Azithromycin

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Generic Name of Azithromycin - Learn More

Azithromycin

Azithromycin Precaution - What You Need to Know

Azithromycin is a broad-spectrum antibiotic used to treat a variety of bacterial infections, including respiratory infections, skin infections, and sexually transmitted diseases. Before using azithromycin, it is important to assess the patient’s medical history, particularly for allergies to macrolide antibiotics or any other components of the drug. Caution is needed in patients with a history of liver disease, as azithromycin is metabolized in the liver, and impaired liver function may affect the drug’s metabolism. Azithromycin can prolong the QT interval on an electrocardiogram, which could lead to arrhythmias, so it should be used with caution in patients with existing heart conditions such as arrhythmia, bradycardia, or electrolyte imbalances. The drug should also be avoided or used with extreme caution in patients with myasthenia gravis due to the risk of worsening symptoms. For pregnant women, azithromycin is generally considered safe during pregnancy (Category B), but it should only be used when necessary, and a healthcare provider should be consulted. Breastfeeding mothers should also consult their healthcare provider as azithromycin passes into breast milk, though the risk to the infant is considered low. Regular monitoring for adverse effects such as liver toxicity, hearing loss, or gastrointestinal disturbances is recommended during prolonged treatment.

Azithromycin Indication - Uses and Benefits

Azithromycin is primarily indicated for the treatment of bacterial infections, including:
- Upper respiratory infections: Such as acute bacterial sinusitis, pharyngitis, and tonsillitis caused by susceptible bacteria.
- Lower respiratory infections: Including community-acquired pneumonia (CAP) and bronchitis.
- Skin and soft tissue infections: Such as cellulitis, impetigo, and wound infections.
- Sexually transmitted infections (STIs): Including chlamydia and gonorrhea.
- Ear infections: Like acute otitis media, particularly in children.
- Other off-label uses: Azithromycin is sometimes used off-label to treat conditions like Helicobacter pylori infections and Lyme disease in combination with other antibiotics. Its anti-inflammatory properties have also led to experimental uses in treating non-bacterial conditions like cystic fibrosis and chronic obstructive pulmonary disease (COPD).
Azithromycin's effectiveness is due to its broad-spectrum activity against many gram-positive and gram-negative bacteria, as well as its ability to penetrate tissue, making it effective for infections that are difficult to treat with other antibiotics.

Azithromycin Contraindications - Important Warnings

Azithromycin is contraindicated in individuals who have a known hypersensitivity to azithromycin, other macrolides (such as erythromycin), or any of the excipients in the formulation. It is also contraindicated in patients with a history of cholestatic jaundice or hepatic dysfunction related to previous use of azithromycin. Azithromycin should not be used in combination with certain drugs that prolong the QT interval, such as certain antiarrhythmics (e.g., quinidine), or with other drugs that can cause significant electrolyte imbalances (e.g., diuretics), as this can increase the risk of life-threatening arrhythmias, including torsades de pointes. Patients with a history of myasthenia gravis should avoid azithromycin, as it has been associated with worsening of neuromuscular symptoms. Azithromycin is also contraindicated in neonates for oral administration due to the risk of adverse effects. Use in pregnant or breastfeeding women should be evaluated on a case-by-case basis, with appropriate medical consultation to weigh the risks and benefits.

Azithromycin Side Effects - What to Expect

The most common side effects of azithromycin include gastrointestinal symptoms such as nausea, vomiting, diarrhea, and abdominal pain. These side effects are generally mild and transient but can be bothersome for some patients. Other common side effects may include headache, dizziness, and fatigue. Serious but less common side effects include liver toxicity, manifested by jaundice or elevated liver enzymes, and hearing loss, particularly with high doses or prolonged treatment. Azithromycin has been associated with the risk of QT interval prolongation, which can lead to arrhythmias, and in rare cases, it can cause torsades de pointes, a life-threatening condition. If any cardiac symptoms, such as palpitations, dizziness, or fainting, occur, the patient should seek medical attention immediately. Allergic reactions, including rash, swelling, and anaphylaxis, have also been reported. Prolonged use of azithromycin may disrupt the normal bacterial flora in the gastrointestinal tract, leading to secondary infections like Clostridium difficile-associated diarrhea. To reduce side effects, azithromycin should be taken as prescribed, and any adverse reactions should be reported to a healthcare provider promptly.

