runny nose, mild sore throat, nonproductive cough, minimal or no fever), anti-infectives may reduce the duration and severity of symptoms and lessen the period of communicability.203 334 After paroxysmal cough is established, anti-infectives may not affect the course of illness but are recommended to limit spread of the disease to others.203
All household and other close contacts of an individual with suspected pertussis should receive anti-infective postexposure prophylaxis, regardless of age or vaccination status.198 203 Prophylaxis should be initiated within 21 days of exposure; if >21 days have elapsed since onset of cough in the index patient, prophylaxis has limited value but should be considered for those in households with high-risk contacts (e.g., young infants, pregnant women, individuals with contact with infants).203 In addition, all close contacts who are unvaccinated or incompletely vaccinated against pertussis should receive age-appropriate vaccination with a preparation containing pertussis antigens.198 203
Scrub Typhus
Alternative for treatment of scrub typhus caused by Orientia tsutsugamushi (formerly Rickettsia tsutsugamushi).362 363 364 Drug of choice usually is doxycycline;15 362 363 364 alternatives are chloramphenicol or a fluoroquinolone.15 362 364 Azithromycin may be a preferred alternative for treatment of scrub typhus in children or pregnant women or when scrub typhus was acquired in areas where doxycycline-resistant O. tsutsugamushi have been reported (e.g., South Korea, Thailand).362 363 364
Syphilis
Alternative for treatment of primary, secondary, or early latent syphilis in nonpregnant adults and adolescents hypersensitive to penicillin†.242 292 293 358
Penicillin G is drug of choice for treatment of all stages of syphilis,8 203 242 but CDC, NIH, and IDSA state azithromycin can be considered for treatment of primary, secondary, or early latent syphilis† in nonpregnant adults and adolescents hypersensitive to penicillin if close follow-up can be ensured.203 242 293 307
Use with caution and with close follow-up; efficacy not well documented (especially in HIV-infected individuals) and resistance and treatment failures reported.8 242 293 307 327 328
Toxoplasmosis
Treatment of infections caused by Toxoplasma gondii, including toxoplasmic encephalitis† in HIV-infected patients127 128 129 296 307 and ocular toxoplasmosis†;295 usually used in conjunction with pyrimethamine.295 296
CDC, NIH, IDSA, and others usually recommend pyrimethamine in conjunction with sulfadiazine and leucovorin for treatment of toxoplasmosis in adults and children, especially immunocompromised patients (e.g., HIV-infected individuals).125 307 308 Azithromycin in conjunction with pyrimethamine and leucovorin is one of several alternative regimens that can be considered in adults and adolescents when the regimen of choice cannot be used;307 this regimen has not been evaluated in children.308
Typhoid Fever and Other Salmonella Infections
Treatment of uncomplicated typhoid fever† caused by susceptible Salmonella.15 321 322 323 332 361 Drugs of choice are fluoroquinolones (e.g., ciprofloxacin, ofloxacin), especially in areas with multidrug-resistant S. typhi (strains resistant to ampicillin, amoxicillin, chloramphenicol, co-trimoxazole); alternatives are azithromycin and third generation cephalosporins (cefotaxime, ceftriaxone, cefixime), especially for fluoroquinolone-resistant strains.15 203 332 361
Prevention of Bacterial Endocarditis
Alternative for prevention of α-hemolytic (viridans group) streptococcal endocarditis† in penicillin-allergic individuals with certain cardiac conditions who are undergoing certain dental procedures (i.e., procedures that involve manipulation of gingival tissue, the periapical region of teeth, or perforation of oral mucosa) or certain invasive respiratory tract procedures (i.e., procedures involving incision or biopsy of respiratory mucosa).201
Consult most recent AHA recommendations for specific information on which cardiac conditions are associated with the highest risk of adverse outcome from endocarditis and specific recommendations regarding use of prophylaxis to prevent endocarditis in these patients.201
Prophylaxis in Sexual Assault Victims
Empiric anti-infective prophylaxis in sexual assault victims†;8 242 used in conjunction with IM ceftriaxone and oral metronidazole.242
Azithromycin Dosage and Administration
Administration
Administer orally1 10 302 or by IV infusion.196 Do not administer IM or by rapid IV injection.196
Oral Administration
Available as conventional film-coated tablets,1 conventional powder for oral suspension,1 and extended-release microspheres for oral suspension.302
Extended-release oral suspension is not bioequivalent to and is not interchangeable with conventional oral suspension or tablets.302
Conventional tablets: Administer orally without regard to meals;1 10 administering tablets with food may increase tolerability.8 10 Two 250-mg tablets are bioequivalent to one 500-mg tablet.1
Reconstituted conventional oral suspension: Administer orally without regard to meals.1 10 The safety of repeating a dose in children who vomit after receiving 30 mg/kg as a single dose has not been established.1 The single-dose 1-g packets should not be used to administer doses other than 1 g and are not for pediatric use.10
Reconstituted ex
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