azithromycin

(ay zi thro my' sin)

Zithromax

Pregnancy Category B

Drug class
Macrolide antibiotic

Therapeutic actions
Bacteriostatic or bactericidal in susceptible bacteria.

Indications
• Treatment of lower respiratory tract infections: acute bacterial exacerbations of
COPD due to H. influenzae, Moraxella catarrhalis, S. pneumoniae; community-
acquired pneumonia due to S. pneumoniae, H. influenzae
• Treatment of lower respiratory tract infections: streptococcal pharyngitis and
tonsillitis due to Streptococcus pyogenes in those who cannot take penicillins
• Treatment of uncomplicated skin infections due to Staphylococcus aureus, S.
pyogenes, Streptococcus agalactiae
• Treatment of nongonococcal urethritis and cervicitis due to C. trachomatis;
treatment of PID
• Treatment of otitis media caused by H. influenzae, M. catarrhalis, S. pneumoniae
in children > 6 mo
• Treatment of pharyngitis and tonsillitis in children > 2 yr who cannot use first-line
therapy
• Prevention and treatment of disseminated Mycobacterium avium complex (MAC)
in patients with advanced AIDS
• Unlabeled uses: Uncomplicated gonococcal infections caused by N. gonorrhoeae;
gonococcal pharyngitis caused by N. gonorrhoeae; chlamydial infections caused
by C. trachomatis; prophylaxis after sexual attack

Contraindications and cautions

• Contraindicated with hypersensitivity to azithromycin, erythromycin, or any
macrolide antibiotic.
• Use cautiously with gonorrhea or syphilis, pseudomembranous colitis, hepatic or
renal impairment, lactation.

Available forms
Tablets—250, 600 mg; powder for injection—500 mg; powder for oral suspension—
100 mg/5 mL, 200 mg/5 mL, 1 g/packet
Dosages
ADULTS
• Mild to moderate acute bacterial exacerbations of COPD, pneumonia,
pharyngitis and tonsillitis (as second-line): 500 mg PO single dose on first day,
 followed by 250 mg PO daily on days 2–5 for a total dose of 1.5 g or 500 mg/day
PO for 3 days.
• Nongonococcal urethritis and cervicitis due to C. trachomati: A single 1-g PO
dose.
• Gonococcal urethritis and cervicitis: A single dose of 2 g PO.
• Disseminated MAC infections: For prevention, 1,200 mg PO taken once weekly.
For treatment, 600 mg/day PO with etambutol.
PEDIATRIC PATIENTS
• Otitis media: Initially, 10 mg/kg PO as a single dose, then 5 mg/kg on days 2–5 or
30 mg/kg PO as a single dose.
• Community-acquired pneumonia: 10 mg/kg PO as a single dose on first day, then
5 mg/kg PO on days 2–5.
• Pharyngitis or tonsillitis: 12 mg/kg/day PO on days 1–5.

Pharmacokinetics
Route Onset Peak Duration
Oral Varies 2.5–3.2 hr 24 hr

Metabolism: T1/2: 11–48 hr

Distribution: Crosses placenta; enters breast milk
Excretion: Unchanged in biliary excretion and urine

Adverse effects
• CNS: Dizziness, headache, vertigo, somnolence, fatigue
• GI: Diarrhea, abdominal pain, nausea, dyspepsia, flatulence, vomiting, melena,
pseudomembranous colitis
• Other: Superinfections, angioedema, rash, photosensitivity, vaginitis

Interactions
Drug-drug
• Decreased serum levels and effectiveness of azithromycin with aluminum and
magnesium-containing antacids
• Possible increased effects of theophylline
• Possible increased anticoagulant effects of warfarin
Drug-food
• Food greatly decreases the absorption of azithromycin

Nursing considerations
Assessment
• History: Hypersensitivity to azithromycin, erythromycin, or any macrolide
antibiotic; gonorrhea or syphilis, pseudomembranous colitis, hepatic or renal
impairment, lactation
• Physical: Site of infection; skin color, lesions; orientation, GI output, bowel
sounds, liver evaluation; culture and sensitivity tests of infection, urinalysis, liver
and renal function tests
Interventions
• Culture site of infection before therapy.
• Administer on an empty stomach 1 hr before or 2–3 hr after meals. Food affects
the absorption of this drug.
• Counsel patients being treated for STDs about appropriate precautions and
additional therapy.

Teaching points
• Take this drug on an empty stomach 1 hr before or 2–3 hr after meals; it should
never be taken with food. Take the full course prescribed. Do not take with
antacids.
• These side effects may occur: Stomach cramping, discomfort, diarrhea; fatigue,
headache (medication may help); additional infections in the mouth or vagina
(consult with health care provider for treatment).
• Report severe or watery diarrhea, severe nausea or vomiting, rash or itching,
mouth sores, vaginal sores.

Adverse effects in Italic are most common; those in Bold are life-threatening.