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azithromycin
generic
Adult Dosing .
Dosage forms: TAB: 250 mg, 500 mg, 600 mg; PWDR: 1 g per pkt; SUSP: 100 mg per 5 mL, 200 mg per 5 mL; INJ: various
infections, bacterial
- [500 mg PO x1 on day 1, then 250 mg PO q24h x4 days]
pharyngitis/tonsillitis, streptococcal
- [500 mg PO x1 on day 1, then 250 mg PO q24h x4 days]
COPD exacerbation, acute bacterial
- [500 mg PO x1 on day 1, then 250 mg PO q24h x4 days]
- Alt: 500 mg PO q24h x3 days
pneumonia, community-acquired
- [500 mg PO x1 on day 1, then 250 mg PO q24h x4 days]
- Alt: 500 mg IV q24h x2 or more days, then 500 mg PO q24h; Info: may give 500 mg PO/IV q24h for at least 5 days as part of multi-drug regimen; refer to IDSA guidelines
infections, chlamydial
- [pregnant pts]
- Dose: 1 g PO x1; Info: 1st-line agent
- [non-pregnant pts]
- Dose: 1 g PO x1; Info: not 1st-line agent
infections, uncomplicated gonococcal
- [2 g PO x1]
- Info: for infections of cervix, urethra, rectum; give w/ gentamicin; not 1st-line agent
PID
- [500 mg IV q24h x1-2 days, then 250 mg PO/IV q24h x12-14 days]
- Info: for pts w/ cephalosporin allergy and low gonorrhea risk; give w/ metronidazole
urethritis, non-gonococcal
- [1 g PO x1]
- Alt: 500 mg PO x1 on day 1, then 250 mg PO q24h x4 days; Info: not 1st-line agent
chancroid
- [1 g PO x1]
MAC tx, disseminated
- [500-600 mg PO q24h]
- Info: not 1st-line agent; use w/ ethambutol
MAC prophylaxis, primary
- [1200 mg PO qwk]
- Alt: 600 mg PO 2x/wk
MAC prophylaxis, secondary (off-label)
- [500-600 mg PO q24h]
- Info: not 1st-line agent; use w/ ethambutol
endocarditis prophylaxis, dental (off-label)
- [500 mg PO x1]
- Start: 30-60min before procedure; Info: see Infectious Disease: Endocarditis Prophylaxis, Adult table
COPD exacerbation risk reduction (off-label)
- [250 mg PO q24h]
- Alt: 500 mg PO 3x/wk; Info: for pts w/ exacerbation hx; search 'gold' for epocrates COPD GOLD decision tools
cervicitis, presumptive (off-label)
- [1 g PO x1]
- Info: not 1st-line agent
lymphogranuloma venereum (off-label)
- [1000 mg PO qwk for at least 3wk]
- Info: not 1st-line agent
granuloma inguinale (off-label)
- [1000 mg PO qwk for at least 3wk]
- Alt: 500 mg PO qd for at least 3wk; Info: may extend tx if not healed after 3wk; 1st-line agent
salmonellosis, acute (off-label)
- [1 g PO q24h x1 day, then 500 mg PO q24h x2-6 days]
- Info: may extend tx x1wk if immunocompromised
shigellosis, severe (off-label)
- [1000-1500 mg PO q24h]
- Info: duration varies w/ infection severity; refer to CDC guidance
campylobacteriosis (off-label)
- [500 mg PO q24h x3 days]
typhoid fever, adjunct tx (off-label)
- [10 mg/kg/dose PO q24h x1wk]
babesiosis (off-label)
- [mild-moderate infection, immunocompetent pts]
- Dose: 500 mg PO x1 on day 1, then 250 mg PO q24h x6-9 days; Info: give w/ atovaquone as 1st-line regimen
- [severe infection, immunocompetent pts]
- Dose: 500-1000 mg IV q24h x7-10 days; Info: give w/ atovaquone as 1st-line regimen; switch to azithromycin 250-500 mg PO q24h for step-down tx
- [immunocompromised pts]
- Dose: 500-1000 mg IV q24h for at least 6wk; Info: give w/ atovaquone as 1st-line regimen; switch to azithromycin 500-1000 mg PO q24h for step-down tx
pertussis (off-label)
- [500 mg PO x1 on day 1, then 250 mg PO q24h x4 days]
Lyme dz (off-label)
- [500 mg PO q24h x7 days]
- Info: for early, localized dz; not 1st-line agent; search 'Lyme' for epocrates Lyme Disease Dx & Tx decision tool
meningococcal prophylaxis (off-label)
- [10 mg/kg/dose PO x1]
- Max: 500 mg; Info: for close contacts of pts w/ invasive meningococcal dz; not 1st-line agent
renal dosing
- [see below]
- CrCl >10: no adjustment; CrCl <10: not defined, caution advised
- HD/PD: no adjustment; no supplement
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised
Peds Dosing .
