Does Zithromax (Azithromycin) cover Streptococcus infections?

From the Guidelines

Yes, Zithromax (azithromycin) does cover strep throat infections, with a recommended dose of 12 mg/kg once daily (max = 500 mg) for 5 days, as stated in the 2012 update by the Infectious Diseases Society of America 1.

Key Points to Consider

• The diagnosis of strep throat should be established through accurate testing, as the signs and symptoms of strep throat overlap with those of non-streptococcal pharyngitis, making clinical diagnosis alone unreliable 1.
• Zithromax is an alternative treatment option for patients with penicillin allergies, with a strong, moderate recommendation for its use in this context 1.
• The typical adult dosage for strep throat is not explicitly stated in the provided evidence, but the dosage for children is clearly outlined as 12 mg/kg once daily (max = 500 mg) for 5 days 1.
• It is essential to complete the full course of antibiotics, even if symptoms improve before finishing the medication, to ensure effective treatment and prevent potential complications.

Important Considerations

• Resistance of Group A Streptococcus (GAS) to azithromycin is well-known and varies geographically and temporally, which may impact treatment efficacy 1.
• Accurate diagnosis and appropriate antimicrobial therapy are crucial for preventing acute rheumatic fever, suppurative complications, and minimizing potential adverse effects of inappropriate antimicrobial therapy 1.

From the FDA Drug Label

Pharyngitis/tonsillitis caused by Streptococcus pyogenes as an alternative to first-line therapy in individuals who cannot use first-line therapy Azithromycin is often effective in the eradication of susceptible strains of Streptococcus pyogenes from the nasopharynx

Zithromax (azithromycin) covers strep as an alternative to first-line therapy in individuals who cannot use first-line therapy. However, penicillin by the intramuscular route is the usual drug of choice in the treatment of Streptococcus pyogenes infection and the prophylaxis of rheumatic fever.

• Key points:
  • Azithromycin is effective against susceptible strains of Streptococcus pyogenes.
  • Susceptibility tests should be performed when patients are treated with azithromycin.
  • Data establishing efficacy of azithromycin in subsequent prevention of rheumatic fever are not available 2, 2, 2.

From the Research

Zithromax Coverage for Strep

• Zithromax, also known as azithromycin, is effective in treating group A beta-haemolytic streptococcal pharyngitis/tonsillitis in adults and adolescents 3.
• A single 2-g dose of azithromycin extended-release is as effective and well tolerated as 3 days of azithromycin immediate-release (500 mg once daily) for treating group A beta-haemolytic streptococcal pharyngitis/tonsillitis in adults and adolescents 3.
• Higher dosages of azithromycin are more effective in treating group A streptococcal tonsillopharyngitis 4.
• Azithromycin administered at a dosage of 60 mg/kg in children or administered for 3 days at a dosage of 500 mg/day in adults is more effective than other treatment regimens in producing eradication and clinical cure of GAS tonsillopharyngitis 4.

Comparison with Other Antibiotics

• Cephalosporins may be more effective than penicillin for symptom resolution and clinical relapse in the treatment of GABHS tonsillopharyngitis, but the evidence is uncertain 5.
• Macrolides, such as azithromycin, may be as effective as penicillin for symptom resolution, but the evidence is uncertain 5.
• Azithromycin may be more effective than amoxicillin for symptom resolution in children, but the evidence is very low-certainty 5.

Adverse Events

• Azithromycin is generally well tolerated, with the most frequent treatment-related adverse event being diarrhea or loose stools 3, 5.
• Adverse events were more common with azithromycin compared to amoxicillin in one study 5.