AZITHROMYCIN oral

Last updated: January 2021

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
– 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 capsules or 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 single dose (max. 1 g)
Adult: 1 g single dose (2 g single dose in early syphilis)

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

– Conjunctivitis due to C. trachomatis
Child: 20 mg/kg once daily for 3 days (max. 1 g daily)
Adult: 1 g once daily for 3 days

– Typhoid fever 
Child: 10 to 20 mg/kg once daily for 7 days (max. 1 g daily)
Adult: 1 g once daily for 7 days

– 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 once daily for 5 days (max. 500 mg daily)
Adult: 500 mg on D1 then 250 mg once daily from D2 to D5

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

– Shigellosis
Child: 12 mg/kg on D1 then 6 mg/kg 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 once daily for 14 days (max. 500 mg daily)
Adult: 500 mg once daily for 14 days

– Streptococcal tonsillitis, only in penicillin-allergic patients
Child: 20 mg/kg once daily for 3 days (max. 500 mg daily)
Adult: 500 mg once daily for 3 days

– Acute otitis media, only in penicillin-allergic patients
Child: 10 mg/kg once daily for 3 days (max. 500 mg daily)

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

– Also comes in 250 mg or 500 mg capsules, to be taken one hour before or 2 hours after a meal.
– Storage: below 25 °C -  - 
For the oral suspension (powder or reconstituted suspension): follow manufacturer’s instructions.