Drug Information for Geriatric Patients with Renal or Hepatic Impairment
Azithromycin (Zithromax®)
Azithromycin is a macrolide antibiotic that requires no dose adjustment in geriatric patients with renal impairment, including those with severe renal dysfunction or on dialysis, making it an ideal choice for elderly patients with compromised kidney function. 1
Generic and Trade Names
- Generic name: Azithromycin
- Common trade name: Zithromax®
- Therapeutic category: Macrolide antibiotic 1
Key Advantages in Renal Impairment
- No dose adjustment required for any degree of renal impairment, including end-stage renal disease requiring dialysis 1
- Predominantly hepatic elimination pathway makes it suitable for use without modification in renal disease 1
- Standard adult dosing regimens remain unchanged: 500 mg daily for 3 days for acute bacterial exacerbations of COPD, or single 1 gram dose for specific infections 1
Comparison with Other Antibiotics
- Clarithromycin (another macrolide) requires 50% dose reduction if creatinine clearance is less than 60 mL/min and 75% reduction if less than 30 mL/min 1
- Aminoglycosides (amikacin, streptomycin) require dose reduction or extended dosing intervals in renal impairment 1
- Ciprofloxacin requires dose adjustment to 250-500 mg at intervals based on creatinine clearance 1
Important Safety Considerations
- Monitor for hepatotoxicity, QT prolongation, and hearing impairment, particularly in patients with severe renal dysfunction 1
- Acute interstitial nephritis is a rare but documented adverse effect that requires immediate discontinuation if suspected 1
- No hepatic dose adjustment required for any degree of hepatic impairment 1