AZITHROMYCIN oral

Last updated: June 2025

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

• Child under 6 months: 10 mg/kg once daily for 5 days
• Child 6 months and over: 10 mg/kg (max. 500 mg) on D1 then 5 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

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.
• Administer with caution to children under 6 weeks of age (risk of hypertrophic pyloric stenosis) and patients with risk factors for QT prolongation (e.g. electrolyte disturbances, pre-existing cardiac and renal disorders, older patients).
• May cause:
  • gastrointestinal disturbances, reversible hearing disorders, electrolytes disturbances, QT prolongation;
  • rarely: hypersensitivity reactions (including severe cutaneous reactions such as Stevens-Johnson, Lyell and DRESS syndromes) and life-threatening hepatotoxicity. In these cases, stop treatment. Signs and symptoms of hypersensitivity reaction (e.g. fever, rash, mouth ulcers, bleeding) and hepatic disorders (e.g. anorexia, nausea, general malaise, dark urine, pale stools, hepatomegaly, jaundice) require immediate medical attention.
• 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 toxicity 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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