Azithromycin

From Drugs Prescribing Information
Jump to: navigation, search

Click on "►" to expand:

Contents

[edit] BRAND NAMES

[edit] STRUCTURE

Azithromycin.jpg

[edit] MECHANISM OF ACTION

Azithromycin is a macrolide antibiotic, it binds to the 50 S subunit of bacterial ribosomes, inhibiting protein synthesis in bacterial cells.

[edit] INDICATIONS

Adults:

  • Acute bacterial exacerbations of chronic obstructive pulmonary disease and Acute bacterial sinusitis, due to Haemophilus influenzae, Moraxella catarrhalis or Streptococcus pneumoniae.
  • Community-acquired pneumonia due to Chlamydophila pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae or Streptococcus pneumoniae
  • Pharyngitis and tonsillitis caused by Streptococcus pyogenes as an alternative to first-line therapy (Penicillin by the intramuscular route is the usual drug of choice in the treatment of Streptococcus pyogenes infection)
  • Uncomplicated skin infections due to Staphylococcus aureus, Streptococcus pyogenes, or Streptococcus agalactiae
  • Urethritis and cervicitis due to Chlamydia trachomatis or Neisseria gonorrhoeae
  • Genital ulcer disease in men due to Haemophilus ducreyi (chancroid)


Pediatric Patients

  • Acute otitis media caused by Haemophilus influenzae, Moraxella catarrhalis or Streptococcus pneumoniae
  • Community-acquired pneumonia due to Chlamydophila pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae or Streptococcus pneumoniae
  • Pharyngitis/tonsillitis caused by Streptococcus pyogenes as an alternative to first-line therapy in individuals who cannot use first-line therapy

[edit] DOSAGE

Azithromycin can be taken with or without food.

Adult Patients:

Infection Recommended Dose/Duration of Therapy
Community-aquired pneumonia (mild severity)
Pharyngitis/tonsillitis (second line therapy)
Skin/skin structure (uncomplicated)
500 mg as a single dose on Day 1, followed 
by 250 mg once daily on Days 2 through 5
Acute bacterial exacerbations of chronic
obstructive pulmonary disease (mild to moderate)
500 mg/day  for  3 days
OR
500 mg as a single dose on Day 1, followed 
by 250 mg once daily on Days 2 through 5.
Acute bacterial sinusitis 500 mg/day  for 3 days
Genital ulcer disease (chancroid) One single 1 gram dose
Non-gonoccocal urethritis and cervicitis One single 1 gram dose
Gonococcal urethritis and cervicitis One single 2 gram dose



Pediatric Patients:

Infection Recommended Dose/Duration of Therapy
Acute Otitis Media
10 mg/kg once daily for 3 days
Acute Bacterial Sinusitis 10 mg/kg once daily for 3 days
Community-Acquired Pneumonia
10 mg/kg as a single dose on the first day followed by 5 mg/kg on Days 2 through 5

[edit] CONTRAINDICATIONS

  • Known hypersensitivity to azithromycin or to any macrolide
  • Patients with a history of cholestatic jaundice/hepatic dysfunction associated with prior use of azithromycin.

[edit] WARNINGS AND PRECAUTIONS

  • Hypersensitivity : Serious allergic reactions, including angioedema, anaphylaxis, and dermatologic reactions including Stevens Johnson Syndrome and toxic epidermal necrolysis have been reported rarely. If an allergic reaction occurs, the drug should be discontinued and appropriate therapy should be instituted.
  • Hepatotoxicity : 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.
  • Clostridium Difficile-associated diarrhea has been reported, and may range in severity from mild diarrhea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C. difficile.
  • QT Prolongation : Prolonged cardiac repolarization and QT interval, imparting a risk of developing cardiac arrhythmia and torsades de pointes, have been seen in treatment with macrolides, including azithromycin. Providers should consider the risk of QT prolongation which can be fatal when weighing the risks and benefits of azithromycin for at-risk groups including:
  1. patients with known prolongation of the QT interval, a history of torsades de pointes, congenital long QT syndrome, bradyarrhythmias or uncompensated heart failure
  2. patients on drugs known to prolong the QT interval
  3. patients with ongoing proarrhythmic conditions such as uncorrected hypokalemia or hypomagnesemia, clinically significant bradycardia, and in patients receiving Class IA (quinidine, procainamide) or Class III (dofetilide, aminodarone, sotalol) antiarrhythmic agents.
    Elderly patients may be more susceptible to drug-associated effects on the QT interval.

[edit] INTERACTIONS

  • Do not to take aluminum- and magnesium-containing antacids and azithromycin simultaneously.

[edit] PREGNANCY AND LACTATION

  • Pregnancy Category B (US). . In the animal studies, no evidence of harm to the fetus due to azithromycin was found. There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, azithromycin should be used during pregnancy only if clearly needed.
  • Nursing Mothers: It is not known whether azithromycin is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when azithromycin is administered to a nursing woman.

[edit] SIDE EFFECTS

Most common side effects in adult and pediatric patients were related to the gastrointestinal system with diarrhea, nausea, vomiting and abdominal pain.

Serious side effects:

  • Angioedema (rarely)
  • Cholestatic jaundice (rarely)

[edit] RELATED LINKS

Macrolides: Mechanisms of Action

[edit] BIBLIOGRAPHY

[edit] REFERENCES