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Azithromycin Dosage

Applies to the following strength(s): 500 mg ; 250 mg ; 1 g ; 600 mg ; 100 mg/5 mL ; 200 mg/5 mL ; 2 g ; 2.5 g

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

Usual Adult Dose for Legionella Pneumonia

Community-acquired pneumonia:
Oral:
-Immediate-release: 500 mg orally as a single dose on day 1, followed by 250 mg orally once a day on days 2 to 5
-Extended-release: 2 g orally once as a single dose

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

Comment: Extended-release formulations should be taken on an empty stomach.

Uses:
-Treatment of mild community acquired pneumonia due to Chlamydophila pneumoniae, Haemophilus influenzae, Mycoplasma pneumonia, or Streptococcus pneumoniae in patients appropriate for oral therapy
-Treatment of community-acquired pneumonia due to C pneumoniae, H influenzae, Legionella pneumophila, Moraxella catarrhalis, M pneumoniae, or S pneumoniae in patients who require initial IV therapy

Usual Adult Dose for Mycoplasma Pneumonia

Community-acquired pneumonia:
Oral:
-Immediate-release: 500 mg orally as a single dose on day 1, followed by 250 mg orally once a day on days 2 to 5
-Extended-release: 2 g orally once as a single dose

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

Comment: Extended-release formulations should be taken on an empty stomach.

Uses:
-Treatment of mild community acquired pneumonia due to Chlamydophila pneumoniae, Haemophilus influenzae, Mycoplasma pneumonia, or Streptococcus pneumoniae in patients appropriate for oral therapy
-Treatment of community-acquired pneumonia due to C pneumoniae, H influenzae, Legionella pneumophila, Moraxella catarrhalis, M pneumoniae, or S pneumoniae in patients who require initial IV therapy

Usual Adult Dose for Pneumonia

Community-acquired pneumonia:
Oral:
-Immediate-release: 500 mg orally as a single dose on day 1, followed by 250 mg orally once a day on days 2 to 5
-Extended-release: 2 g orally once as a single dose

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

Comment: Extended-release formulations should be taken on an empty stomach.

Uses:
-Treatment of mild community acquired pneumonia due to Chlamydophila pneumoniae, Haemophilus influenzae, Mycoplasma pneumonia, or Streptococcus pneumoniae in patients appropriate for oral therapy
-Treatment of community-acquired pneumonia due to C pneumoniae, H influenzae, Legionella pneumophila, Moraxella catarrhalis, M pneumoniae, or S pneumoniae in patients who require initial IV therapy

Usual Adult Dose for Tonsillitis/Pharyngitis

Immediate-release: 500 mg orally as a single dose on day 1, followed by 250 mg orally once a day on days 2 to 5

Use: Treatment of pharyngitis/tonsillitis caused by Streptococcus pyogenes as an alternative to first-line therapy in patients who cannot use first-line therapy

The IDSA recommends:
Immediate-release:
Individuals with penicillin allergy: 12 mg/kg orally once a day
-Maximum dose: 500 mg/day
-Duration of therapy: 5 days

Use: Treatment of Group A streptococcal pharyngitis

Usual Adult Dose for Sinusitis

Immediate-release: 500 mg orally once a day for 3 days
Extended-release: 2 g orally once as a single dose

Comment: Extended-release formulations should be taken on an empty stomach.

Use: Treatment of mild to moderate acute bacterial sinusitis due to Haemophilus influenzae, Moraxella catarrhalis, or Streptococcus pneumoniae

Usual Adult Dose for Skin and Structure Infection

Immediate-release: 500 mg orally as a single dose on day 1, followed by 250 mg orally once a day on days 2 to 5

Use: Treatment of mild to moderate uncomplicated skin and skin structure infections due to Staphylococcus aureus, Streptococcus pyogenes, or Streptococcus agalactiae

The IDSA and NIH recommend:
Immediate-release:
Patients greater than 45 kg: 500 mg orally on day 1, then 250 mg orally once a day on days 2 through 5
Patients less than 45 kg: 10 mg/kg orally on day 1, then 5 mg/kg orally once a day for 4 additional days

Alternative therapy for Bartonella infections (not endocarditis or central nervous system infections): 500 mg orally once a day for at least 3 months

Uses:
-Treatment of bacillary angiomatosis and cat scratch disease
-Alternative therapy for Bartonella infections

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

Non-gonococcal urethritis and cervicitis:
-Immediate-release: 1 g orally once

Comment: A 1 g oral dose given once a week for 3 weeks may be effective in the treatment of lymphogranuloma venereum due to Chlamydia trachomatis.

Uses:
-Treatment of mild to moderate urethritis and cervicitis due to C trachomatis
-Treatment of nongonococcal urethritis, cervicitis, and chlamydial infections

Usual Adult Dose for Chlamydia Infection

Non-gonococcal urethritis and cervicitis:
-Immediate-release: 1 g orally once

Comment: A 1 g oral dose given once a week for 3 weeks may be effective in the treatment of lymphogranuloma venereum due to Chlamydia trachomatis.