- Dosage forms: TAB: 250 mg, 500 mg, 600 mg; PWDR: 1 g per pkt; SUSP: 100 mg per 5 mL, 200 mg per 5 mL; INJ: various
pharyngitis/tonsillitis, streptococcal
- [2 yo and older]
- Dose: 12 mg/kg/dose PO x1 on day 1, then 6 mg/kg/dose PO q24h x4 days; Max: 500 mg for 1st dose, 250 mg for subsequent doses
community-acquired pneumonia, atypical
- [mild infection, >3 mo]
- Dose: 10 mg/kg/dose PO x1 on day 1, then 5 mg/kg/dose PO q24h x4 days; Max: 500 mg for 1st dose, 250 mg for subsequent doses
- [moderate-severe infection, >3 mo (off-label)]
- Dose: 10 mg/kg/dose IV q24h x2 days, then 5 mg/kg/dose PO q24h x3 days; Max: 500 mg/dose IV; 250 mg/dose PO
endocarditis prophylaxis, dental (off-label)
- [15 mg/kg/dose PO x1]
- Start: 30-60min before procedure; Info: see Infectious Disease: Endocarditis Prophylaxis, Pediatric table
infections, chlamydial (off-label)
- [infants]
- Dose: 20 mg/kg/dose PO qd x3 days; Info: not 1st-line agent
- [preadolescents 8 yo and older or >45 kg]
- Dose: 1 g PO x1; Info: 1st-line agent
- [pregnant pts, adolescents]
- Dose: 1 g PO x1; Info: 1st-line agent
- [non-pregnant pts, adolescents]
- Dose: 1 g PO x1; Info: not 1st-line agent
infections, uncomplicated gonococcal (off-label)
- [adolescents]
- Dose: 2 g PO x1; Info: for infections of cervix, urethra, rectum; give w/ gentamicin; not 1st-line agent
PID (off-label)
- [adolescents]
- Dose: 500 mg IV q24h x1-2 days, then 250 mg PO/IV q24h x12-14 days; Info: for pts w/ cephalosporin allergy and low gonorrhea risk; give w/ metronidazole
urethritis, non-gonococcal (off-label)
- [preadolescents >45 kg and adolescents]
- Dose: 1 g PO x1; Alt: 500 mg PO x1 on day 1, then 250 mg PO q24h x4 days; Info: not 1st-line agent
chancroid (off-label)
- [preadolescents <45 kg]
- Dose: 20 mg/kg/dose PO x1; Max: 1 g/dose
- [preadolescents >45 kg and adolescents]
- Dose: 1 g PO x1
MAC tx (off-label)
- [1 mo-12 yo]
- Dose: 10-12 mg/kg/dose PO q24h for at least 1mo; Max: 500 mg/day; Info: not 1st-line agent; use w/ ethambutol
- [13 yo and older]
- Dose: 500-600 mg PO q24h; Info: not 1st-line agent; use w/ ethambutol
MAC prophylaxis, primary (off-label)
- [1 mo-12 yo]
- Dose: 20 mg/kg/dose PO qwk; Max: 1200 mg/wk; Alt: 5 mg/kg/dose PO q24h, max 250 mg/day
- [13 yo and older]
- Dose: 1200 mg PO qwk; Alt: 600 mg PO 2x/wk
MAC prophylaxis, secondary (off-label)
- [1 mo-12 yo]
- Dose: 5 mg/kg/dose PO q24h; Max: 250 mg/day; Info: not 1st-line agent; use w/ ethambutol
- [13 yo and older]
- Dose: 500-600 mg PO q24h; Info: not 1st-line agent; use w/ ethambutol
cervicitis, presumptive (off-label)
- [preadolescents >45 kg and adolescents]
- Dose: 1 g PO x1; Info: not 1st-line agent
lymphogranuloma venereum (off-label)
- [adolescents]
- Dose: 1000 mg PO qwk for at least 3wk; Info: not 1st-line agent
