Azithromycin

Question 1

What drug class is azithromycin?

Answer 1

macrolide

Question 2

What is the MOA of azithromycin?

Answer 2

Bacteriostatic

Also has immunomodulatory and anti-inflammatory effects

Question 3

What is the treatment indications for azithromycin

Answer 3

1. Treatment of choice for chlamydial infections
2. Streptococcal pharyngitis/tonsillitis
3. Community-acquired pneumonia
4. Prevention and treatment of Mycobacterium avium complex (MAC) infection, with other agents
5. Donovanosis
6. Typhoid , paratyphoid (enteric fever)
7. Traveller’s diarrhoea
8. Prevention and treatment of pertussis

Question 4

What are the precautions for use of azithromycin?

Answer 4

1. Risk factors for prolonged QT interval - azithromycin associated with porlonged QT interval
2. Diabetes - oral liquid contains sucrose
3. Serious allergy to macrolides or ketolides - CI
   4.

Question 5

Is azithromycin safe in pregnancy or breastfeeding?

Answer 5

Azithromycin is consider safe in both pregnancy and breastfeeding (may cause loose bowel actions in infant when breastfeeding).

Question 6

What are the common adverse effects of azithromycin?

Answer 6

Nausea
Vomiting
Diarrhoea 
Abdominal Pain and Cramps 
Candidal infections 
Inflammation and pain at infusion site

Question 7

What are some rare adverse effects of azithromycin?

Answer 7

Torsades de pointes (very rare)
Hypersensitivity 
Ototoxicity 
Clostridum difficile-associated disease
Prolonged QT interval 
Blood dyscrasias

Question 8

What is the usual adult dose for azithromycin?

Answer 8

Oral, 500mg once on day ONE, then give 500mg once daily for 2 days or 250mg once daily for 4 days.

The higher dose can be given for >3 days, depending on the infection.

Question 9

What is the azithromycin treatment dose for chlamydial infection, non-gonococcal genital infection?

Answer 9

Adult, oral 1 g as a single dose.

Question 10

What is the azithromycin treatment dose for trachoma and chlamydia trachomatis conjunctivitis infection?

Answer 10

Adult, child, oral 20mg/kg (maximum 1 g) as a single dose.

Question 11

What is the azithromycin treatment dose for community-acquired pneumonia?

Answer 11

Adult, IV 500mg once daily; change to oral route when possible.

Question 12

What is the azithromycin treatment dose for mycobacterium avium complex (MAC)?

Answer 12

HIV-negative adult, oral 250 mg once daily.

HIV-positive adult, oral 500–600 mg once daily.

HIV-positive child, oral 10 mg/kg (maximum 500 mg) once daily.

Question 13

What is the azithromycin preventative dose for mycobacterium avium complex (MAC)?

Answer 13

Primary prevention, adult, oral 1.2 g taken once a week.

Primary prevention, child, oral 20 mg/kg (maximum 1.2 g) once a week or 5 mg/kg (maximum 250 mg) once daily.

Secondary prevention, adult, oral 500–600 mg once daily.

Secondary prevention, child, oral 5 mg/kg (maximum 250 mg) once daily.

Question 14

What is the azithromycin treatment dose for typhoid, paratyphoid?

Answer 14

Adult, oral 500mg once daily for 7 days.

Question 15

What is the azithromycin treatment dose for traveller’s diarrhoea?

Answer 15

Adult, oral 1 g single dose or 500mg once dialy for 3 days

Question 16

What is the azithromycin treatment and prevention dose for pertussis?

Answer 16

Adult, oral 500mg on day ONE, then 250mg once daily for 4 days

Question 17

What is the maximum treatment dose for azithromycin?

Answer 17

oral, 1,2 g as a single dose (in MAC)

Question 18

What other antimicrobial class has cross resistance with azithromycin?

Answer 18

There is often cross-resistance between macrolides and lincosamides (clindamycin and lincomycin)