Uses:
-Treatment of mild to moderate urethritis and cervicitis due to C trachomatis
-Treatment of nongonococcal urethritis, cervicitis, and chlamydial infections

Usual Adult Dose for Cervicitis

Non-gonococcal urethritis and cervicitis:
-Immediate-release: 1 g orally once

Comment: A 1 g oral dose given once a week for 3 weeks may be effective in the treatment of lymphogranuloma venereum due to Chlamydia trachomatis.

Uses:
-Treatment of mild to moderate urethritis and cervicitis due to C trachomatis
-Treatment of nongonococcal urethritis, cervicitis, and chlamydial infections

Usual Adult Dose for Chancroid

Immediate-release: 1 g orally once

Comments:
-The efficacy of this drug in female patients with chancroid has not been established.
-The patient's sexual partner(s) during the 10 days preceding the onset of symptoms should be evaluated/treated.
-Patients should be tested for HIV infection when chancroid is diagnosed and a serologic test for HIV and syphilis should be performed 3 months after diagnosis in patients with negative initial HIV test results.

Use: Treatment of genital ulcer disease in men due to Haemophilus ducreyi (chancroid)

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

Comment: Antimicrobial drugs with anaerobic activity should be used concurrently if anaerobic microorganisms are suspected in contributing to the infection.

Use: Treatment of pelvic inflammatory disease due to Chlamydia trachomatis, Neisseria gonorrhoeae, or Mycoplasma hominis

Usual Adult Dose for Chronic Obstructive Pulmonary Disease - Acute

Immediate-release: 500 mg orally once a day for 3 days OR 500 mg orally as a single dose on day 1, followed by 250 mg orally once a day on days 2 to 5

Uses:
-Mild to moderate acute bacterial exacerbations of COPD
-Treatment of mild to moderate acute bacterial exacerbations of chronic bronchitis due to Haemophilus influenza, Moraxella catarrhalis, or Streptococcus pneumoniae

Usual Adult Dose for Bronchitis

Immediate-release: 500 mg orally once a day for 3 days OR 500 mg orally as a single dose on day 1, followed by 250 mg orally once a day on days 2 to 5

Uses:
-Mild to moderate acute bacterial exacerbations of COPD
-Treatment of mild to moderate acute bacterial exacerbations of chronic bronchitis due to Haemophilus influenza, Moraxella catarrhalis, or Streptococcus pneumoniae

Usual Adult Dose for Mycobacterium avium-intracellulare - Prophylaxis

The manufacturer gives no specific dosing instructions.

The NIH, IDSA, and ATS recommend:
Immediate-release:
Patients with AIDS and CD4 counts less than 50 cells/mcL:
-Primary prophylaxis: 1200 mg orally once a week OR 600 mg orally 2 times a week

Comment: Primary prophylaxis may be discontinued when the CD3 count is greater than 100 cells/mm3 for at least 3 months in response to antiretroviral therapy.

Use: Preventing the first episode of disseminated Mycobacterium avium-intracellulare (MAC) disease

Usual Adult Dose for Mycobacterium avium-intracellulare - Treatment

The manufacturer gives no specific dosing instructions.

The NIH, IDSA, and ATS recommend:
Immediate-release:
-Initial treatment of nodular/bronchiectatic disease: 500 mg orally 3 times a week plus rifampin and ethambutol

-Initial treatment of fibrocavitary Mycobacterium avium-intracellulare complex (MAC) pulmonary or severe nodular/bronchiectatic disease: 250 mg orally once a day plus ethambutol and rifampin, with/without streptomycin or amikacin

-Advanced/severe or previously treated MAC disease: 250 to 300 mg orally once a day plus ethambutol

-Treatment of disseminated MAC disease: 250 mg orally once a day plus ethambutol
---Some experts recommend: 500 to 600 mg orally once a day plus ethambutol

Comments:
-Patients with severe/advanced disease should be treated until culture negative (e.g., 1 year).
-Patients with disseminated MAC disease may discontinue treatment when symptoms resolve and cell-mediated immune function resumes.
-Treatment of disseminated MAC disease is preferred when drug interactions/intolerance preclude use of clarithromycin.

Use: Alternative treatment of MAC pulmonary disease

Usual Adult Dose for Granuloma Inguinale

The manufacturer gives no specific dosing instructions.

The US CDC recommends:
Immediate-release: 1 g orally once a week OR 500 mg orally once a day for at least 3 weeks and until all lesions have completely healed

Comments:
-Patients diagnosed with granuloma inguinale should be tested for HIV.
-Patients should be monitored until all signs/symptoms have resolved.
-The patient's sexual partner(s) during the 60 days preceding the onset of symptoms should be evaluated and offered treatment.

