Azithromycin Dosage

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Usual Adult Dose for Mycoplasma Pneumonia

Community-acquired pneumonia:
Oral:
Immediate-release: 500 mg orally as a single dose on the first day followed by 250 mg orally once a day on days 2 through 5 for mild infections

Extended-release suspension: 2 g orally as a single dose for mild to moderate infections

IV: 500 mg IV once a day for at least 2 days followed by 500 mg (immediate-release formulation) orally once a day to complete a 7- to 10-day course of therapy

Usual Adult Dose for Pneumonia

Community-acquired pneumonia:
Oral:
Immediate-release: 500 mg orally as a single dose on the first day followed by 250 mg orally once a day on days 2 through 5 for mild infections

Extended-release suspension: 2 g orally as a single dose for mild to moderate infections

IV: 500 mg IV once a day for at least 2 days followed by 500 mg (immediate-release formulation) orally once a day to complete a 7- to 10-day course of therapy

Usual Adult Dose for Legionella Pneumonia

Community-acquired pneumonia: 500 mg IV once a day for at least 2 days followed by 500 mg (immediate-release formulation) orally once a day to complete a 7- to 10-day course of therapy

(Not approved by FDA)

Legionnaires' disease: 500 mg IV or orally once a day
Duration: 3 to 5 days for mild to moderate infections in immunocompetent patients; a longer treatment duration (at least 7 to 10 days or 3 weeks) may be necessary to prevent relapse in patients with more severe infections or with underlying comorbidity or immunodeficiency

Usual Adult Dose for Tonsillitis/Pharyngitis

Immediate-release: 500 mg orally as a single dose on the first day followed by 250 mg orally once a day on days 2 through 5

Recommended as an alternative (second-line therapy) in patients who cannot use first-line therapy

Usual Adult Dose for Sinusitis

Acute bacterial sinusitis:
Immediate-release: 500 mg orally once a day for 3 days
Extended-release suspension: 2 g orally as a single dose for mild to moderate infections

Usual Adult Dose for Skin and Structure Infection

Uncomplicated:
Immediate-release: 500 mg orally as a single dose on the first day followed by 250 mg orally once a day on days 2 through 5

Usual Adult Dose for Gonococcal Infection - Uncomplicated

Immediate-release:
Gonococcal urethritis and cervicitis: 2 g orally as a single dose

Centers for Disease Control and Prevention (CDC) recommendations:
Uncomplicated infections of the cervix, urethra, or rectum:
Recommended regimen: 1 g orally as a single dose plus ceftriaxone

Alternative regimens:
If ceftriaxone is not available: 1 g orally as a single dose plus cefixime plus test-of-cure in 1 week
If patient has severe cephalosporin allergy: 2 g orally as a single dose plus test-of-cure in 1 week

Uncomplicated infections of the pharynx:
Recommended regimen: 1 g orally as a single dose plus ceftriaxone

The patient's sexual partner(s) should also be evaluated/treated.

Usual Adult Dose for Nongonococcal Urethritis

Urethritis and cervicitis due to Chlamydia trachomatis:
Immediate-release: 1 g orally as a single dose

The patient's sexual partner(s) should also be evaluated/treated.

Usual Adult Dose for Chlamydia Infection

Urethritis and cervicitis due to Chlamydia trachomatis:
Immediate-release: 1 g orally as a single dose

The patient's sexual partner(s) should also be evaluated/treated.

Usual Adult Dose for Cervicitis

Urethritis and cervicitis due to Chlamydia trachomatis:
Immediate-release: 1 g orally as a single dose

The patient's sexual partner(s) should also be evaluated/treated.

Usual Adult Dose for Chancroid

Immediate-release: 1 g orally as a single dose

The patient's sexual partner(s) should also be evaluated/treated.

Usual Adult Dose for Pelvic Inflammatory Disease

500 mg IV once a day for 1 or 2 days followed by 250 mg (immediate-release formulation) orally once a day to complete a 7-day course of therapy

The patient's sexual partner(s) should also be evaluated/treated.

