Nafithromycin Information Not Available - Azithromycin Dosing Provided Instead
Nafithromycin is not addressed in the available evidence; however, comprehensive azithromycin dosing guidelines are provided below as the most relevant macrolide antibiotic information.
Standard Adult Azithromycin Dosing
For most respiratory tract infections (community-acquired pneumonia, pharyngitis, sinusitis, skin infections), the standard regimen is 500 mg on day 1, followed by 250 mg once daily on days 2-5. 1
Alternative Adult Regimens by Indication:
Acute bacterial sinusitis or COPD exacerbations: 500 mg once daily for 3 consecutive days 1
Sexually transmitted infections (non-gonococcal urethritis/cervicitis, chlamydia): Single 1-gram dose 1, 2
Gonococcal urethritis/cervicitis: Single 2-gram dose 1
Chancroid (genital ulcer disease): Single 1-gram dose 1
Disseminated MAC disease in AIDS patients: 250 mg daily with ethambutol, with or without rifabutin 3
MAC prophylaxis in AIDS (CD4 <50 cells/μL): 1,200 mg once weekly 3
Pediatric Azithromycin Dosing
For acute otitis media and community-acquired pneumonia in children ≥6 months, use 10 mg/kg on day 1 (maximum 500 mg), followed by 5 mg/kg daily on days 2-5 (maximum 250 mg per day). 1
Alternative Pediatric Regimens:
Acute otitis media (alternative): 30 mg/kg as a single dose OR 10 mg/kg once daily for 3 days 1
Acute bacterial sinusitis: 10 mg/kg once daily for 3 days 1
Pharyngitis/tonsillitis (age ≥2 years): 12 mg/kg once daily for 5 days (maximum 500 mg per day) 1
- The higher dose of 12 mg/kg is necessary to prevent recurrence of streptococcal pharyngitis 4
Pertussis treatment/prophylaxis (infants <6 months): 10 mg/kg per day for 5 days 2
Pertussis (infants/children ≥6 months): 10 mg/kg (maximum 500 mg) on day 1, then 5 mg/kg per day (maximum 250 mg) on days 2-5 2
Chlamydial conjunctivitis in neonates: 20 mg/kg per day once daily for 3 days 2
Administration Considerations
Azithromycin can be taken with or without food 1
Avoid concurrent administration with aluminum or magnesium-containing antacids, as absorption may be reduced 2
Dispense medication on-site when possible to improve adherence 2
Critical Safety Precautions
Before initiating azithromycin in patients with cardiac risk factors, obtain an ECG to assess QTc interval. 5
Avoid azithromycin if QTc >450 ms (men) or >470 ms (women) 5
Common adverse effects include gastrointestinal symptoms (nausea, vomiting, abdominal pain, diarrhea), occurring in approximately 3% of patients, though less frequent than with erythromycin 2, 5, 6
In infants <1 month, azithromycin is preferred over erythromycin due to lower risk of infantile hypertrophic pyloric stenosis 2
Pregnancy Category B 2
Special Populations
Renal impairment (GFR 10-80 mL/min): No dosage adjustment required 1
Severe renal impairment (GFR <10 mL/min): Exercise caution; AUC increases 35% 1
Hepatic impairment: No established dosing recommendations; pharmacokinetics not studied 1
Pregnant women with chlamydial infections: Single 1-gram dose is an acceptable alternative regimen 2
Clinical Pearls
Azithromycin achieves low serum concentrations but extensive tissue penetration, with tissue levels exceeding those of erythromycin 6, 7
The terminal elimination half-life extends up to 5 days, allowing once-daily or single-dose regimens 6, 7
Patients treated for sexually transmitted infections should abstain from sexual intercourse for 7 days after completing therapy 2
For persistent non-gonococcal urethritis after doxycycline failure, consider extended azithromycin: 500 mg on day 1, then 250 mg daily for 4 additional days 2
Azithromycin demonstrates superior activity against Haemophilus influenzae, Moraxella catarrhalis, and Neisseria gonorrhoeae compared to erythromycin 6, 8