Azithromycin
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Trade Name
Zithromax, Z-Pak (common brand names); generic azithromycin
Classification
Macrolide antibiotic
Dosage/Route
- * Dosage:
- – Tablets: 250 mg, 500 mg, 600 mg
- – Suspension: 100 mg/5 mL, 200 mg/5 mL
- – IV: 500 mg vial
- * Route: Oral (PO), intravenous (IV)
Usual Dosage
- * Adults:
- – Community-acquired pneumonia (CAP): 500 mg PO day 1, then 250 mg PO daily days 2-5 (Z-Pak)
- – Chlamydia: 1 g PO single dose
- – IV (severe CAP): 500 mg IV daily for 1-2 days, then PO
- * Children:
- – 10 mg/kg PO day 1, then 5 mg/kg PO daily days 2-5 (max 500 mg day 1, 250 mg thereafter)
- * Duration: 3-5 days typically (shorter than other antibiotics)
Mechanism of Action
Binds to the 50S ribosomal subunit of bacterial RNA, inhibiting protein synthesis. Bacteriostatic (sometimes bactericidal at high doses) against gram-positive (e.g., Streptococcus), some gram-negative (e.g., H. influenzae), and atypical bacteria (e.g., Mycoplasma, Chlamydia)
Side Effects & Adverse Effects
- * Side Effects: Nausea, diarrhea, abdominal pain, headache.
- * Adverse Effects:
- – QT prolongation (arrhythmias, torsades de pointes; boxed warning).
- – Clostridioides difficile-associated diarrhea (CDAD).
- – Hepatotoxicity (rare; jaundice, elevated LFTs).
- – Hypersensitivity (rash, anaphylaxis, rare)
Nursing Management (Implications & Teachings)
- * Implications:
- – Monitor ECG (QT interval) in patients with CV risk or on QT-prolonging drugs (e.g., amiodarone)
- – Assess for diarrhea (CDAD risk) and liver function (jaundice)
- – IV: Infuse 500 mg over 1-3 hours (1 mg/mL or 2 mg/mL dilution); avoid rapid push
- – PO: Give 1 hr before or 2 hr after meals (food delays absorption)
- * Teachings:
- – Finish full course; take as prescribed
- – Report palpitations, severe diarrhea, or yellow skin
- – Avoid antacids (aluminum/magnesium) within 2 hours (reduce absorption)
- – Store suspension at room temp; shake well
Indication for This Patient
- * Bacterial infections:
- – Respiratory (e.g., CAP, bronchitis, sinusitis)
- – STDs (e.g., Chlamydia)
- – Otitis media, pharyngitis (Streptococcus)
- * Mycobacterium avium complex (MAC) prophylaxis/treatment (HIV patients)
Time
- * Timing: PO: Once daily; IV: Daily (1-3 hr infusion)
- * Onset: Symptom relief in 1-3 days
- * Duration: 3-5 days (or single dose for Chlamydia)