Usual Adult Dose for Chronic Obstructive Pulmonary Disease - Acute

Acute bacterial exacerbations of COPD (mild to moderate):
Immediate-release: 500 mg orally once a day for 3 days
or
500 mg orally as a single dose on the first day followed by 250 mg orally once a day on days 2 through 5

Usual Adult Dose for Mycobacterium avium-intracellulare - Prophylaxis

Immediate-release:
Prevention of disseminated Mycobacterium avium complex (MAC) disease in patients with advanced HIV infection: 1200 mg orally once a week; may be combined with the approved dosage regimen of rifabutin

(Not approved by FDA)

American Thoracic Society (ATS), CDC, National Institutes of Health (NIH), and Infectious Diseases Society of America (IDSA) recommendations for HIV-infected patients:
Primary prevention of disseminated MAC disease: 1200 mg orally once a week

Chronic maintenance therapy (secondary prophylaxis) for disseminated MAC disease: 500 to 600 mg orally once a day plus ethambutol, with or without rifabutin; recommended as an alternative regimen

Secondary prophylaxis is usually continued for life; however, discontinuation may be considered in patients with sustained immune recovery in response to antiretroviral therapy.

Usual Adult Dose for Mycobacterium avium-intracellulare - Treatment

Immediate-release:
Treatment of disseminated MAC infections in patients with advanced HIV infection: 600 mg orally once a day plus ethambutol

Other antimycobacterial drugs with in vitro activity against MAC may be added to this regimen at the physician's discretion.

(Not approved by FDA)

ATS, CDC, NIH, and IDSA recommendations:
Treatment of disseminated MAC infections in HIV-infected patients: 500 to 600 mg orally once a day plus ethambutol, with or without rifabutin; recommended as an alternative regimen

Combination therapy with at least 2 drugs is recommended. Chronic suppressive therapy (secondary prophylaxis) is recommended after initial therapy.

Usual Adult Dose for Granuloma Inguinale

(Not approved by FDA)

CDC recommendations:
Immediate-release: 1 g orally once a week for at least 3 weeks and until all lesions have completely healed

This regimen is recommended as an alternative to doxycyline.

The patient's sexual partner(s) should also be evaluated/treated.

Usual Adult Dose for STD Prophylaxis

(Not approved by FDA)

CDC recommendations for sexual assault victims:
Immediate-release: 1 g orally as a single dose, in conjunction with metronidazole plus (ceftriaxone or cefixime)

Usual Adult Dose for Pertussis Prophylaxis

(Not approved by FDA)

CDC recommendations for treatment and postexposure prophylaxis:
Immediate-release: 500 mg orally as a single dose on the first day followed by 250 mg orally once a day on days 2 through 5

Usual Adult Dose for Pertussis

(Not approved by FDA)

CDC recommendations for treatment and postexposure prophylaxis:
Immediate-release: 500 mg orally as a single dose on the first day followed by 250 mg orally once a day on days 2 through 5

Usual Adult Dose for Lyme Disease - Erythema Chronicum Migrans

(Not approved by FDA)

IDSA recommendations:
Early localized or early disseminated Lyme disease associated with erythema migrans, in the absence of specific neurologic manifestations or advanced atrioventricular heart block:
Immediate-release: 500 mg orally once a day for 7 to 10 days

Azithromycin is recommended when first-line agents (oral doxycycline, amoxicillin, or cefuroxime) cannot be used. Patients should be monitored closely to ensure resolution of clinical manifestations.

Usual Adult Dose for Babesiosis

(Not approved by FDA)

IDSA recommendations:
Immediate-release: 500 to 1000 mg orally as a single dose on the first day followed by 250 mg orally once a day for a total of 7 to 10 days, in combination with atovaquone

For immunocompromised patients, azithromycin 600 to 1000 mg orally per day may be used.

