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Macrolide antibiotic for broad-spectrum infections
Respiratory Infections:
Lower tract (bronchitis, pneumonia)
Upper tract (sinusitis, pharyngitis/tonsillitis)
Otitis media
Skin/Soft Tissue Infections
Sexually Transmitted Infections:
Non-gonococcal urethritis/cervicitis (Chlamydia trachomatis)
Pelvic inflammatory disease (PID) - see dosing
(Use under registered physician's guidance)
Binds to 50S ribosomal subunit → inhibits bacterial protein synthesis
Spectrum of Activity:
| Bacteria Class | Key Pathogens |
|---|---|
| Gram-positive | Staphylococcus aureus, Streptococcus pneumoniae |
| Gram-negative | Haemophilus influenzae, Moraxella catarrhalis |
| Atypicals | Chlamydia trachomatis, Mycoplasma pneumoniae |
| Parameter | Profile |
|---|---|
| Absorption | Rapid (Tₘₐₓ: 2-3h); ↓ by 50% with food → take fasting |
| Distribution | High tissue penetration (50× plasma) • Concentrates in phagocytes |
| Elimination | t½: 68h • Biliary excretion (unchanged) • Renal clearance: 6% |
| Key Advantage | Prolonged tissue persistence → short-course therapy |
| Indication | Regimen |
|---|---|
| Respiratory/Skin Infections | 500 mg daily × 3 days |
| STI (Chlamydia) | 1 g single dose (two 500mg tablets) |
| Alternative STI Regimen | 500 mg Day 1 → 250 mg Days 2-5 |
| Weight | Dose per Day (×3 days) | Form |
|---|---|---|
| 15-25 kg | 200 mg | Suspension/Tablet |
| 26-35 kg | 300 mg | Suspension/Tablet |
| 36-45 kg | 400 mg | Suspension/Tablet |
| Typhoid Fever | 20 mg/kg/day (max 500mg) ×7-10 days | Suspension |
| Indication | IV Regimen | Oral Follow-Up | Total Duration |
|---|---|---|---|
| Community-Acquired Pneumonia | 500 mg daily × ≥2 days | 500 mg daily | 7-10 days |
| Pelvic Inflammatory Disease | 500 mg daily × 1-2 days | 250 mg daily | 7 days |
Critical Notes:
Oral: Take 1h before or 2h after food/antacids
IV: Infuse 500mg in 250-500mL fluid over ≥60 minutes
Suspension: Shake vigorously; add water to mark line
(Follow registered physician's advice)
| Concomitant Drug | Risk | Management |
|---|---|---|
| Ergot Derivatives | Acute ergotism → CONTRAINDICATED | Absolute avoidance |
| Cyclosporine | ↑ Cyclosporine levels (theoretical) | Monitor levels; adjust dose |
| Digoxin | ↑ Digoxin levels (theoretical) | Monitor digoxin levels |
| Antacids | ↓ Azithromycin absorption | Separate doses by 2+ hours |
Hypersensitivity to macrolides
Hepatic impairment (Child-Pugh C)
Concomitant ergot alkaloids
History of cholestatic jaundice with azithromycin
Common (≥5%):
GI: Nausea • Diarrhea • Abdominal pain • Vomiting
Serious:
Hepatotoxicity: Cholestatic jaundice, ↑ transaminases
Cardiac: QT prolongation → torsades de pointes (rare)
Hypersensitivity: Angioedema, anaphylaxis
Hematologic: Neutropenia (transient)
Pregnancy (Category B):
Use only if benefit > risk (limited human data)
Lactation:
Excreted in milk; use caution
Hepatotoxicity:
Monitor LFTs (discontinue if ALT/AST >5× ULN)
QT Prolongation:
Avoid in patients with:
Known QT prolongation
Concurrent QT-prolonging drugs
Electrolyte imbalances
C. difficile Risk:
Antibiotic-associated colitis (watery/bloody diarrhea)
| Group | Guidance |
|---|---|
| Renal Impairment | No adjustment if CrCl >40 mL/min; caution if severe |
| Hepatic Impairment | Contraindicated in severe disease |
| Elderly | ↑ QT risk; monitor cardiac function |
Symptoms: Nausea, vomiting, diarrhea, reversible hearing loss
Treatment:
Gastric lavage if recent ingestion
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