From the Guidelines
A Z-pack (azithromycin) should be dosed at 12 mg per kg once daily (maximum = 500 mg) for 5 days. This dosing regimen is based on the strongest and most recent evidence available, specifically the 2013 IDSA guideline update for managing group A streptococcal pharyngitis 1.
Key Points to Consider
- The recommended dose for azithromycin is 12 mg per kg once daily, with a maximum dose of 500 mg per day 1.
- The duration of treatment is 5 days, which is a relatively short course due to the medication's ability to remain active in the body for several days after the last dose.
- It is essential to complete the entire course of antibiotics, even if symptoms improve before finishing the treatment.
- Common side effects may include stomach upset, diarrhea, or nausea, but severe side effects like allergic reactions, severe diarrhea, or irregular heartbeat require immediate medical attention.
Administration and Precautions
- Azithromycin can be taken with or without food, but taking it with food may help reduce stomach upset.
- The medication comes in a convenient blister pack with tablets clearly marked for each day, making it easy to follow the prescribed dosing regimen.
From the FDA Drug Label
DOSAGE & ADMINISTRATION SECTION Adults Infection *Recommended Dose/Duration of Therapy *DUE TO THE INDICATED ORGANISMS (See INDICATIONS AND USAGE.) Community-acquired pneumonia (mild severity) Pharyngitis/tonsillitis (second line therapy) Skin/skin structure (uncomplicated) 500 mg as a single dose on Day 1, followed by 250 mg once daily on Days 2 through 5 Acute bacterial exacerbations of chronic obstructive pulmonary disease (mild to moderate) 500 mg QD × 3 days OR 500 mg as a single dose on Day 1, followed by 250 mg once daily on Days 2 through 5
The dosing for a Z-pack is:
- 500 mg as a single dose on Day 1, followed by 250 mg once daily on Days 2 through 5
- Alternatively, 500 mg once daily for 3 days can be used for certain indications, such as acute bacterial exacerbations of chronic obstructive pulmonary disease (mild to moderate) or acute bacterial sinusitis 2
From the Research
Dosing for a Z-Pack
- The dosing for a Z-pack, which contains azithromycin, varies depending on the specific condition being treated 3, 4, 5.
- For adult patients with mild to moderate acute bacterial sinusitis or community-acquired pneumonia, a single 2.0 g dose of azithromycin extended release has been shown to be effective 3.
- A 3-day course of azithromycin has also been compared to 10 days of other antibiotics for the treatment of community-acquired pneumonia, with similar efficacy 4.
- Azithromycin monotherapy has been evaluated for patients hospitalized with mild-to-moderate community-acquired pneumonia, with outcomes similar to those receiving other recommended antibiotics 5.
- The appropriate dosing and duration of azithromycin treatment should be determined based on the specific condition being treated and the patient's individual needs, with consideration of factors such as pneumonia severity and potential risks such as QTc interval prolongation 6, 7.