Usual Adult Dose for Bacterial Endocarditis Prophylaxis

(Not approved by FDA)

American Heart Association (AHA) recommendations for patients allergic to penicillins:
Immediate-release: 500 mg orally as a single dose 30 to 60 minutes prior to the procedure

Usual Adult Dose for Toxoplasmosis

(Not approved by FDA)

CDC, NIH, and IDSA recommendations for HIV-infected patients:
Immediate-release: 900 to 1200 mg orally once a day, in conjunction with pyrimethamine and leucovorin
Duration: At least 6 weeks; longer duration if disease is extensive or response is incomplete at 6 weeks

Azithromycin is recommended as an alternative regimen.

Usual Adult Dose for Typhoid Fever

(Not approved by FDA)

Immediate-release: 1000 mg orally once a day for 5 days

Alternatively, a dosage of 8 to 10 mg/kg (maximum: 500 mg/dose) orally once a day for 7 days has been recommended.

Usual Adult Dose for Upper Respiratory Tract Infection

(Not approved by FDA)

Immediate-release: 500 mg orally as a single dose on the first day followed by 250 mg orally once a day on days 2 through 5

Usual Adult Dose for Bronchitis

(Not approved by FDA)

Immediate-release: 500 mg orally as a single dose on the first day followed by 250 mg orally once a day on days 2 through 5

Usual Pediatric Dose for Otitis Media

Acute:
Immediate-release:
6 months or older: 30 mg/kg (maximum: 1500 mg/dose) orally as a single dose
or
10 mg/kg (maximum: 500 mg/dose) orally once a day for 3 days
or
10 mg/kg (maximum: 500 mg/dose) orally as a single dose on the first day followed by 5 mg/kg (maximum: 250 mg/dose) orally once a day on days 2 thru 5

Usual Pediatric Dose for Mycoplasma Pneumonia

Community-acquired pneumonia:
Oral:
Immediate-release:
6 months or older: 10 mg/kg (maximum: 500 mg/dose) orally as a single dose on the first day followed by 5 mg/kg (maximum: 250 mg/dose) orally once a day on days 2 thru 5

16 years or older: 500 mg orally as a single dose on the first day followed by 250 mg orally once a day on days 2 through 5 for mild infections

Extended-release suspension:
6 months or older:
Less than 34 kg: 60 mg/kg orally as a single dose for mild to moderate infections
34 kg or more: 2 g orally as a single dose for mild to moderate infections

16 years or older: 2 g orally as a single dose for mild to moderate infections

IV:
16 years or older: 500 mg IV once a day for at least 2 days followed by 500 mg (immediate-release formulation) orally once a day to complete a 7- to 10-day course of therapy

Usual Pediatric Dose for Pneumonia

Community-acquired pneumonia:
Oral:
Immediate-release:
6 months or older: 10 mg/kg (maximum: 500 mg/dose) orally as a single dose on the first day followed by 5 mg/kg (maximum: 250 mg/dose) orally once a day on days 2 thru 5

16 years or older: 500 mg orally as a single dose on the first day followed by 250 mg orally once a day on days 2 through 5 for mild infections

Extended-release suspension:
6 months or older:
Less than 34 kg: 60 mg/kg orally as a single dose for mild to moderate infections
34 kg or more: 2 g orally as a single dose for mild to moderate infections

16 years or older: 2 g orally as a single dose for mild to moderate infections

IV:
16 years or older: 500 mg IV once a day for at least 2 days followed by 500 mg (immediate-release formulation) orally once a day to complete a 7- to 10-day course of therapy

Usual Pediatric Dose for Legionella Pneumonia

Community-acquired pneumonia:
16 years or older: 500 mg IV once a day for at least 2 days followed by 500 mg (immediate-release formulation) orally once a day to complete a 7- to 10-day course of therapy

