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Immediate release: 500 mg orally on the first day followed by 250 mg orally once a day on days 2 through 5
Community acquired: 6 months or older: Immediate release: 10 mg/kg (maximum: 500 mg/dose) orally as a single dose on the first day followed by 5 mg/kg (maximum: 250 mg/dose) orally once a day on days 2 thru 5 or 30 mg/kg orally once or 10 mg/kg orally once a day for 3 days Extended release suspension: Less than 34 kg: 60 mg/kg orally once for mild to moderate infections 34 kg or more: 2 g orally once for mild to moderate infections
Children: 5 mg/kg (maximum: 250 mg/dose) orally once a day plus ethambutol, with or without rifabutin.
Precautions
Azithromycin is contraindicated in patients with a history of cholestatic jaundice/hepatic dysfunction associated with prior use of azithromycin. Abnormal liver function, hepatitis, cholestatic jaundice, hepatic necrosis, and hepatic failure have been reported, some of which have resulted in death. Azithromycin should be discontinued immediately if signs and symptoms of hepatitis occur. Serious allergic reactions, including angioedema, anaphylaxis, Stevens-Johnson syndrome, and toxic epidermal necrolysis, have been reported rarely in patients on azithromycin therapy. Rarely, fatalities have been reported. Reappearance of allergic symptoms may occur without further azithromycin exposure when symptomatic therapy is discontinued, which may be related to the long tissue half-life of the drug. Patients experiencing allergic symptoms generally require prolonged periods of observation and symptomatic treatment. In the treatment of pneumonia, azithromycin oral formulation should not be used in patients who are inappropriate candidates for oral therapy due to severe illness. Patients are also inappropriate candidates for oral therapy if they have the following risk factors: cystic fibrosis; nosocomially acquired infections; bacteremia; need for hospitalization; elderly or debilitated; or a significant underlying health problem that compromises their ability to respond to illness (e.g., immunodeficiency or functional asplenia). Clostridium difficile associated diarrhea (CDAD) has been reported with almost all antibacterial agents and may potentially be life-threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhea following azithromycin therapy. Mild cases generally improve with discontinuation of the drug, while severe cases may require supportive therapy and treatment with an antimicrobial agent effective against C difficile. Hypertoxin producing strains of C difficile cause increased morbidity and mortality; these infections can be resistant to antimicrobial treatment and may necessitate colectomy. Physicians should consider additional antibiotic therapy in patients who vomit within 5 minutes after taking the extended release suspension. Alternative therapy should be considered for patients who vomit between 5 and 60 minutes after administration. Patients with normal gastric emptying who vomit 60 minutes or more following administration do not need a second dose of the extended release suspension or alternative therapy; however, alternative therapy should be considered for patients with delayed gastric emptying. To reduce the risk of development of drug-resistant organisms, antibiotics should only be used to treat or prevent proven or suspected infections caused by bacteria. Culture and susceptibility information should be considered when selecting treatment. If no data are available, local epidemiology and susceptibility patterns may be considered when selecting empiric therapy. Patients should be advised to avoid missing doses and to complete the entire course of therapy.
Dialysis
Data not available
Other Comments
Azithromycin immediate release tablets and oral suspension may be given without regard to meals. Azithromycin extended release suspension should be given 1 hour before or 2 hours after a meal. The extended release suspension is not interchangeable with immediate release formulations. Mycobacterium avium infections are usually treated with a combination of two to four drugs for a duration of 2 years to lifetime.