granuloma inguinale (off-label)
- [preadolescents >45 kg and adolescents]
- Dose: 1000 mg PO qwk for at least 3wk; Alt: 500 mg PO qd for at least 3wk; Info: may extend tx if not healed after 3wk; 1st-line agent
salmonellosis, acute (off-label)
- [10 mg/kg/dose PO q24h x3-7 days]
- Max: 500 mg/day; Info: may extend tx x1wk if immunocompromised
shigellosis, severe (off-label)
- [1 mo and older]
- Dose: 6-20 mg/kg/dose PO q24h; Max: 1000 mg/day; Info: duration varies w/ infection severity; refer to CDC guidance
campylobacteriosis (off-label)
- [1 mo and older]
- Dose: 10 mg/kg/dose up to 500 mg PO q24h x3-5 days
typhoid fever, adjunct tx (off-label)
- [10 mg/kg/dose PO q24h x1wk]
babesiosis (off-label)
- [mild-moderate infection, immunocompetent pts]
- Dose: 10 mg/kg/dose PO x1 on day 1, then 5 mg/kg/dose PO q24h x6-9 days; Max: 500 mg on day 1; 250 mg/day on days 2-10; Info: give w/ atovaquone as 1st-line regimen
- [severe infection, immunocompetent pts]
- Dose: 10 mg/kg/dose IV q24h x7-10 days; Max: 500 mg/day; Info: give w/ atovaquone as 1st-line regimen; switch to azithromycin 10 mg/kg/dose PO q24h for step-down tx
- [immunocompromised pts]
- Dose: 10 mg/kg/dose IV q24h for at least 6wk; Max: 500 mg/day; Info: give w/ atovaquone as 1st-line regimen; switch to azithromycin 10 mg/kg/dose PO q24h for step-down tx
pertussis (off-label)
- [<6 mo]
- Dose: 10 mg/kg/dose PO q24h x5 days; Info: 1st-line agent for pts <1 mo
- [6 mo and older]
- Dose: 10 mg/kg/dose PO x1 on day 1, then 5 mg/kg/dose PO q24h x4 days; Max: 500 mg for 1st dose, 250 mg for subsequent doses
Lyme dz (off-label)
- [10 mg/kg/dose PO q24h x7 days]
- Max: 500 mg/day; Info: for early, localized dz; not 1st-line agent; search 'Lyme' for epocrates Lyme Disease Dx & Tx decision tool
meningococcal prophylaxis (off-label)
- [10 mg/kg/dose PO x1]
- Max: 500 mg; Info: for close contacts of pts w/ invasive meningococcal dz; not 1st-line agent
renal dosing
- [see below]
- CrCl >10: no adjustment; CrCl <10: not defined, caution advised
- HD/PD: no adjustment; no supplement
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- cholestatic jaundice hx, azithromycin-associated
- hepatic impairment hx, azithromycin-associated
- bronchiolitis obliterans syndrome prophylaxis use (long-term use in allogeneic HSCT pts)
- caution: elderly pts
- caution: hepatic impairment
- caution: CrCl <10
- caution: QT prolongation
- caution: QT prolongation family hx
- caution: long QT syndrome, congenital
- caution: torsades de pointes hx
- caution: ventricular arrhythmia
- caution: bradycardia
- caution: MI, recent
- caution: CHF
- caution: electrolyte abnormalities
- caution: myasthenia gravis
- caution: abx-associated colitis hx, recent
Drug Interactions .