Use: Treatment of granuloma inguinale/donovanosis caused by Klebsiella granulomatis

Usual Adult Dose for STD Prophylaxis

The manufacturer gives no specific dosing instructions.

The US CDC recommends:
Immediate-release: 1 g orally once as a single dose, in conjunction with ceftriaxone plus (metronidazole or tinidazole)

Use: Postexposure prophylaxis of sexually transmitted diseases in survivors of sexual assault

Usual Adult Dose for Pertussis Prophylaxis

The manufacturer gives no specific dosing instructions.

The American Society for Blood and Marrow Transplantation (ASBMT) and IDSA recommend:
Immediate-release:
Immunization against pertussis:
-Alternative treatment: 250 mg orally once a day

Postexposure prophylaxis: 500 mg orally once on day 1, then 250 mg orally once a day for 4 days

Comments:
-Patients should receive the acellular pertussis vaccine after hematopoietic cell transplantation (HCT).
-Treatment with this drug may be given to patients with an incomplete vaccination series.

Uses:
-Immunization against pertussis for adult recipients after HCT
-Postexposure prophylaxis for HCT recipients, regardless of vaccination status
-Prophylaxis against bacterial infections

Usual Adult Dose for Pertussis

The manufacturer gives no specific dosing instructions.

The American Society for Blood and Marrow Transplantation (ASBMT) and IDSA recommend:
Immediate-release:
Immunization against pertussis:
-Alternative treatment: 250 mg orally once a day

Postexposure prophylaxis: 500 mg orally once on day 1, then 250 mg orally once a day for 4 days

Comments:
-Patients should receive the acellular pertussis vaccine after hematopoietic cell transplantation (HCT).
-Treatment with this drug may be given to patients with an incomplete vaccination series.

Uses:
-Immunization against pertussis for adult recipients after HCT
-Postexposure prophylaxis for HCT recipients, regardless of vaccination status
-Prophylaxis against bacterial infections

Usual Adult Dose for Lyme Disease - Erythema Chronicum Migrans

The manufacturer gives no specific dosing instructions.

The IDSA recommends:
Immediate-release:
Early Lyme disease: 500 mg orally once a day for 7 to 10 days

Comment: Use should be reserved for patients who are intolerant or should not take amoxicillin, doxycycline, and cefuroxime axetil.

Use: Alternative treatment for early Lyme disease

Usual Adult Dose for Babesiosis

The manufacturer gives no specific dosing instructions.

The IDSA recommends:
Immediate-release: 500 to 1000 mg orally once on day 1, followed by 250 mg orally once a day for a total of 7 to 10 days

Comments:
-This drug should be taken in combination with atovaquone.
-Immunocompromised patients may be given 600 to 1000 mg orally on day 1.

Use: Treatment of babesiosis

Usual Adult Dose for Bacterial Endocarditis Prophylaxis

The manufacturer gives no specific dosing instructions.

The AHA and IDSA recommend:
Immediate-release: 500 mg orally as a single dose 30 to 60 minutes prior to the procedure

Use: Prevention of infective endocarditis in patients allergic to penicillins/ampicillin

Usual Adult Dose for Toxoplasmosis

The manufacturer gives no specific dosing instructions.

The NIH recommends:
Immediate-release: 900 to 1200 mg orally once a day plus pyrimethamine and leucovorin
-Duration of therapy: At least 6 weeks; longer treatment may be required if clinical/radiologic disease is extensive or response is incomplete at 6 weeks

Comments:
-This drug is recommended as an alternative regimen.
-Patients should continue chronic maintenance therapy once acute treatment is complete.

Use: Treatment of Toxoplasma gondii encephalitis

Usual Adult Dose for Campylobacter Gastroenteritis

The manufacturer gives no specific dosing instructions.

The NIH recommends:
Immediate-release:
Campylobacteriosis:
-Mild to moderate disease: 500 mg orally once a day for 5 days

Shigellosis:
-Alternative therapy: 500 mg orally once a day for 5 days

Comment: This drug should not be used to treat Shigella or Campylobacter bacteremia.

Uses:
-Treatment of gastroenteritis caused by Shigella infection
-Treatment of mild to moderate campylobacteriosis

Usual Adult Dose for Shigellosis

The manufacturer gives no specific dosing instructions.

The NIH recommends:
Immediate-release:
Campylobacteriosis:
-Mild to moderate disease: 500 mg orally once a day for 5 days

Shigellosis:
-Alternative therapy: 500 mg orally once a day for 5 days

Comment: This drug should not be used to treat Shigella or Campylobacter bacteremia.

Uses:
-Treatment of gastroenteritis caused by Shigella infection
-Treatment of mild to moderate campylobacteriosis

Usual Adult Dose for Upper Respiratory Tract Infection

The manufacturer gives no specific dosing instructions.

