Azithromycin is used to treat a wide variety of bacterial infections. Unnecessary use or misuse of any antibiotic can lead to its decreased effectiveness. This medication will not work for viral infections (such as common cold, flu). Read the Patient Information Leaflet if available from your pharmacist before you start taking azithromycin and each time you get a refill. If you have any questions, ask your doctor or pharmacist. Take this medication by mouth as directed by your doctor, usually once daily with or without food. You may take this medication with food if stomach upset occurs. The dosage is based on your medical condition and response to treatment. Azithromycin has relatively broad but shallow antibacterial activity. It inhibits some Gram-positive bacteria, some Gram-negative bacteria, and many atypical bacteria. A strain of gonorrhea reported to be highly resistant to azithromycin was found in the population in 2015. Neisseria gonorrhoeae is normally susceptible to azithromycin, Safety of the medication during breastfeeding is unclear. It has been reported that because only low levels are found in breastmilk and the medication has also been used in young children, it is unlikely that breastfed infants would suffer adverse effects. Most common adverse effects are diarrhea (5%), nausea (3%), abdominal pain (3%), and vomiting. Fewer than 1% of people stop taking the drug due to side effects.
The content of this evidence summary was up-to-date in November 2014. See summaries of product characteristics (SPCs), British national formulary (BNF), BNF for children (BNFc) or the MHRA or NICE websites for up-to-date information. A Cochrane review (10 studies, n=959) assessed the use of long-term azithromycin for cystic fibrosis. Various dosing regimens were used, the most common being 250−500 mg 3 times weekly. In 4 studies (n=549), treatment with azithromycin statistically significantly improved forced expired volume in 1 second (FEV; the primary outcome) over 6 months compared with placebo. Azithromycin doubled the rate of being free of exacerbations over 6 months compared with placebo; however, the data were heterogeneous and should be interpreted with caution. The need for oral antibiotics was statistically significantly reduced with azithromycin, but there were limited data on the need for intravenous antibiotics and other secondary outcomes. Adverse events were uncommon and not obviously associated with azithromycin. 500 mg PO once, then 250 mg once daily for 4 days 2 g extended release suspension PO once 500 mg IV as single dose for at least 2 days; follow with oral therapy with single dose of 500 mg to complete 7-10 days course of therapy Infection of pharynx, cervix, urethra, or rectum: Ceftriaxone 250 mg IM once plus azithromycin 1 g PO once (preferred) or alternatively doxycycline 100 mg PO q12hr for 7 days CDC STD guidelines: MMWR Recomm Rep. June 5, 20(RR3);1-137 Agitation Allergic reaction Anemia Anorexia Candidiasis Chest pain Conjunctivitis Constipation Dermatitis (fungal) Dizziness Eczema Edema Enteritis Facial edema Fatigue Gastritis Headache Hyperkinesia Hypotension Increased cough Insomnia Leukopenia Malaise Melena Mucositis Nervousness Oral candidiasis Pain Palpitations Pharyngitis Pleural effusion Pruritus Pseudomembranous colitis Rash Rhinitis Seizures Somnolence Urticaria Vertigo Anaphylaxis Angioedema Anorexia Bronchospasm Constipation Dermatologic reactions Dyspepsia Elevated liver enzymes Erythema multiforme Flatulence Oral candidiasis Pancreatitis Pseudomembranous colitis Pyloric stenosis, rare reports of tongue discoloration Stevens-Johnson syndrome Torsades de pointes Toxic epidermal necrolysis Vomiting/diarrhea, rarely resulting in dehydration Neutropenia Elevated bilirubin, AST, ALT, BUN, creatinine Alterations in potassium Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Use with caution in abnormal liver function, hepatitis, cholestatic jaundice, hepatic necrosis, and hepatic failure have been reported, some of which have resulted in death; discontinue azithromycin immediately if signs and symptoms of hepatitis occur Injection-site reactions can occur with IV route In treatment of gonorrhea or syphilis, perform susceptibility culture tests before initiating azithromycin therapy; may mask or delay symptoms of incubating gonorrhea or syphilis. Bacterial or fungal superinfection may result from prolonged use Prolonged QT interval: Cases of torsades de pointes have been reported during postmarketing surveillance; use with caution in patients with known QT prolongation, history of torsades de pointes, congenital long QT syndrome, bradyarrhythmias, or uncompensated heart failure; also use with caution if coadministering with drugs that prolong QT interval or proarrhythmic conditions (eg, hypokalemia, hypomagnesemia); elderly patients may be more susceptible to drug-associated effects on QT interval Pneumonia: PO azithromycin is safe and effective only for community-acquired pneumonia (CAP) due to C pneumoniae, H influenzae, M pneumoniae, or S pneumoniae Cases of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) reported; despite successful symptomatic treatment of allergic symptoms, when symptomatic therapy was discontinued, allergic symptoms recurred soon thereafter in some patients without further azithromycin exposure; if allergic reaction occurs, the drug should be discontinued and appropriate therapy instituted; physicians should be aware that allergic symptoms may reappear when symptomatic therapy discontinued Endocarditis prophylaxis: Indicated only for high-risk patients, per current AHA guidelines Use caution in renal impairment (Cr Cl Because of the low levels of azithromycin in breastmilk and use in infants in higher doses, it would not be expected to cause adverse effects in breastfed infants (Lact Med; https://nih.gov/newtoxnet/lactmed.htm) Binds to 50S ribosomal subunit of susceptible microorganisms and blocks dissociation of peptidyl t RNA from ribosomes, causing RNA-dependent protein synthesis to arrest; does not affect nucleic acid synthesis Concentrates in phagocytes and fibroblasts, as demonstrated by in vitro incubation techniques; in vivo studies suggest that concentration in phagocytes may contribute to drug distribution to inflamed tissues Y-site: Amikacin, aztreonam, cefotaxime, ceftazidime, ceftriaxone, cefuroxime, ciprofloxacin, clindamycin, droperidol, famotidine, fentanyl, furosemide, gentamicin, imipenem, cilastatin, ketorolac, levofloxacin, morphine, piperacillin-tazobactam, ondansetron(? ), potassium chloride, ticarcillin-clavulanate, tobramycin The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.
Medscape - Infection-specific dosing for Zithromax, Zmax azithromycin, frequency-based adverse effects, comprehensive interactions, contraindications, pregnancy. All Azithromycin labels now have strengthened warnings and precaution sections that identify those with QT interval prolongation, low bleed levels of potassium, a slower normal heart rate, or other heart medicine as susceptible to major heart complications.