Usual Pediatric Dose for Tonsillitis/Pharyngitis

Immediate-release:
2 years or older: 12 mg/kg (maximum: 500 mg/dose) orally once a day for 5 days
16 years or older: 500 mg orally as a single dose on the first day followed by 250 mg orally once a day on days 2 through 5

Recommended as an alternative (second-line therapy) in patients who cannot use first-line therapy

Usual Pediatric Dose for Sinusitis

Acute bacterial sinusitis:
Immediate-release:
6 months or older: 10 mg/kg (maximum: 500 mg/dose) orally once a day for 3 days
16 years or older: 500 mg orally once a day for 3 days

Extended-release suspension:
16 years or older: 2 g orally as a single dose for mild to moderate infections

Usual Pediatric Dose for Skin and Structure Infection

Uncomplicated:
Immediate-release:
16 years or older: 500 mg orally as a single dose on the first day followed by 250 mg orally once a day on days 2 through 5

Usual Pediatric Dose for Gonococcal Infection - Uncomplicated

Immediate-release:
Gonococcal urethritis and cervicitis:
16 years or older: 2 g orally as a single dose

(Not approved by FDA)

CDC recommendations for children weighing greater than 45 kg and adolescents:
Uncomplicated infections of the cervix, urethra, or rectum:
Recommended regimen: 1 g orally as a single dose plus ceftriaxone

Alternative regimens:
If ceftriaxone is not available: 1 g orally as a single dose plus cefixime plus test-of-cure in 1 week
If patient has severe cephalosporin allergy: 2 g orally as a single dose plus test-of-cure in 1 week

Uncomplicated infections of the pharynx:
Recommended regimen: 1 g orally as a single dose plus ceftriaxone

The patient's sexual partner(s) should also be evaluated/treated.

Usual Pediatric Dose for Nongonococcal Urethritis

Immediate-release:
Urethritis and cervicitis due to C trachomatis:
16 years or older: 1 g orally as a single dose

(Not approved by FDA)

CDC recommendations:
Children less than 8 years who weigh 45 kg or more, children 8 years or older, and adolescents: 1 g orally as a single dose

The patient's sexual partner(s) should also be evaluated/treated.

Usual Pediatric Dose for Chlamydia Infection

Immediate-release:
Urethritis and cervicitis due to C trachomatis:
16 years or older: 1 g orally as a single dose

(Not approved by FDA)

CDC recommendations:
Children less than 8 years who weigh 45 kg or more, children 8 years or older, and adolescents: 1 g orally as a single dose

The patient's sexual partner(s) should also be evaluated/treated.

Usual Pediatric Dose for Cervicitis

Immediate-release:
Urethritis and cervicitis due to C trachomatis:
16 years or older: 1 g orally as a single dose

(Not approved by FDA)

CDC recommendations:
Children less than 8 years who weigh 45 kg or more, children 8 years or older, and adolescents: 1 g orally as a single dose

The patient's sexual partner(s) should also be evaluated/treated.

Usual Pediatric Dose for Chancroid

Immediate-release:
16 years or older: 1 g orally as a single dose

(Not approved by FDA)

American Academy of Pediatrics (AAP) recommendations:
Infants and children weighing less than 45 kg: 20 mg/kg (maximum: 1 g/dose) orally as a single dose
Children weighing 45 kg or more and adolescents: 1 g orally as a single dose

The patient's sexual partner(s) should also be evaluated/treated.

Usual Pediatric Dose for Pelvic Inflammatory Disease

16 years or older: 500 mg IV once a day for 1 or 2 days followed by 250 mg (immediate-release formulation) orally once a day to complete a 7-day course of therapy

The patient's sexual partner(s) should also be evaluated/treated.