The ASBMT and IDSA recommend:
Immediate-release:
Bacterial infections within the first 100 days of HCT:
-Alternative treatment: 250 mg orally once a day

Use: Prevention of bacterial infections for HCT patients with anticipated neutropenic periods of at least 7 days

Usual Adult Dose for Syphilis - Early

The manufacturer gives no specific dosing instructions.

The NIH recommends:
Immediate-release:
-Alternative treatment: 2 g orally as a single dose

Comments:
-This drug may be given to patients with penicillin allergies.
-Use should be avoided in men who have sex with men or pregnant patients.

Use: Alternative therapy for the treatment of early stage syphilis, including primary, secondary, and early latent stage syphilis

Usual Pediatric Dose for Otitis Media

6 months and older:
Immediate-release: 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 on day 1, followed by 5 mg/kg (maximum: 250 mg/dose) orally once a day on days 2 to 5

Comment: The safety of a re-dosing a 30 mg/kg dose in a patient who vomits has not been established.

Use: Treatment of mild to moderate acute otitis media caused by Haemophilus influenza, Moraxella catarrhalis, or Streptococcus pneumoniae

Usual Pediatric Dose for Legionella Pneumonia

6 months and older:
Immediate-release: 10 mg/kg (maximum: 500 mg/dose) orally on day 1, followed by 5 mg/kg (250 mg/dose) orally once a day on days 2 to 5
Extended-release:
-Patients less than 34 kg: 60 mg/kg (maximum dose: 2 g/dose) orally as a single dose
-Patients 34 kg or greater: 2 g orally as a single dose

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

Comment: Extended-release formulations should be taken on an empty stomach.

Uses:
-Treatment of mild to moderate community acquired pneumonia due to Chlamydophila pneumoniae, Haemophilus influenzae, Mycoplasma pneumonia, or Streptococcus pneumoniae in patients appropriate for oral therapy
-Treatment of community-acquired pneumonia due to C pneumoniae, H influenzae, Legionella pneumophila, Moraxella catarrhalis, M pneumoniae, or S pneumoniae in patients who require initial IV therapy

The IDSA and Pediatric Infectious Disease Society (PIDS) recommend:
3 months to less than 5 years:
Parenteral: 10 mg/kg on days 1 and 2 of treatment, transitioning to oral treatment when possible
Oral: 10 mg/kg orally on day 1, then 5 mg/kg/day orally once a day on days 2 to 5

5 years and older:
Oral: 10 mg/kg (maximum: 500 mg/day) orally on day 1, followed by 5 mg/kg/day (maximum: 250 mg/day) orally on days 2 to 5

Comments:
-Oral therapy may be used in patients with mild infections and/or as outpatient empiric therapy for patients with presumed atypical pneumonia.
-Beta lactam antibiotics may be added to inpatients with presumed atypical pneumonia if diagnosis is in doubt.

Uses:
-Treatment of community-acquired pneumonia caused by M pneumoniae, Chlamydia trachomatis, or C pneumoniae
-Treatment of presumed atypical pneumonia in outpatient and inpatient settings

Usual Pediatric Dose for Mycoplasma Pneumonia

6 months and older:
Immediate-release: 10 mg/kg (maximum: 500 mg/dose) orally on day 1, followed by 5 mg/kg (250 mg/dose) orally once a day on days 2 to 5
Extended-release:
-Patients less than 34 kg: 60 mg/kg (maximum dose: 2 g/dose) orally as a single dose
-Patients 34 kg or greater: 2 g orally as a single dose

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

Comment: Extended-release formulations should be taken on an empty stomach.

Uses:
-Treatment of mild to moderate community acquired pneumonia due to Chlamydophila pneumoniae, Haemophilus influenzae, Mycoplasma pneumonia, or Streptococcus pneumoniae in patients appropriate for oral therapy
-Treatment of community-acquired pneumonia due to C pneumoniae, H influenzae, Legionella pneumophila, Moraxella catarrhalis, M pneumoniae, or S pneumoniae in patients who require initial IV therapy

The IDSA and Pediatric Infectious Disease Society (PIDS) recommend:
3 months to less than 5 years:
Parenteral: 10 mg/kg on days 1 and 2 of treatment, transitioning to oral treatment when possible
Oral: 10 mg/kg orally on day 1, then 5 mg/kg/day orally once a day on days 2 to 5

5 years and older:
Oral: 10 mg/kg (maximum: 500 mg/day) orally on day 1, followed by 5 mg/kg/day (maximum: 250 mg/day) orally on days 2 to 5

Comments:
-Oral therapy may be used in patients with mild infections and/or as outpatient empiric therapy for patients with presumed atypical pneumonia.
-Beta lactam antibiotics may be added to inpatients with presumed atypical pneumonia if diagnosis is in doubt.

