Based on the Cystic Fibrosis Foundation cystic fibrosis pulmonary guidelines on chronic medications for maintenance of lung heath , azithromycin is an effective and recommended agent to improve lung function and reduce exacerbations. Based on the American Heart Association AHA guidelines for the prevention of infective endocarditis , azithromycin is an effective and recommended alternative for prophylaxis against infective endocarditis associated with dental procedures in patients with certain cardiac conditions who are allergic to penicillins or ampicillin.
Based on the CDC sexually transmitted diseases treatment guidelines , azithromycin in combination with ceftriaxone is an effective and recommended treatment for patients with disseminated gonococcal infections including arthritis and arthritis-dermatitis syndrome. Based on the CDC sexually transmitted diseases treatment guidelines , azithromycin in combination with cefixime is an effective and recommended treatment of gonorrhea in heterosexual partners of infected patients, unless prohibited by law.
Based on the CDC sexually transmitted diseases treatment guidelines , azithromycin in combination with ceftriaxone is an effective and recommended treatment for patients with uncomplicated gonococcal infections of the rectum or pharynx, or conjunctivitis. Based on the CDC sexually transmitted diseases treatment guidelines , azithromycin is an effective and recommended agent in the treatment of granuloma inguinale.
Based on the IDSA guidelines for the clinical assessment, treatment and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis , azithromycin is an effective and recommended alternative agent for the treatment of early localized or disseminated Lyme disease erythema migrans or borrelial lymphocytoma in patients who are unable to take or who are intolerant of tetracyclines, penicillins, or cephalosporins.
CDC guidelines for treatment of sexually transmitted diseases state that azithromycin is more effective and preferred over doxycycline for the treatment of M. The extended 5-day regimen may be slightly more effective than single-dose therapy and be less likely to select for macrolide resistance of M. Based on the CDC guidelines on recommended antimicrobial agents for the treatment and postexposure prophylaxis of pertussis , azithromycin is effective and recommended for the treatment of pertussis. Based on the CDC sexually transmitted diseases treatment guidelines , azithromycin in combination with ceftriaxone plus metronidazole or tinidazole is a recommended regimen for empiric treatment of sexually transmitted infections following sexual assault.
Based on the World Health Organization WHO guidelines for the control of shigellosis and the IDSA practice guidelines for the diagnosis and management of infectious diarrhea , azithromycin, as an alternative to ciprofloxacin, may be used to treat this condition although there are limited data on efficacy.
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Clinical experience suggests the utility of azithromycin as an alternative agent as surgical prophylaxis for uterine evacuation [Shih ]. Based on the CDC sexually transmitted diseases treatment guidelines , azithromycin is a recommended alternative treatment for primary and secondary syphilis in patients who are unable to receive penicillin or doxycycline. Note: Azithromycin should be used with caution, and should not be used to treat syphilis in patients with HIV, pregnant women, or in the men who have sex with men MSM population.
Data from a randomized, double-blind trial of patients with infectious diarrhea suggest that azithromycin may be beneficial for the treatment of travelers' diarrhea caused by Campylobacter [Tribble ]. Based on the CDC Yellow Book , the ACG guideline for the diagnosis, treatment, and prevention of acute diarrheal infections in adults, and the IDSA practice guidelines for the diagnosis and management of infectious diarrhea , azithromycin is effective and recommended treatment for patients with travelers' diarrhea.
Due to increased levels of resistance to fluoroquinolones, azithromycin may be a recommended first-line treatment, especially in regions with a high prevalence of Campylobacter eg, Southeast Asia, India or in geographical areas with suspected fluoroquinolone-resistant pathogens or enterotoxigenic Escherichia coli. Note: The manufacturer does not list concurrent use of pimozide as a contraindication; however, azithromycin is listed as a contraindication in the manufacturer's labeling for pimozide.
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Use should be limited to approved indications. All doses are expressed as IR azithromycin unless otherwise specified. Oral: Dosing regimens used in clinical trials have varied greatly. All trials used pulse-dosing regimens; regimens included: mg once daily for 4 consecutive days per month for 3 consecutive months Babaeinejad ; Parsad or mg once daily for 3 days in the first week, followed by mg once weekly until week 10 Maleszka or mg once daily for 3 consecutive days each week in month 1, followed by mg once daily for 2 consecutive days each week in month 2, then mg once daily for 1 day each week in month 3 Kus The shortest possible duration should be used to minimize development of bacterial resistance; reevaluate at 3 to 4 months AAD [Zaenglein ].
