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Medication Safety Issues
Sound-alike/look-alike issues:
Azithromycin may be confused with erythromycin
Zithromax® may be confused with Zinacef®
Pronunciation
(az ith roe MYE sin)
U.S. Brand Names
Index Terms
Generic Available
Yes: Injection, powder for oral suspension, tablet
Canadian Brand Names
Pharmacologic Category
Pharmacologic Category Synonyms
Use: Labeled Indications
Oral, I.V.: Treatment of acute otitis media due to H. influenzae, M. catarrhalis, or S. pneumoniae; pharyngitis/tonsillitis due to S. pyogenes; treatment of mild-to-moderate upper and lower respiratory tract infections, infections of the skin and skin structure, community-acquired pneumonia, pelvic inflammatory disease (PID), sexually-transmitted diseases (urethritis/cervicitis), pharyngitis/tonsillitis (alternative to first-line therapy), and genital ulcer disease (chancroid) due to susceptible strains of C. trachomatis, M. catarrhalis, H. influenzae, S. aureus, S. pneumoniae, Mycoplasma pneumoniae, and C. psittaci; acute bacterial exacerbations of chronic obstructive pulmonary disease (COPD) due to H. influenzae, M. catarrhalis, or S. pneumoniae; acute bacterial sinusitis
Ophthalmic: Bacterial conjunctivitis
Use: Dental
Alternate oral antibiotic for prevention of infective endocarditis in individuals allergic to penicillins or ampicillin, when amoxicillin cannot be used; alternate antibiotic in the treatment of common orofacial infections caused by aerobic gram-positive cocci and susceptible anaerobes
Use: Unlabeled/Investigational
Prevention of (or to delay onset of) or treatment of MAC in patients with advanced HIV infection; prophylaxis of infective endocarditis in patients who are allergic to penicillin and undergoing surgical or dental procedures; pertussis
Pregnancy Risk Factor
B
Pregnancy Considerations
Adverse events were not observed in animal studies; therefore, azithromycin is classified as pregnancy category B. Low levels of azithromycin have been shown to cross the placenta. Azithromycin may be used for the treatment of some infections during pregnancy. The CDC and IDSA provide recommendations for the treatment of chlamydial infections and MAC in pregnant patients. Since serum concentrations determine fetal exposure and azithromycin has much higher concentrations in tissue than serum, treatment results in the mother may be obtained with lower exposure to the fetus. Although no adverse reports in human or animal fetuses have been documented, information in pregnant women is limited.
Lactation
Enters breast milk/use caution
Breast-Feeding Considerations
Azithromycin is excreted in low amounts into breast milk. Compared to erythromycin, azithromycin achieves higher tissue concentrations when compared to serum concentrations. Since serum concentrations determine infant exposure, azithromycin may achieve treatment results in the mother with less exposure to the breast-feeding infant. Nondose-related effects could include modification of bowel flora.
Contraindications
Hypersensitivity to azithromycin, other macrolide antibiotics, or any component of the formulation
Warnings/Precautions
Concerns related to adverse effects:
• Altered cardiac conduction: Macrolides have been associated with rare QTc prolongation and ventricular arrhythmias, including torsade de pointes; use with caution in patients at risk of prolonged cardiac repolarization.
• Superinfection: Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.
Disease-related concerns:
• Gonorrhea/syphilis: May mask or delay symptoms of incubating gonorrhea or syphilis, so appropriate culture and susceptibility tests should be performed prior to initiating azithromycin.
• Hepatic impairment: Use with caution in patients with pre-existing liver disease; hepatic impairment, including hepatocellular and/or cholestatic hepatitis, with or without jaundice, has been observed. Discontinue if symptoms of malaise, nausea, vomiting, abdominal colic, and fever.
• Renal impairment: Use with caution in patients with severe renal impairment (Clcr <10 mL/minute).
Special populations:
• Contact lens wearers: Ophthalmic solution contains benzalkonium chloride which may be absorbed by contact lenses; contact lens should not be worn during treatment of ophthalmic infections.
• Pediatrics: Safety and efficacy of systemically-administered azithromycin (oral, intravenous) have not been established in children <6 months of age with acute otitis media, acute bacterial sinusitis, or community-acquired pneumonia, or in children <2 years of age with pharyngitis/tonsillitis. Safety and efficacy for ophthalmic use have not been established in children <1 year of age.
Dosage form specific issues:
• Oral suspensions: Immediate release and extended release suspensions are not interchangeable.
• Ophthalmic solution: Eye drops should not be injected subconjunctivally or introduced directly into the anterior chamber of the eye.
