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azithromycin

Pronunciation

Generic Name: azithromycin (a ZITH roe MYE sin)
Brand Name: Azithromycin 3 Day Dose Pack, Azithromycin 5 Day Dose Pack, Zithromax, Zithromax TRI-PAK, Zithromax Z-Pak, Zmax, Zithromax IV

What is azithromycin?

Azithromycin is an antibiotic that fights bacteria.

Azithromycin is used to treat many different types of infections caused by bacteria, such as respiratory infections, skin infections, ear infections, and sexually transmitted diseases.

Azithromycin may also be used for purposes not listed in this medication guide.

What is the most important information I should know about azithromycin?

You should not use this medication if you have ever had jaundice or liver problems caused by taking azithromycin.

What should I discuss with my healthcare provider before taking azithromycin?

You should not use azithromycin if you are allergic to it, or if:

  • you have ever had jaundice or liver problems caused by taking azithromycin; or

  • you are allergic to similar drugs such as clarithromycin, erythromycin, or telithromycin.

To make sure azithromycin is safe for you, tell your doctor if you have:

  • liver disease;

  • kidney disease;

  • myasthenia gravis;

  • a heart rhythm disorder; or

  • a history of Long QT syndrome.

This medicine is not expected to harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

It is not known whether azithromycin passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

Do not give this medicine to a child younger than 6 months old.

How should I take azithromycin?

Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended. The dose and length of treatment with azithromycin may not be the same for every type of infection.

You may take most forms of azithromycin with or without food.

Take Zmax extended release liquid (oral suspension) on an empty stomach, at least 1 hour before or 2 hours after a meal.

To use the oral suspension single dose packet: Open the packet and pour the medicine into 2 ounces of water. Stir this mixture and drink all of it right away. Do not save for later use. To make sure you get the entire dose, add a little more water to the same glass, swirl gently and drink right away.

Throw away any mixed Zmax oral suspension that has not been used within 12 hours.

Shake the oral suspension (liquid) well just before you measure a dose. Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.

Use this medicine for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics. Azithromycin will not treat a viral infection such as the flu or a common cold.

Store at room temperature away from moisture and heat. Throw away any unused liquid medicine after 10 days.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking azithromycin?

Do not take antacids that contain aluminum or magnesium within 2 hours before or after you take azithromycin. This includes Acid Gone, Aldroxicon, Alternagel, Di-Gel, Gaviscon, Gelusil, Genaton, Maalox, Maldroxal, Milk of Magnesia, Mintox, Mylagen, Mylanta, Pepcid Complete, Rolaids, Rulox, and others. These antacids can make azithromycin less effective when taken at the same time.

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, stop taking azithromycin and call your doctor. Do not use anti-diarrhea medicine unless your doctor tells you to.

Avoid exposure to sunlight or tanning beds. Azithromycin can make you sunburn more easily. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors.

Azithromycin side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

In rare cases, olanzapine may cause a severe skin reaction that can be fatal if it spreads to other parts of the body. Seek medical treatment if you have a new or worsening skin rash with fever, swollen glands, flu symptoms, or severe tingling or numbness.

Call your doctor at once if you have:

  • severe stomach pain, diarrhea that is watery or bloody;

  • headache with chest pain and severe dizziness, fainting, fast or pounding heartbeats;

  • liver problems--nausea, upper stomach pain, itching, tired feeling, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes); or

  • severe skin reaction--fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain or swelling, pus-filled pimples, red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Call your doctor right away if a baby taking azithromycin becomes irritable or vomits while eating or nursing.

Older adults may be more likely to have side effects on heart rhythm, including a life-threatening fast heart rate.

Common side effects may include:

  • diarrhea;

  • nausea, vomiting, stomach pain; or

  • headache.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Azithromycin dosing information

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 pneumoniae, 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 pneumoniae, 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 pneumoniae, 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

IDSA Recommendations:
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 H influenzae, M catarrhalis, or S 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

IDSA and NIH Recommendations:
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:

Gonococcal urethritis and cervicitis:
Immediate-release: 2 g orally once

Use: Treatment of mild to moderate urethritis and cervicitis due to Neisseria gonorrhoeae

US Centers for Disease Control and Prevention (CDC) Recommendations:
Immediate-release:
-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 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 C trachomatis, N 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 H influenzae, M catarrhalis, or S 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 H influenzae, M catarrhalis, or S pneumoniae

Usual Adult Dose for Mycobacterium avium-intracellulare -- Prophylaxis:

Immediate-release:
1200 mg orally once a week

Comment: This drug may be given with rifabutin.