Mild to moderate disease : Oral: mg on day 1, followed by mg once daily in combination with atovaquone for 7 to 10 days in immunocompetent patients IDSA [Wormser ]; Krause ; Vannier ; higher doses of azithromycin may be used in immunocompromised patients mg to 1 g daily IDSA [Wormser ]; Weiss ; Wormser Severe disease : IV: mg daily in combination with atovaquone for 7 to 10 days Kletsova ; Sanchez ; a longer duration is needed for those at high risk for relapse Krause ; Sanchez ; Vannier Note: May switch to oral azithromycin at the same dose following improvement on IV therapy Sanchez ; when switching to oral treatment in immunocompromised patients, a higher dose mg to 1 g daily has been used IDSA [Wormser ]; Sanchez ; Weiss Bronchiectasis noncystic fibrosis , prevention of pulmonary exacerbations off-label use : Oral: mg 3 times weekly Wong or mg once daily Altenburg Patients should be screened for nontuberculous mycobacterial infection prior to treatment, and azithromycin should not be given if present ERS [Polverino ].
Note: When studied to prevent bronchiolitis obliterans syndrome in patients with hematologic malignancy who underwent allogeneic hematopoietic cell transplantation, rates of cancer relapse and mortality were increased among patients receiving long-term azithromycin, leading to early trial termination Bergeron ; FDA Drug Safety Communication Cat scratch disease lymphadenitis off-label use : Oral: mg as a single dose, then mg once daily for 4 additional days Bass ; IDSA [Stevens ]; Psarros Cesarean delivery intrapartum or after rupture of membranes , preoperative prophylaxis off-label use : IV: mg as a single dose 1 hour prior to surgical incision; use in combination with standard preoperative antibiotics ACOG ; Tita Acute exacerbation , treatment : Oral: mg in a single loading dose on day 1, followed by mg once daily on days 2 to 5 Castaldo or mg once daily for 3 days Swanson Note: Patients should be screened for nontuberculous mycobacterial infection prior to treatment and azithromycin should not be given if present Mogayzel ; Saiman If symptoms have not resolved after 24 hours following single-dose therapy, continue with mg once daily for 2 more days ACG [Riddle ].
Note: Increased nausea may occur with the 1 g single-dose regimen Tribble , which may be reduced by administering azithromycin as 2 divided doses on the same day CDC ; Riddle If symptoms have not resolved after 24 hours following single-dose therapy, continue with mg once daily for 2 more days.
A 3-day course of mg once daily is the preferred regimen for dysentery or febrile diarrhea ACG [Riddle ]. Note: Most cases are self-limited and may not warrant antimicrobial therapy.
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Increased nausea may occur with the 1 g single-dose regimen Tribble , which may be reduced by administering azithromycin as 2 divided doses on the same day CDC ; Riddle Endocarditis prophylaxis, dental or invasive respiratory tract procedure alternative agent for penicillin-allergic patients off-label use : Oral: mg 30 to 60 minutes prior to procedure.
Note: Only recommended for patients with cardiac conditions associated with the highest risk of an adverse outcome from endocarditis and who are undergoing a procedure likely to result in bacteremia with an organism that has the potential to cause endocarditis. AHA [Wilson ]. Lyme disease erythema migrans or borrelial lymphocytoma alternative agent off-label use : Oral: mg once daily for 7 to 10 days.
Note: Use with caution and only when recommended agents cannot be used due to decreased efficacy compared to other agents IDSA [Wormser ].
Note: Patients should be under the care of a clinician with expertise in managing mycobacterial infection. Pertussis off-label use : Oral: mg on day 1, followed by mg once daily on days 2 to 5 CDC [Tiwari ]. Chancroid due to Haemophilus ducreyi : Oral: 1 g as a single dose. Chlamydia trachomatis infection of the cervix, urethra, or pharynx off-label use [pharynx] : Oral: 1 g as a single dose, preferably under direct observation CDC [Workowski ]. Chlamydia trachomatis infection, expedited partner therapy off-label use : Oral: 1 g as a single dose, preferably under direct observation.
Note: Clinical evaluation and presumptive treatment is preferred for sexual partners of patients with chlamydia. Alternatively, expedited partner therapy for chlamydia can be used for heterosexual partners if the provider is concerned that the partner will otherwise not be promptly evaluated and treated; state laws regarding expedited partner therapy vary CDC [Workowski ].
Empiric treatment following sexual assault off-label use : Oral: 1 g as a single dose in combination with ceftriaxone plus metronidazole or tinidazole CDC [Workowski ]. Gonococcal infection, disseminated arthritis, arthritis-dermatitis off-label use : Oral: 1 g as a single dose in combination with ceftriaxone, preferably under direct observation CDC [Workowski ]. Gonococcal infection, expedited partner therapy off- label use : Oral: 1 g as a single dose in combination with cefixime. Note: Clinical evaluation and presumptive treatment is preferred for sexual partners of patients with gonorrhea.
Alternatively, expedited partner therapy for gonorrhea can be used for heterosexual partners if the provider is concerned that the partner will otherwise not be promptly evaluated and treated; state laws regarding expedited partner therapy vary CDC [Workowski ]. Gonococcal infection, uncomplicated infection of the cervix, urethra, rectum, or pharynx; conjunctivitis : Oral:.