Overview
azithromycin
macrolide
- P-gp inhibitor, moderate
- affected by altered gastrointestinal motility
- alters GI flora
- binds to polyvalent cations
- impairs immunomodulatory bacterial infective agent
- prolongs QT interval (known)
Contraindicated
- cisapride
- colchicine
- domperidone
- dronedarone
- levoketoconazole
- pimozide
- thioridazine
Avoid/Use Alternative
- adagrasib
- amiodarone
- anagrelide
- apalutamide
- apixaban
- apomorphine
- arsenic trioxide
- artemether/lumefantrine
- asenapine
- bedaquiline
- bremelanotide
- cabozantinib
- chloroquine
- cholera vaccine, live
- ciprofloxacin
- citalopram
- clofazimine
- crizotinib
- dabigatran
- degarelix
- desflurane
- desipramine
- dexmedetomidine
- dexmedetomidine injection
- disopyramide
- dofetilide
- donepezil
- doxorubicin
- droperidol
- efavirenz
- encorafenib
- entrectinib
- ephedra
- epirubicin
- eribulin
- etrasimod
- fecal microbiota, live
- fexinidazole
- flecainide
- fluorouracil
- fluoxetine
- foscarnet
- futibatinib
- gilteritinib
- glasdegib
- goserelin
- grapefruit
- haloperidol
- histrelin
- hydroxychloroquine
- hydroxyzine
- ibutilide
- iloperidone
- inotuzumab ozogamicin
- isoflurane
- ivabradine
- ivosidenib
- lefamulin
- lenacapavir
- leuprolide
- levofloxacin
- lofexidine
- lonafarnib
- loperamide
- lopinavir/ritonavir
- macimorelin
- methadone
- methotrexate
- mifepristone
- mobocertinib
- moxifloxacin
- neratinib
- nilotinib
- oliceridine
- ondansetron
- osimertinib
- ozanimod
- pacritinib
- paliperidone
- palonosetron
- panobinostat
- pasireotide
- pazopanib
- pentamidine
- phenobarbital
- pimavanserin
- pitolisant
- ponesimod
- pralsetinib
- procainamide
- propafenone
- quetiapine
- quinidine (antiarrhythmic)
- quinidine (CYP2D6 inhibitor)
- quinine
- quizartinib
- relugolix
- repotrectinib
- ribociclib
- rivaroxaban
- romidepsin
- rucaparib
- saquinavir
- selpercatinib
- sertraline
- sevoflurane
- siponimod
- sirolimus albumin-bound
- solifenacin
- sorafenib
- sotalol
- telavancin
- tetrabenazine
- topotecan
- toremifene
- tramadol
- trazodone
- triclabendazole
- trifluridine
- triptorelin
- typhoid vaccine, live
- vandetanib
- vemurafenib
- venetoclax
- ziprasidone
Monitor/Modify Tx
- afatinib
- albuterol
- albuterol inhaled
- alfuzosin
- aluminum hydroxide
- amisulpride
- amitriptyline
- arformoterol inhaled
- asciminib
- avatrombopag
- berotralstat
- buprenorphine
- carvedilol
- ceritinib
- chlorpromazine
- clomipramine
- clozapine
- cyclosporine
- dasatinib
- deutetrabenazine
- digoxin
- edoxaban
- eliglustat
- enfortumab vedotin
- escitalopram
- everolimus
- exenatide
- fingolimod
- fluconazole
- formoterol inhaled
- fostemsavir
- gemtuzumab ozogamicin
- gepirone
- granisetron
- hydrocodone
- imatinib
- lapatinib
- lenvatinib
- levalbuterol inhaled
- lovastatin
- lumateperone
- lurasidone
- magnesium carbonate
- magnesium citrate
- magnesium hydroxide
- magnesium oxide
- magnesium supplement
- mavorixafor
- mefloquine
- meperidine
- metronidazole
- midostaurin
- mirtazapine
- morphine
- nelfinavir
- ofloxacin
- olodaterol inhaled
- osilodrostat
- oxaliplatin
- paclitaxel
- posaconazole
- primaquine
- promethazine
- quinapril
- ranolazine
- red yeast rice
- rilpivirine
- rimegepant
- riociguat
- sacituzumab govitecan
- salmeterol inhaled
- sirolimus
- sucralfate
- sulfate bowel prep
- sunitinib
- tacrolimus
- talazoparib
- tazemetostat
- tenofovir disoproxil
- terbutaline
- tolterodine
- ubrogepant
- valbenazine
- vardenafil
- venlafaxine
- vilanterol inhaled
- voclosporin
- voriconazole
- warfarin
Caution Advised
- aliskiren
- darolutamide
- glecaprevir
- lactulose
- maraviroc
- mycophenolate mofetil
- mycophenolic acid
- naldemedine
- pibrentasvir
- silodosin
- sodium picosulfate
- tirzepatide
Adverse Reactions .