Uses:
-Treatment of community-acquired pneumonia caused by M pneumoniae, Chlamydia trachomatis, or C pneumoniae
-Treatment of presumed atypical pneumonia in outpatient and inpatient settings

Usual Pediatric Dose for Pneumonia

6 months and older:
Immediate-release: 10 mg/kg (maximum: 500 mg/dose) orally on day 1, followed by 5 mg/kg (250 mg/dose) orally once a day on days 2 to 5
Extended-release:
-Patients less than 34 kg: 60 mg/kg (maximum dose: 2 g/dose) orally as a single dose
-Patients 34 kg or greater: 2 g orally as a single dose

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

Comment: Extended-release formulations should be taken on an empty stomach.

Uses:
-Treatment of mild to moderate community acquired pneumonia due to Chlamydophila pneumoniae, Haemophilus influenzae, Mycoplasma pneumonia, or Streptococcus pneumoniae in patients appropriate for oral therapy
-Treatment of community-acquired pneumonia due to C pneumoniae, H influenzae, Legionella pneumophila, Moraxella catarrhalis, M pneumoniae, or S pneumoniae in patients who require initial IV therapy

The IDSA and Pediatric Infectious Disease Society (PIDS) recommend:
3 months to less than 5 years:
Parenteral: 10 mg/kg on days 1 and 2 of treatment, transitioning to oral treatment when possible
Oral: 10 mg/kg orally on day 1, then 5 mg/kg/day orally once a day on days 2 to 5

5 years and older:
Oral: 10 mg/kg (maximum: 500 mg/day) orally on day 1, followed by 5 mg/kg/day (maximum: 250 mg/day) orally on days 2 to 5

Comments:
-Oral therapy may be used in patients with mild infections and/or as outpatient empiric therapy for patients with presumed atypical pneumonia.
-Beta lactam antibiotics may be added to inpatients with presumed atypical pneumonia if diagnosis is in doubt.

Uses:
-Treatment of community-acquired pneumonia caused by M pneumoniae, Chlamydia trachomatis, or C pneumoniae
-Treatment of presumed atypical pneumonia in outpatient and inpatient settings

Usual Pediatric Dose for Tonsillitis/Pharyngitis

2 years and older:
Immediate-release: 12 mg/kg (maximum: 500 mg/dose) orally once a day for 5 days

Use: Treatment of mild to moderate pharyngitis/tonsillitis caused by Streptococcus pyogenes as an alternative to first-line therapy in patients who cannot use first-line therapy

Usual Pediatric Dose for Sinusitis

6 months and older:
Immediate-release: 10 mg/kg (maximum: 500 mg/dose) once a day for 3 days

16 years and older:
Extended-release:
-Patients less than 34 kg: 60 mg/kg (maximum dose: 2 g/dose) orally as a single dose
-Patients 34 kg or greater: 2 g orally as a single dose

Comment: The effectiveness of a 1- or 5-day treatment has not been established.

Use: Treatment of mild to moderate acute bacterial sinusitis due to Haemophilus influenza, Moraxella catarrhalis, or Streptococcus pneumoniae

Usual Pediatric Dose for Skin and Structure Infection

The manufacturer gives no specific dosing instructions.

The IDSA recommends:
Immediate-release:
Patients greater than 45 kg: 500 mg orally on day 1, then 250 mg orally once a day on days 2 through 5
Patients less than 45 kg: 10 mg/kg orally on day 1, then 5 mg/kg orally once a day for 4 additional days

Use: Treatment of bacillary angiomatosis and cat scratch disease

Usual Pediatric Dose for Gonococcal Infection - Uncomplicated

The manufacturer gives no specific dosing instructions.

The US CDC recommends:
Immediate-release:
Adolescents:
-Recommended regimen: 1 g orally once as a single dose plus ceftriaxone
-Alternative regimen: 1 g orally once as a single dose plus cefixime

Comments:
-The alternative regimen may be used for uncomplicated infections if ceftriaxone is unavailable.
-Arthritis and arthritis-dermatitis syndrome may be treated with 1 g orally once plus cefotaxime OR ceftizoxime.

Uses:
-Uncomplicated gonococcal infections of the pharynx, cervix, urethra, and rectum
-Treatment of gonococcal conjunctivitis
-Treatment of arthritis and arthritis-dermatitis syndrome caused by disseminated gonococcal infection
-Treatment of gonococcal meningitis and endocarditis

Usual Pediatric Dose for Nongonococcal Urethritis

The manufacturer gives no specific dosing instructions.

The US CDC recommends:
Immediate-release:
30 days or younger:
-Ophthalmia neonatorum: 20 mg/kg orally (oral suspension) once a day for 3 days

1 to 3 months:
-Infant pneumonia: 20 mg/kg orally (oral suspension) once a day for 3 days

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

Comments:
-Neonates should be monitored for signs/symptoms of hypertrophic pyloric stenosis.
-Healthcare providers should follow-up to determine whether treatment was effective.