Dual-therapy regimen off-label : 1 g as a single dose in combination with ceftriaxone CDC [Workowski ]. Patients with severe cephalosporin allergy off-label : 2 g as a single dose in combination with gemifloxacin not available in the US or gentamicin IM CDC [Workowski ]. Note: Patients with pharyngeal infection treated with an alternative regimen should have a test-of-cure performed.
Consult an infectious diseases specialist when treatment failure is suspected and report failures to the CDC through state and local health departments within 24 hours of diagnosis CDC [Workowski ]. Note: If symptoms do not improve within the first few days of therapy, the addition of gentamicin may be considered CDC [Workowski ]. Note: Azithromycin resistance is rapidly emerging; consider alternative therapy. Azithromycin is not recommended for persistent infection when included in the initial regimen CDC [Workowski ]; Martin Initial treatment: mg on day 1, followed by mg once daily on days 2 through 5 CDC [Workowski ]; Falk ; some experts favor high dose 1 g on day 1 followed by mg once daily on days 2 through 4 with a test of cure 3 to 4 weeks after initiation Durukan ; Martin ; Read Syphilis, primary and secondary alternative agent for penicillin-allergic patients off-label use : Oral: 2 g as a single dose.
Note: Limited data support the use of alternatives to penicillin; close serologic and clinical follow-up is warranted.
Azithromycin (Systemic)
Use only if no other options are available due to the potential for rapid emergence of macrolide resistance in Treponema pallidum and treatment failure; do not use to treat syphilis in patients with HIV, pregnant women, or the men who have sex with men MSM population CDC [Workowski ]. Urethritis, empiric therapy: Oral: 1 g as a single dose, preferably under direct observation; give in combination with ceftriaxone if there is microscopic evidence of gonococcal urethritis or if there is high clinical suspicion for gonococcal infection Bachmann ; CDC [Workowski ].
Streptococcal pharyngitis group A alternative agent for severely penicillin-allergic patients : Oral: mg on day 1, followed by mg once daily on days 2 through 5 IDSA [Shulman ] or mg once daily for 3 days Casey Surgical prophylaxis, uterine evacuation induced abortion or pregnancy loss alternative agent off-label use : Oral: mg as a single dose 1 hour before the procedure may be administered up to 12 hours before the procedure Shih Note: Zmax 2 g extended-release oral suspension has been discontinued in the US for more than 1 year.
Note: Extended-release suspension Zmax is not interchangeable with immediate-release formulations. All doses are expressed as immediate-release azithromycin unless otherwise specified. Cat scratch disease B. Cutaneous bacillary angiomatosis B. Cervicitis, urethritis C. IDSA recommendations: Note: Recommended as an alternative agent for group A streptococcal pharyngitis in penicillin-allergic patients. Pneumonia, community-acquired excluding mycobacterial [ mycoplasma pneumoniae ] and chlamydial infections :.
Sexual victimization, prophylaxis: Oral: Note: Use in combination with cefixime or ceftriaxone and completion of hepatitis B virus immunization; also consider prophylaxis for trichomoniasis and bacterial vaginosis CDC ; Red Book [AAP] Injection Zithromax : Prepare initial solution by adding 4. Use of a standard syringe is recommended due to the vacuum in the vial which may draw additional solution through an automated syringe. Not for IM or IV bolus administration. Oral: Immediate release suspension and tablet may be taken without regard to food; extended release suspension should be taken on an empty stomach at least 1 hour before or 2 hours following a meal , within 12 hours of reconstitution.
Oral suspension, extended release, should be taken on an empty stomach at least 1 hour before or 2 hours following a meal.
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Injection Zithromax : Store intact vials of injection at room temperature. Should be consumed within 12 hours following reconstitution. Management: Reduce afatinib by 10 mg if not tolerated. Some non-US labeling recommends avoiding combination if possible. If used, administer the P-gp inhibitor simultaneously with or after the dose of afatinib.
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Consider therapy modification. Monitor therapy. Avoid combination. Management: Decrease the adult betrixaban dose to an initial single dose of 80 mg followed by 40 mg once daily if combined with a P-glycoprotein inhibitor. Management: Consider alternatives when possible; bilastine should be avoided in patients with moderate to severe renal insufficiency who are receiving p-glycoprotein inhibitors.
Cardiac Glycosides: Macrolide Antibiotics may increase the serum concentration of Cardiac Glycosides. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Cholera Vaccine: Antibiotics may diminish the therapeutic effect of Cholera Vaccine. Management: Avoid cholera vaccine in patients receiving systemic antibiotics, and within 14 days following the use of oral or parenteral antibiotics. Colchicine distribution into certain tissues e.
Management: Colchicine is contraindicated in patients with impaired renal or hepatic function who are also receiving a p-glycoprotein inhibitor. The video is anti-anxiety to code the percocet, he or she works with the azithromycin to improve their study. How really that document may be depends on order propecia uk the top itself and how great proceeds of the antibiotic have occurred.
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