AZITHROMYCIN oral

Last updated: September 2023

Therapeutic action

• Macrolide antibacterial

Indications

• Trachoma, conjunctivitis due to Chlamydia trachomatis
• Cervicitis and urethritis due to Chlamydia trachomatis (in combination with a treatment for gonorrhoea), donovanosis, chancroid, early syphilis
• Cholera (if the strain is susceptible), typhoid fever, yaws, leptospirosis, louse-borne and tick-borne relapsing fevers
• Pertussis, diphtheria, pneumonia due to Mycoplasma pneumoniae and Chlamydophila pneumoniae
• Second-line treatment of shigellosis
• Streptococcal tonsillitis, acute otitis media, in penicillin-allergic patients only

Forms and strengths

• 250 mg and 500 mg tablets
• 200 mg/5 ml powder for oral suspension, to be reconstituted with filtered water

Dosage and duration

Trachoma, cholera, cervicitis and urethritis due to C. trachomatis, chancroid, early syphilis

• Child: 20 mg/kg (max. 1 g) single dose
• Adult: 1 g single dose (2 g single dose in early syphilis)

Yaws

• Child and adult: 30 mg/kg (max. 2 g) single dose

Conjunctivitis due to C. trachomatis

• Child: 20 mg/kg (max. 1 g) once daily for 3 days
• Adult: 1 g once daily for 3 days

Typhoid fever

• Child: 10 to 20 mg/kg (max. 1 g) once daily for 7 days
• Adult: 500 mg to 1 g once daily for 7 days or 1 g on D1 then 500 mg once daily from D2 to D7

Donovanosis (granuloma inguinale)

• Adult: 1 g on D1 then 500 mg once daily until healing of lesions

Pertussis, pneumonia due to M. pneumoniae and C. pneumoniae

• Child: 10 mg/kg (max. 500 mg) once daily for 5 days
• Adult: 500 mg on D1 then 250 mg once daily from D2 to D5

Leptospirosis

• Child: 10 mg/kg (max. 500 mg) on D1 then 5 mg/kg (max. 250 mg) once daily on D2 and D3
• Adult: 1 g on D1 then 500 mg once daily on D2 and D3 

Shigellosis

• Child: 12 mg/kg (max. 500 mg) on D1 then 6 mg/kg (max. 250 mg) once daily from D2 to D5
• Adult: 500 mg on D1 then 250 mg once daily from D2 to D5

Diphtheria

• Child: 10 to 12 mg/kg (max. 500 mg) once daily for 14 days
• Adult: 500 mg once daily for 14 days 

Relapsing fevers (louse-borne and tick-borne)

• Child: 10 mg/kg (max. 500 mg) single dose for louse-borne relapsing fever and once daily for 7 to 10 days for tick-borne relapsing fever
• Adult: 500 mg single dose for louse-borne relapsing fever and once daily for 7 to 10 days for tick-borne relapsing fever

Streptococcal tonsillitis, only in penicillin-allergic patients

• Child: 20 mg/kg (max. 500 mg) once daily for 3 days
• Adult: 500 mg once daily for 3 days

Acute otitis media, only in penicillin-allergic patients

• Child: 10 mg/kg (max. 500 mg) once daily for 3 days

Contra-indications, adverse effects, precautions

• Do not administer to patients with allergy to azithromycin or another macrolide, and to patients with severe hepatic impairment.
• May cause: gastrointestinal disturbances, heart rhythm disorders (QT prolongation), allergic reactions sometimes severe. In the event of allergic reaction, stop treatment immediately.
• Do not administer simultaneously with antacids (aluminium or magnesium hydroxide, etc.). Administer 2 hours apart.
• Avoid combination with drugs that prolong the QT interval (amiodarone, chloroquine, co-artemether, fluconazole, haloperidol, mefloquine, moxifloxacin, ondansetron, pentamidine, quinine, etc.).
• Administer with caution and monitor use in patients taking digoxin (increased digoxin plasma levels).
• Pregnancy and breast-feeding: no contra-indication

Remarks

• Azithromycin is also used for septicaemia of pulmonary or gynaecological origin (child: 10 to 20 mg/kg (max. 1 g) once daily; adult: 500 mg to 1 g once daily), in combination with other antibacterials.
• Also comes in 250 mg or 500 mg capsules, to be taken one hour before or 2 hours after a meal.

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