Z-Pack (Azithromycin) and Steroid (Prednisone) Combination Dosage
For respiratory infections, the recommended dosage is azithromycin 500 mg on day 1 followed by 250 mg daily for days 2-5, combined with prednisone 30 mg daily initially, tapering to 10 mg daily over 4 weeks. 1, 2
Azithromycin (Z-pack) Dosing
Standard Z-pack Regimen for Adults:
- 500 mg as a single dose on day 1, followed by 250 mg once daily on days 2 through 5 for respiratory infections 1
- Alternative 3-day regimen: 500 mg once daily for 3 days (total dose 1.5g) - shown to be equally effective as the 5-day regimen for atypical pneumonia 3, 4
- For certain infections like non-gonococcal urethritis or chancroid: single 1 gram dose 1
Pediatric Dosing:
- For children with respiratory infections: 10 mg/kg on day 1, followed by 5 mg/kg once daily for days 2-5 1, 5
- Alternative 3-day regimen for children: 10 mg/kg daily for 3 days 5
Prednisone Dosing
Standard Regimen:
- Initial dose: 30 mg daily 2
- Taper schedule: Reduce to 20 mg daily after 1 week, then to 15 mg daily after 2 weeks, then to 10 mg daily after 3-4 weeks 2
- Maintenance dose: 5-10 mg daily as needed 2
Higher Dose Option:
- For severe inflammatory conditions: 60 mg daily initially, reducing to 40 mg after 1 week, 30 mg after 2 weeks, and 20 mg after 3 weeks 2
Combination Therapy Considerations
Timing and Administration:
- Both medications can be taken orally with or without food 1
- Azithromycin should be taken at least 2 hours before or after antacids 1
- Prednisone is typically taken in the morning to minimize sleep disturbances 2
Duration of Therapy:
- Azithromycin: Short-term (3-5 days) 1, 3
- Prednisone: Variable depending on condition, typically tapered over 2-4 weeks 2
Special Populations
Renal Impairment:
- No azithromycin dosage adjustment needed for GFR >10 mL/min 1
- Use caution with azithromycin in severe renal impairment (GFR <10 mL/min) 1
Hepatic Impairment:
Safety Considerations
Cardiovascular Risk:
- Assess QTc interval before initiating azithromycin in patients with cardiac risk factors 2
- Avoid azithromycin if QTc is >450 ms for men and >470 ms for women 2
Bone Health:
- Patients on prednisone should receive calcium and vitamin D supplementation 2
- Consider bone mineral density testing for patients on long-term prednisone therapy 2
Common Side Effects:
- Azithromycin: Gastrointestinal upset, diarrhea 1, 6
- Prednisone: Facial rounding, weight gain, mood changes, increased blood glucose 2
Common Pitfalls and Caveats
- Avoid concurrent use of azithromycin with medications that prolong QT interval to prevent cardiac arrhythmias 2
- Do not abruptly discontinue prednisone after prolonged use; always taper to prevent adrenal insufficiency 2
- Monitor for opportunistic infections when using combination therapy, as both medications can suppress immune function 2
- Be aware of potential drug interactions: azithromycin may interact with warfarin, and prednisone may affect blood glucose control 2
- Corticosteroid-related side effects occur in approximately 80% of patients after 2 years of treatment, with severe complications more common after 18 months of therapy 2