Azithromycin Pregnancy Category ID - Safety Information

2

Azithromycin Mode of Action - How It Works

Azithromycin is a macrolide antibiotic that works by inhibiting bacterial protein synthesis. It binds to the 50S ribosomal subunit of susceptible bacteria, blocking the elongation of the polypeptide chain, which prevents the bacteria from producing the proteins necessary for growth and reproduction. Azithromycin is bacteriostatic, meaning it inhibits the growth of bacteria rather than directly killing them, though it may be bactericidal at higher concentrations. This action is effective against a wide range of bacterial pathogens, including both gram-positive and gram-negative bacteria. Azithromycin’s ability to penetrate tissues and achieve high concentrations in sites of infection, such as the lungs and sinuses, makes it particularly effective for respiratory and soft tissue infections. Unlike other antibiotics, azithromycin has a long half-life, allowing for once-daily dosing and a shorter duration of therapy, typically lasting 5 to 7 days for most infections.

Azithromycin Drug Interactions - What to Avoid

Azithromycin has relatively few significant drug-drug interactions, but caution should be exercised when it is used in combination with other medications. Notably, azithromycin can interact with drugs that affect the QT interval, increasing the risk of potentially life-threatening arrhythmias. These include antiarrhythmics, antipsychotics, antidepressants, and certain antihistamines. Concurrent use of azithromycin with anticoagulants like warfarin may increase the risk of bleeding, as azithromycin can potentiate the anticoagulant effect. Azithromycin is metabolized by the cytochrome P450 enzyme system (CYP3A4), but it has a minimal inhibitory effect on this system compared to other macrolides. However, caution is advised when using azithromycin alongside drugs that are metabolized by CYP3A4, such as certain benzodiazepines or statins, as azithromycin may increase their plasma concentrations and the risk of side effects. Additionally, azithromycin’s absorption can be affected by the presence of food, so it is generally recommended to take it on an empty stomach for optimal absorption, although some formulations are designed to be taken with food. Alcohol does not significantly interact with azithromycin but should still be consumed in moderation, as excessive alcohol intake can impair immune function and complicate the recovery process from infections.

Azithromycin Adult Dose - Recommended Dosage

The standard adult dose of azithromycin varies depending on the type of infection being treated:
- Community-acquired pneumonia (CAP): The typical dose is 500 mg once daily for 3 days.
- Acute bacterial sinusitis: 500 mg once daily for 3 days.
- Pharyngitis or tonsillitis: 500 mg once daily for 5 days.
- Sexually transmitted infections (e.g., chlamydia): A single dose of 1 g.
For chronic or more severe infections, longer durations or higher doses may be used. It is crucial to follow the prescribed dosage and complete the full course of therapy to reduce the risk of antibiotic resistance. Azithromycin can be taken with or without food, but taking it on an empty stomach may enhance its absorption.

Azithromycin Child Dose - Dosage for Children

For children, the dosage of azithromycin is based on weight:
- For children weighing 15-24 kg (33-53 lbs): 200 mg once daily for 3 days, or a single dose of 1 g for chlamydia.
- For children weighing 25-40 kg (55-88 lbs): 250 mg once daily for 3 days.
- For children over 40 kg (88 lbs): The adult dosage may apply.
Azithromycin should be used in children under the guidance of a healthcare provider, especially for conditions like respiratory infections or ear infections. It is important to ensure proper dosing, as incorrect dosing may lead to reduced efficacy or an increased risk of side effects. As with adults, it is essential to complete the full course of therapy to avoid relapse or development of antibiotic resistance.

Azithromycin Renal Dose - Dosage for Kidney Conditions

Azithromycin is primarily excreted unchanged in the bile, with minimal renal elimination. Therefore, no dose adjustments are necessary for patients with mild to moderate renal impairment (creatinine clearance greater than 10 mL/min). However, caution should be used in patients with severe renal impairment (creatinine clearance less than 10 mL/min), as the drug may accumulate in the system due to reduced renal clearance. Close monitoring for side effects, especially gastrointestinal or liver-related symptoms, should be performed in this patient group. For patients on dialysis, no specific dosing adjustments are required, but due to the minimal renal excretion, it is important to monitor for any potential adverse effects.