From the Guidelines
Azithromycin (Zithromax, Z-pack) should be used to treat specific bacterial infections, such as nontuberculous mycobacterial (NTM) pulmonary disease 1, traveler's diarrhea 1, acute bacterial sinusitis, community-acquired pneumonia, and uncomplicated skin infections.
Key Considerations for Use
- Azithromycin is typically prescribed as part of a multi-drug regimen for NTM pulmonary disease, and the treatment duration can be lengthy, often lasting 12 months beyond culture conversion 1.
- For traveler's diarrhea, azithromycin is recommended as a first-line agent for dysentery and acute watery diarrhea with fever, due to its efficacy against common pathogens such as Campylobacter and Shigella 1.
- The dose and duration of azithromycin treatment may vary depending on the specific infection being treated, with common regimens including a single 1-gm dose or 500 mg daily for 3 days 1.
- Azithromycin should only be used under the guidance of a healthcare professional, as it can have side effects and contribute to antibiotic resistance if used inappropriately 1.
Important Precautions
- It is essential to complete the full treatment course, even if symptoms improve before finishing the medication, to ensure effective treatment and prevent the development of resistance 1.
- Azithromycin may interact with other medications, and patients should be monitored for potential adverse effects, such as gastrointestinal complaints, central nervous system effects, and rare but serious conditions like Achilles tendon rupture and QT interval prolongation 1.
From the FDA Drug Label
Azithromycin Tablets, USP are indicated for the treatment of patients with mild to moderate infections (pneumonia: see WARNINGS) caused by susceptible strains of the designated microorganisms in the specific conditions listed below
Adults Acute bacterial exacerbations of chronic obstructive pulmonary disease due to Haemophilus influenzae, Moraxella catarrhalis or Streptococcus pneumoniae Acute bacterial sinusitis due to Haemophilus influenzae, Moraxella catarrhalis or Streptococcus pneumoniae. Community-acquired pneumonia due to Chlamydophila pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae or Streptococcus pneumoniae in patients appropriate for oral therapy
Pediatric Patients: Acute otitis media caused by Haemophilus influenzae, Moraxella catarrhalis or Streptococcus pneumoniae. Community-acquired pneumonia due to Chlamydophila pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae or Streptococcus pneumoniae in patients appropriate for oral therapy.
Azithromycin (Zithromax, Z-pack) should be used to treat:
- Mild to moderate infections caused by susceptible strains of designated microorganisms, including:
- Acute bacterial exacerbations of chronic obstructive pulmonary disease
- Acute bacterial sinusitis
- Community-acquired pneumonia
- Pharyngitis/tonsillitis
- Uncomplicated skin and skin structure infections
- Urethritis and cervicitis
- Genital ulcer disease in men due to Haemophilus ducreyi (chancroid)
- Acute otitis media (in pediatric patients)
Key considerations:
- Azithromycin should only be used to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria.
- Culture and susceptibility tests should be performed before treatment to determine the causative organism and its susceptibility to azithromycin.
- Therapy with azithromycin may be initiated before results of these tests are known, but antimicrobial therapy should be adjusted accordingly once the results become available 2.
From the Research
Indications for Azithromycin Use
Azithromycin can be used to treat various bacterial infections, including:
- Acute bacterial sinusitis (ABS) 3
- Community-acquired pneumonia (CAP) 3
- Skin and soft-tissue infections, such as uncomplicated skin and skin structure infections (SSSIs) 4, 5, 6
- Sexually transmitted infections, including urethritis and/or cervicitis caused by Neisseria gonorrhoeae and/or Chlamydia trachomatis 4, 7
- Genital chlamydial infections, which can be treated with a single dose of azithromycin 7
Dosage and Administration
The dosage and administration of azithromycin vary depending on the specific infection being treated:
- For ABS and CAP, a single 2.0 g dose of azithromycin extended release can be effective 3
- For skin and soft-tissue infections, azithromycin can be given as a 500 mg once-daily dose for 3-5 days 5, 6
- For sexually transmitted infections, azithromycin can be given as a single 1 g dose or as a 500 mg dose on day 1 and 250 mg once daily on days 2 and 3 4
Efficacy and Safety
Azithromycin has been shown to be effective and generally well-tolerated in the treatment of various bacterial infections:
- Clinical cure rates for azithromycin are comparable to those of other antibiotics, such as levofloxacin and clarithromycin 3, 5
- Azithromycin has a broad spectrum of in vitro antibacterial activity against Gram-positive, Gram-negative, and atypical pathogens 3
- Adverse reactions to azithromycin are usually mild and have not included serious organ toxicity 7