Uses:
-Alternative treatment of ophthalmia neonatorum caused by Chlamydia trachomatis
-Alternative treatment of chlamydia pneumonia in infants
-Treatment of chlamydial infections in children

Usual Pediatric Dose for Chlamydia Infection

The manufacturer gives no specific dosing instructions.

The US CDC recommends:
Immediate-release:
30 days or younger:
-Ophthalmia neonatorum: 20 mg/kg orally (oral suspension) once a day for 3 days

1 to 3 months:
-Infant pneumonia: 20 mg/kg orally (oral suspension) once a day for 3 days

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

Comments:
-Neonates should be monitored for signs/symptoms of hypertrophic pyloric stenosis.
-Healthcare providers should follow-up to determine whether treatment was effective.

Uses:
-Alternative treatment of ophthalmia neonatorum caused by Chlamydia trachomatis
-Alternative treatment of chlamydia pneumonia in infants
-Treatment of chlamydial infections in children

Usual Pediatric Dose for Cervicitis

The manufacturer gives no specific dosing instructions.

The US CDC recommends:
Immediate-release:
30 days or younger:
-Ophthalmia neonatorum: 20 mg/kg orally (oral suspension) once a day for 3 days

1 to 3 months:
-Infant pneumonia: 20 mg/kg orally (oral suspension) once a day for 3 days

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

Comments:
-Neonates should be monitored for signs/symptoms of hypertrophic pyloric stenosis.
-Healthcare providers should follow-up to determine whether treatment was effective.

Uses:
-Alternative treatment of ophthalmia neonatorum caused by Chlamydia trachomatis
-Alternative treatment of chlamydia pneumonia in infants
-Treatment of chlamydial infections in children

Usual Pediatric Dose for Chancroid

The manufacturer gives no specific dosing instructions.

The US CDC recommends:
Immediate-release:
Adolescents: 1 g orally once

Comments:
-The efficacy of this drug in female patients with chancroid has not been established.
-The patient's sexual partner(s) during the 10 days preceding the onset of symptoms should be evaluated/treated.
-Patients should be tested for HIV infection when chancroid is diagnosed and a serologic test for HIV and syphilis should be performed 3 months after diagnosis in patients with negative initial HIV test results.

Use: Treatment of genital ulcer disease in men due to Haemophilus ducreyi (chancroid)

Usual Pediatric Dose for Pelvic Inflammatory Disease

16 years and older:
Parenteral: 500 mg IV once a day for 1 or 2 days, followed by 250 mg orally once a day to complete a 7-day course of therapy

Comment: Antimicrobial drugs with anaerobic activity should be used concurrently if anaerobic microorganisms are suspected in contributing to the infection.

Use: Treatment of pelvic inflammatory disease due to Chlamydia trachomatis, Neisseria gonorrhoeae, or Mycoplasma hominis

Usual Pediatric Dose for Mycobacterium avium-intracellulare - Prophylaxis

The manufacturer gives no specific dosing instructions.

The NIH and IDSA recommend:
Immediate-release:
CHILDREN:
Primary prophylaxis of Mycobacterium avium-intracellulare complex (MAC) disease:
-First choice: 20 mg/kg orally once a week (max 1200 mg/week)
-Alternative choice: 5 mg/kg orally once a day (max 250 mg/day)

Secondary prophylaxis/chronic suppressive therapy):
-Alternative choice: 5 mg/kg (maximum: 250 mg) orally once a day plus ethambutol with/without rifabutin

ADOLESCENTS:
Patients with AIDS and CD4 counts less than 50 cells/mcL:
-Primary prophylaxis: 1200 mg orally once a week OR 600 mg orally 2 times a week

Comments:
-Primary prophylaxis may be discontinued when the CD3 count is greater than 100 cells/mm3 for at least 3 months in response to antiretroviral therapy (ART).
-Secondary prophylaxis is usually continued for life; however, discontinuation may be considered in patients with sustained immune recovery in response to ART.

Use: Preventing the first episode of disseminated MAC disease

Usual Pediatric Dose for Mycobacterium avium-intracellulare - Treatment

The manufacturer gives no specific dosing instructions.