Usual Pediatric Dose for Chronic Obstructive Pulmonary Disease - Acute

Acute bacterial exacerbations of COPD (mild to moderate):
Immediate-release:
16 years or older: 500 mg orally once a day for 3 days
or
500 mg orally as a single dose on the first day followed by 250 mg orally once a day on days 2 through 5

Usual Pediatric Dose for Mycobacterium avium-intracellulare - Prophylaxis

Immediate-release:
Prevention of disseminated MAC disease in patients with advanced HIV infection:
16 years or older: 1200 mg orally once a week; may be combined with the approved dosage regimen of rifabutin

(Not approved by FDA)

ATS, CDC, NIH, IDSA, and AAP recommendations for HIV-exposed and HIV-infected infants and children:
Primary prevention of MAC infections:
Preferred regimen: 20 mg/kg (maximum: 1200 mg/dose) orally once a week
Alternative regimen: 5 mg/kg (maximum: 250 mg/dose) orally once a day

Secondary prevention of MAC infections: 5 mg/kg (maximum: 250 mg/dose) orally once a day plus ethambutol, with or without rifabutin; recommended as an alternative regimen

ATS, CDC, NIH, and IDSA recommendations for HIV-infected adolescents:
Primary prevention of disseminated MAC disease: 1200 mg orally once a week

Chronic maintenance therapy (secondary prophylaxis) for disseminated MAC disease: 500 to 600 mg orally once a day plus ethambutol, with or without rifabutin; recommended as alternative therapy

Secondary prophylaxis is usually continued for life; however, discontinuation may be considered in patients with sustained immune recovery in response to antiretroviral therapy.

Usual Pediatric Dose for Mycobacterium avium-intracellulare - Treatment

Immediate-release:
Treatment of disseminated MAC infections in patients with advanced HIV infection:
16 years or older: 600 mg orally once a day plus ethambutol

Other antimycobacterial drugs with in vitro activity against MAC may be added to this regimen at the physician's discretion.

(Not approved by FDA)

ATS, CDC, NIH, IDSA, and AAP recommendations for HIV-exposed and HIV-infected infants and children:
Treatment of MAC infections: 10 to 12 mg/kg (maximum: 500 mg/dose) orally once a day plus ethambutol, with or without rifabutin; recommended as an alternative regimen

ATS, CDC, NIH, and IDSA recommendations for HIV-infected adolescents:
Treatment of disseminated MAC infections: 500 to 600 mg orally once a day plus ethambutol, with or without rifabutin; recommended as an alternative regimen

Combination therapy with at least 2 drugs is recommended. Chronic suppressive therapy (secondary prophylaxis) is recommended after initial therapy.

Usual Pediatric Dose for STD Prophylaxis

(Not approved by FDA)

CDC recommendations for adolescent sexual assault victims:
Immediate-release: 1 g orally as a single dose, in conjunction with metronidazole plus (ceftriaxone or cefixime)

Usual Pediatric Dose for Pertussis Prophylaxis

(Not approved by FDA)

CDC recommendations for treatment and postexposure prophylaxis:
Immediate-release:
Less than 1 month: 10 mg/kg orally once a day for 5 days
1 to 5 months: 10 mg/kg orally once a day for 5 days
6 months or older: 10 mg/kg (maximum: 500 mg/dose) orally as a single dose on the first day followed by 5 mg/kg (maximum: 250 mg/dose) orally once a day on days 2 thru 5

Usual Pediatric Dose for Pertussis

(Not approved by FDA)

CDC recommendations for treatment and postexposure prophylaxis:
Immediate-release:
Less than 1 month: 10 mg/kg orally once a day for 5 days
1 to 5 months: 10 mg/kg orally once a day for 5 days
6 months or older: 10 mg/kg (maximum: 500 mg/dose) orally as a single dose on the first day followed by 5 mg/kg (maximum: 250 mg/dose) orally once a day on days 2 thru 5

Usual Pediatric Dose for Lyme Disease - Erythema Chronicum Migrans

(Not approved by FDA)

IDSA recommendations for children:
Early localized or early disseminated Lyme disease associated with erythema migrans, in the absence of specific neurologic manifestations or advanced atrioventricular heart block:
Immediate-release: 10 mg/kg (maximum: 500 mg/dose) orally once a day for 7 to 10 days

Azithromycin is recommended when first-line agents (oral doxycycline, amoxicillin, or cefuroxime) cannot be used. Patients should be monitored closely to ensure resolution of clinical manifestations.