Use: Prevention of disseminated Mycobacterium avium-intracellulare complex (MAC) disease

NIH, IDSA, and ATS Recommendations:
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 MAC disease

Usual Adult Dose for Mycobacterium avium-intracellulare -- Treatment:

Immediate-release:
600 mg orally once a day plus ethambutol

Use: Treatment of disseminated MAC infections

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

-Initial treatment of fibrocavitary 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:

US CDC Recommendations:
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:

US CDC Recommendations:
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:

American Society for Blood and Marrow Transplantation (ASBMT) and IDSA Recommendations:
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:

American Society for Blood and Marrow Transplantation (ASBMT) and IDSA Recommendations:
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:

IDSA Recommendations:
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:

IDSA Recommendations:
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:

AHA and IDSA Recommendations:
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:

NIH Recommendations:
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:

NIH Recommendations:
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:

NIH Recommendations:
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:

ASBMT and IDSA Recommendations:
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:

NIH Recommendations:
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 H influenza, M catarrhalis, or S 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 C pneumoniae, H influenzae, M pneumonia, or S pneumoniae in patients appropriate for oral therapy
-Treatment of community-acquired pneumonia due to C pneumoniae, H influenzae, L pneumophila, M catarrhalis, M pneumoniae, or S pneumoniae in patients who require initial IV therapy

IDSA and Pediatric Infectious Disease Society (PIDS) Recommendations:
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, C 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 C pneumoniae, H influenzae, M pneumonia, or S pneumoniae in patients appropriate for oral therapy
-Treatment of community-acquired pneumonia due to C pneumoniae, H influenzae, L pneumophila, M catarrhalis, M pneumoniae, or S pneumoniae in patients who require initial IV therapy

IDSA and Pediatric Infectious Disease Society (PIDS) Recommendations:
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, C 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 C pneumoniae, H influenzae, M pneumonia, or S pneumoniae in patients appropriate for oral therapy
-Treatment of community-acquired pneumonia due to C pneumoniae, H influenzae, L pneumophila, M catarrhalis, M pneumoniae, or S pneumoniae in patients who require initial IV therapy

IDSA and Pediatric Infectious Disease Society (PIDS) Recommendations:
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, C 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 S 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 H influenza, M catarrhalis, or S pneumoniae

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 C trachomatis, N gonorrhoeae, or M hominis

Usual Pediatric Dose for Bacterial Infection:

American Academy of Pediatrics (AAP) Recommendations:
Immediate-release:
Less than 1 month:
-IV: 10 mg/kg IV every 24 hours
-Oral: 10 to 20 mg/kg orally every 24 hours

1 month or older:
-Mild to moderate infections: 5 to 12 mg/kg orally once a day
-Severe infections: 10 mg/kg IV once a day

Comments:
-The single or total course dose for adult oral therapy is 1.5 to 2 g.
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Skin and Structure Infection:

IDSA Recommendations:
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:

US CDC Recommendations:
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:

US CDC Recommendations:
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 C trachomatis
-Alternative treatment of chlamydial pneumonia in infants
-Treatment of chlamydial infections in children

Usual Pediatric Dose for Chlamydia Infection:

US CDC Recommendations:
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 C trachomatis
-Alternative treatment of chlamydial pneumonia in infants
-Treatment of chlamydial infections in children

Usual Pediatric Dose for Cervicitis:

US CDC Recommendations:
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 C trachomatis
-Alternative treatment of chlamydial pneumonia in infants
-Treatment of chlamydial infections in children

Usual Pediatric Dose for Chancroid:

US CDC Recommendations:
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 H ducreyi (chancroid)

Usual Pediatric Dose for Mycobacterium avium-intracellulare -- Prophylaxis:

NIH and IDSA Recommendations:
Immediate-release:
CHILDREN:
Primary prophylaxis of 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:

NIH and IDSA Recommendations:
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 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:

US CDC Recommendations:
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:

ASBMT and IDSA Recommendations:
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:

ASBMT and IDSA Recommendations:
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:

IDSA Recommendations:
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:

IDSA Recommendations:
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:

AHA and IDSA Recommendations:
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:

US CDC Recommendations:
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 T gondii encephalitis

Usual Pediatric Dose for Campylobacter Gastroenteritis:

NIH Recommendations:
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:

NIH Recommendations:
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:

NIH Recommendations:
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:

US CDC Recommendations:
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 K granulomatis

What other drugs will affect azithromycin?

Tell your doctor about all your current medicines and any you start or stop using, especially:

  • nelfinavir; or

  • a blood thinner--warfarin, Coumadin, Jantoven.

This list is not complete. Other drugs may interact with azithromycin, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Where can I get more information?

  • Your pharmacist can provide more information about azithromycin.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 17.06.

Last reviewed: April 13, 2017
Date modified: June 01, 2017

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