The NIH and IDSA recommend:
Immediate-release:
CHILDREN:
-Alternative: 10 to 12 mg/kg (maximum: 500 mg/day) orally once a day plus ethambutol with/without rifabutin for at least 12 months

ADOLESCENTS:
-Initial treatment of nodular/bronchiectatic disease: 500 mg orally 3 times a week plus rifampin and ethambutol

-Initial treatment of fibrocavitary Mycobacterium avium-intracellulare complex (MAC) pulmonary or severe nodular/bronchiectatic disease: 250 mg orally once a day plus ethambutol and rifampin, with/without streptomycin or amikacin

-Advanced/severe or previously treated MAC disease: 250 to 300 mg orally once a day plus ethambutol

-Treatment of disseminated MAC disease: 250 mg orally once a day plus ethambutol
---Some experts recommend: 500 to 600 mg orally once a day plus ethambutol

Comments:
-Patients with severe/advanced disease should be treated until culture negative (e.g., 1 year).
-Patients with disseminated MAC disease may discontinue treatment when symptoms resolve and cell-mediated immune function resumes.
-Treatment of disseminated MAC disease is preferred when drug interactions/intolerance preclude use of clarithromycin.
-Once patients are treated, chronic suppressive therapy/secondary prophylaxis should be considered.

Use: Alternative treatment of MAC pulmonary disease

Usual Pediatric Dose for STD Prophylaxis

The manufacturer gives no specific dosing instructions.

The US CDC recommends:
Immediate-release:
Adolescents: 1 g orally once as a single dose, in conjunction with ceftriaxone plus (metronidazole or tinidazole)

Use: Postexposure prophylaxis of sexually transmitted diseases in survivors of sexual assault

Usual Pediatric Dose for Pertussis Prophylaxis

The manufacturer gives no specific dosing instructions.

The American Society for Blood and Marrow Transplantation (ASBMT) and IDSA recommend:
Immediate-release:
Immunization against pertussis:
-Alternative treatment: 5 mg/kg orally once a day

Postexposure prophylaxis: 10 mg/kg orally (as a loading dose), then 5 mg/kg orally once a day for 4 days

Comments:
-Patients should receive the acellular pertussis vaccine after hematopoietic cell transplantation (HCT).
-Treatment with this drug may be given to patients with an incomplete vaccination series.

Uses:
-Immunization against pertussis for adult HCT recipients
-Postexposure prophylaxis for HCT recipients, regardless of vaccination status

Usual Pediatric Dose for Pertussis

The manufacturer gives no specific dosing instructions.

The American Society for Blood and Marrow Transplantation (ASBMT) and IDSA recommend:
Immediate-release:
Immunization against pertussis:
-Alternative treatment: 5 mg/kg orally once a day

Postexposure prophylaxis: 10 mg/kg orally (as a loading dose), then 5 mg/kg orally once a day for 4 days

Comments:
-Patients should receive the acellular pertussis vaccine after hematopoietic cell transplantation (HCT).
-Treatment with this drug may be given to patients with an incomplete vaccination series.

Uses:
-Immunization against pertussis for adult HCT recipients
-Postexposure prophylaxis for HCT recipients, regardless of vaccination status

Usual Pediatric Dose for Lyme Disease - Erythema Chronicum Migrans

The manufacturer gives no specific dosing instructions.

The IDSA recommends:
Immediate-release:
Early Lyme disease: 10 mg/kg orally once a day
-Maximum dose: 500 mg/day

Comment: Use should be reserved for patients who are intolerant or should not take amoxicillin, doxycycline, and cefuroxime axetil.

Use: Alternative treatment for early Lyme disease

Usual Pediatric Dose for Babesiosis

The manufacturer gives no specific dosing instructions.

The IDSA recommends:
Immediate-release:
10 mg/kg (maximum: 500 mg/dose) orally once on day 1, followed by 5 mg/kg (maximum: 250 mg/dose) orally once a day for a total of 7 to 10 days

Comment: This drug should be given with atovaquone.

Use: Treatment of babesiosis

Usual Pediatric Dose for Bacterial Endocarditis Prophylaxis

The manufacturer gives no specific dosing instructions.

The AHA/IDSA recommend:
Immediate-release:
Children: 15 mg/kg orally as a single dose 30 to 60 minutes prior to the procedure

Adolescents: 500 mg orally as a single dose 30 to 60 minutes prior to the procedure

Use: Prevention of infective endocarditis in patients allergic to penicillins/ampicillin

Usual Pediatric Dose for Toxoplasmosis

The manufacturer gives no specific dosing instructions.

The US CDC recommends:
Immediate-release:
Adolescents: 900 to 1200 mg orally once a day plus pyrimethamine and leucovorin
-Duration of treatment: At least 6 weeks; longer treatment may be required if clinical/radiologic disease is extensive or response is incomplete at 6 weeks

Comments:
-This drug is recommended as an alternative regimen.
-Patients should be continued on chronic maintenance therapy once acute treatment ends.

Use: Treatment of Toxoplasma gondii encephalitis

Usual Pediatric Dose for Campylobacter Gastroenteritis

The manufacturer gives no specific dosing instructions.

The NIH recommends:
Immediate-release:
Adolescents:
Campylobacteriosis:
-Mild to moderate disease: 500 mg orally once a day for 5 days

Shigellosis:
-Alternative therapy: 500 mg orally once a day for 5 days

Comment: This drug should not be used to treat Shigella or Campylobacter bacteremia.