Usual Pediatric Dose for Babesiosis

(Not approved by FDA)

Immediate-release:
IDSA recommendations for children: 10 mg/kg (maximum: 500 mg/dose) orally as a single dose on the first day followed by 5 mg/kg (maximum: 250 mg/dose) orally once a day for a total of 7 to 10 days, in combination with atovaquone

Alternatively, a dosage of 12 mg/kg (maximum: 600 mg/dose) orally once a day for 7 to 10 days in combination with atovaquone has been recommended for pediatric patients.

Usual Pediatric Dose for Bacterial Endocarditis Prophylaxis

(Not approved by FDA)

AHA recommendations for children allergic to penicillins:
Immediate-release: 15 mg/kg (maximum: 500 mg) orally as a single dose 30 to 60 minutes prior to procedure

Usual Pediatric Dose for Toxoplasmosis

(Not approved by FDA)

CDC, NIH, and IDSA recommendations for HIV-infected adolescents:
Immediate-release: 900 to 1200 mg orally once a day, in conjunction with pyrimethamine and leucovorin
Duration: At least 6 weeks; longer duration if disease is extensive or response is incomplete at 6 weeks

Azithromycin is recommended as an alternative regimen.

Usual Pediatric Dose for Typhoid Fever

(Not approved by FDA)

Immediate-release:
3 years or older: 20 mg/kg (maximum: 1 g/dose) orally once a day for 5 to 7 days

Alternatively, a dosage of 10 mg/kg (maximum: 500 mg/dose) orally once a day for 7 days has been recommended.

Usual Pediatric Dose for Cystic Fibrosis

(Not approved by FDA)

Chronic Pseudomonas aeruginosa infections in CF patients:
6 years or older, weight 25 kg or more and adolescents:
25 to less than 40 kg: 250 mg orally on Mondays, Wednesdays, Fridays
40 kg or more: 500 mg orally on Mondays, Wednesdays, Fridays

If side effects are intolerable, the dose should be decreased to twice a week, or if necessary, once a week.

Usual Pediatric Dose for Upper Respiratory Tract Infection

(Not approved by FDA)

Immediate-release:
6 months or older: 10 mg/kg (maximum: 500 mg/dose) orally as a single dose on the first day followed by 5 mg/kg (maximum: 250 mg/dose) orally once a day on days 2 thru 5

Renal Dose Adjustments

No adjustment recommended. The manufacturer recommends caution when administering this drug to patients with GFR less than 10 mL/min.

Liver Dose Adjustments

No adjustment recommended. The manufacturer recommends caution when administering this drug to patients with liver dysfunction.

Precautions

Consult WARNINGS section for dosing related precautions.

Dialysis

Data not available

Other Comments

Administration advice:
-IV azithromycin should be infused over at least 60 minutes; infusate concentration and rate of infusion should be either 1 mg/mL over 3 hours or 2 mg/mL over 1 hour.
-IV azithromycin should not be given as a bolus or as an IM injection.
-The timing of the switch from IV to oral therapy should be done at the discretion of the physician and according to clinical response.
-The immediate-release tablets and oral suspension may be given without regard to meals; the extended-release suspension should be given 1 hour before or 2 hours after a meal.
-Aluminum- and magnesium-containing antacids should not be used at the same time as immediate-release formulations of oral azithromycin.
-The extended-release suspension is not interchangeable with immediate-release formulations.

Storage requirements: The manufacturer's product information should be consulted.

Reconstitution/preparation techniques: The manufacturer's product information should be consulted.

IV compatibility: Other IV substances, additives, or medications should not be added to azithromycin, or infused simultaneously through the same IV line.

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