Serious Reactions
- angioedema
- anaphylaxis
- cholestatic jaundice
- hepatotoxicity
- pancreatitis
- infantile hypertrophic pyloric stenosis
- Stevens-Johnson syndrome
- toxic epidermal necrolysis
- drug rxn w/ eosinophilia and systemic sx
- acute generalized exanthematous pustulosis
- C. difficile-assoc. diarrhea
- QT prolongation
- torsades de pointes
- myasthenia gravis exacerbation
Common Reactions
- diarrhea
- nausea
- abdominal pain
- vaginitis
- dyspepsia
- dizziness
- rash
- vomiting
- flatulence
- headache
- anorexia
- pruritus
- impaired hearing (high-dose use)
Safety/Monitoring .
Monitoring Parameters
no routine tests recommended
Look/Sound-Alike Drug Names
azithromycin confused with: azaTHIOprine; aztreonam; erythromycin; vancomycin; Zaroxolyn
Pregnancy/Lactation .
Pregnancy
Clinical Summary
may use during pregnancy; possible risk of spontaneous abortion based on conflicting human data; no known risk of fetal harm for PO route based on animal data at 1.6x and 3.2x recommended human dose
Lactation
Clinical Summary
may use while breastfeeding; possible risk of infant diarrhea, vomiting, and rash based on limited human data; possible risk of infantile hypertrophic pyloric stenosis based on conflicting human data; no human data available to assess effects on milk production
Pharmacology .
Metabolism: liver; CYP450: unknown
Excretion: bile primarily (>50% unchanged), urine (6% unchanged); Half-life: 68h; Info: extensive uptake and eventual release from tissues
Subclass: Macrolides
Mechanism of Action
binds to 50S ribosomal subunit, inhibiting protein synthesis
Formulary .
No Formulary Selected
Manufacturer/Pricing .
Manufacturer: generic
DEA/FDA: Rx
Approximate Retail Price
from http://www.goodrx.com/azithromycin
oral tablet:
- 250 mg (6 ea): $9.00
- 500 mg (2 ea): $9.00
- 600 mg (30 ea): $66.00
oral powder for reconstitution:
- 1 g (1 packet): $21.00
oral tablet:
- 250 mg (1 z-pak, 6 tablets): $9.00
oral tablet:
- 500 mg (1 tri-pak, 3 tablets): $12.00
intravenous powder for injection:
- 500 mg (3 vial): $16.00
oral powder for reconstitution:
- 100 mg/5 mL (2 bottle of oral suspension, 15 mL): $23.00
- 200 mg/5 mL (1 bottle of oral suspension, 15 mL): $10.00
oral powder for reconstitution:
- 200 mg/5 mL (1 bottle of oral suspension, 22.5 mL): $12.00
oral powder for reconstitution:
- 200 mg/5 mL (1 bottle of oral suspension, 30 mL): $14.00
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