Uses:
-Treatment of gastroenteritis caused by Shigella infection
-Treatment of mild to moderate campylobacteriosis

Usual Pediatric Dose for Shigellosis

The manufacturer gives no specific dosing instructions.

The NIH recommends:
Immediate-release:
Adolescents:
Campylobacteriosis:
-Mild to moderate disease: 500 mg orally once a day for 5 days

Shigellosis:
-Alternative therapy: 500 mg orally once a day for 5 days

Comment: This drug should not be used to treat Shigella or Campylobacter bacteremia.

Uses:
-Treatment of gastroenteritis caused by Shigella infection
-Treatment of mild to moderate campylobacteriosis

Usual Pediatric Dose for Syphilis - Early

The manufacturer gives no specific dosing instructions.

The NIH recommends:
Immediate-release:
Adolescents:
-Alternative treatment: 2 g orally as a single dose

Comments:
-This drug may be given to patients with penicillin allergies.
-Use should be avoided in men who have sex with men or pregnant patients.

Use: Alternative therapy for the treatment of early stage syphilis, including primary, secondary, and early latent stage syphilis

Usual Pediatric Dose for Granuloma Inguinale

The manufacturer gives no specific dosing instructions.

The US CDC recommends:
Immediate-release:
Adolescents: 1 g orally once a week OR 500 mg orally once a day for at least 3 weeks and until all lesions have completely healed

Comments:
-Patients diagnosed with granuloma inguinale should be tested for HIV.
-Patients should be monitored until all signs/symptoms have resolved.
-The patient's sexual partner(s) during the 60 days preceding the onset of symptoms should be evaluated and offered treatment.

Use: Treatment of granuloma inguinale/donovanosis caused by Klebsiella granulomatis

Renal Dose Adjustments

Mild to moderate renal dysfunction (CrCl greater than 10 mL/min): No adjustment recommended.
Severe renal dysfunction (CrCl less than 10 mL/min): Use with caution.

Liver Dose Adjustments

Data not available

Patients who develop signs/symptoms of cholestatic jaundice, jaundice, or hepatic dysfunction: Discontinue treatment.

Precautions

Safety and efficacy of immediate-release formulations in the treatment of otitis media, acute bacterial sinusitis, and community-acquired pneumonia have not been established in patients younger than 6 months, and the safety and efficacy of immediate-release formulations in the treatment of tonsillitis/pharyngitis have not been established in patients younger than 2 years. Safety and efficacy of parenteral formulations have not been established in patients younger than 16 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:
-IV formulations should be infused over at least 1 hour. IM and bolus IV administration should be avoided.
-Immediate-release formulations may be given with or without food.
-Extended-release formulations should be given at least 1 hour before or 2 hours after a meal. Additional antibiotic treatment should be considered for patients who vomit within 5 minutes of taking the dose; alternative antibiotic treatment should be considered for patients who vomit with delayed gastric emptying and/or those who vomit within 5 to 60 minutes of taking the dose.

Storage requirements:
-Oral suspension formulations should be stored at room temperature and consumed within 12 hours of reconstitution.

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

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

General:
-Immediate and extended-release formulations are not interchangeable.
-Spectrum of Activity: This drug has shown activity in vitro and in clinical infections against most isolates of Staphylococcus aureus, Streptococcus pneumoniae, S pyogenes, S agalactiae, Haemophilus influenzae, Haemophilus ducreyi, Moraxella catarrhalis, Neisseria gonorrhea, Chlamydophila pneumoniae, Chlamydia trachomatis, Mycoplasma pneumoniae, Mycoplasma hominis, Legionella pneumophila, and Mycobacterium avium complex.
-Azithromycin penetrates extensively into various tissues and bodily fluids, including sinus mucosa, prostatic tissue, bone, the central nervous system, bronchial secretions, and middle ear exudates. Since azithromycin concentrates preferentially in brain tissue and not in cerebral spinal fluid, it should not be used to treat meningitis.
-Limitations of use: Oral formulations of this drug should not be used in patients with pneumonia who are inappropriate for oral treatment and those with cystic fibrosis, nosocomial infections, known/suspected bacteremia, or significant underlying health problems that may compromise the ability to respond to an illness (including immunodeficiency and functional asplenia), and/or those who are elderly, debilitated, or require hospitalization.

Monitoring:
-Liver function tests
-Auditory and vestibular function, especially in patients receiving long-term treatment

Patient advice:
-Patients should be advised to avoid missing doses and to complete the entire course of therapy.
-Patients and/or caregivers should be told to discard any of the remaining oral solution formulation after treatment is complete.
-Patients should be instructed to report signs/symptoms of Clostridium difficile (e.g., watery/bloody stools, stomach cramps, fever), for up to 2 months after stopping treatment.

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