Adverse Reactions
>10%: Gastrointestinal: Diarrhea (4% to 9%; high single-dose regimens 14%), nausea (?7%; high single-dose regimens 18%)
2% to 10%:
Dermatologic: Pruritus, rash
Gastrointestinal: Abdominal pain, anorexia, cramping, vomiting (especially with high single-dose regimens)
Genitourinary: Vaginitis
Local: (with I.V. administration): Injection site pain, inflammation
Ocular (with ophthalmic solution use): Eye irritation (1% to 2%)
?1%: Systemic therapy: Agitation, allergic reaction, anemia, angioedema, bronchospasm, candidiasis, chest pain, cholestatic jaundice, conjunctivitis, constipation, cough increased, dermatitis (fungal), diaphoresis, dizziness, dyspepsia, eczema, enteritis, facial edema, fatigue, fever, flatulence, fungal infection, gastritis, headache, hyperkinesia, insomnia, jaundice, leukopenia, malaise, melena, mucositis, nephritis, nervousness, oral moniliasis, pain, palpitation, pharyngitis, photosensitivity, pleural effusion, rhinitis, somnolence, taste perversion, urticaria, vertigo, vesiculobullous rash
1%: Ophthalmic solution: Contact dermatitis, corneal erosion, dysgeusia, nasal congestion, ocular discharge, ocular dryness; ocular stinging, burning, and irritation upon instillation; punctate keratitis, sinusitis
Postmarketing and/or case reports (all formulations): Acute renal failure, aggressive behavior, anaphylaxis, anxiety, arrhythmia (including ventricular tachycardia), arthralgia, deafness, dehydration, edema, erythema multiforme (rare), hearing disturbance, hearing loss, hepatic failure (rare), hepatic necrosis (rare), hepatitis, hyperactivity, hypertrophic pyloric stenosis, hypotension, interstitial nephritis, loss of smell, loss of taste, LFTs increased, neutropenia (mild), oral candidiasis, pancreatitis, paresthesia, pseudomembranous colitis, QTc prolongation (rare), seizure, smell perversion, somnolence, Stevens-Johnson syndrome (rare), syncope, thrombocytopenia, tinnitus, tongue discoloration (rare), torsade de pointes (rare), toxic epidermal necrolysis (rare), weakness
Metabolism/Transport Effects
Substrate of CYP3A4 (minor); Inhibits CYP3A4 (weak)
Drug Interactions
Amiodarone: Azithromycin may enhance the QTc-prolonging effect of Amiodarone. Risk D: Consider therapy modification
Cardiac Glycosides: Macrolide Antibiotics may increase the serum concentration of Cardiac Glycosides. Risk D: Consider therapy modification
Coumarin Derivatives: Macrolide Antibiotics may decrease the metabolism of Coumarin Derivatives. Risk C: Monitor therapy
CycloSPORINE: Macrolide Antibiotics may decrease the metabolism of CycloSPORINE. Risk C: Monitor therapy
Nelfinavir: May decrease the excretion of Azithromycin. Risk C: Monitor therapy
Tacrolimus: Macrolide Antibiotics may increase the serum concentration of Tacrolimus. Risk C: Monitor therapy
Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Risk D: Consider therapy modification
Ethanol/Nutrition/Herb Interactions
Food: Rate and extent of GI absorption may be altered depending upon the formulation. Azithromycin suspension, not tablet form, has significantly increased absorption (46%) with food.
Storage
Injection (Zithromax®): Store intact vials of injection at room temperature. Reconstituted solution is stable for 24 hours when stored below 30°C/86°F.
Ophthalmic solution: Prior to use, store unopened under refrigeration at 2°C to 8°C (36°F to 46°F). After opening, store at 2°C to 25°C (36°F to 77°F) for ?14 days; discard any remaining solution after 14 days.
Suspension, immediate release (Zithromax®): Store dry powder below 30°C (86°F). Following reconstitution, store at 5°C to 30°C (41°F to 86°F).
Suspension, extended release (Zmax™): Store dry powder below 30°C (86°F). Following reconstitution, store at 15°C to 30°C (59°F to 86°F); do not freeze. Should be consumed within 12 hours following reconstitution.
Tablet (Zithromax®): Store between 15°C to 30°C (59°F to 86°F).
Reconstitution
Injection (Zithromax®): Prepare initiation solution by adding 4.8 mL of sterile water for injection to the 500 mg vial (resulting concentration: 100 mg/mL). Use of a standard syringe is recommended due to the vacuum in the vial (which may draw additional solution through an automated syringe).
The initial solution should be further diluted to a concentration of 1 mg/mL (500 mL) to 2 mg/mL (250 mL) in 0.9% sodium chloride, 5% dextrose in water, or lactated Ringer's. The diluted solution is stable for 24 hours at or below room temperature (30°C or 86°F) and for 7 days if stored under refrigeration (5°C or 41°F).
Compatibility
Other medications should not be infused simultaneously through the same I.V. line.
Mechanism of Action
Inhibits RNA-dependent protein synthesis at the chain elongation step; binds to the 50S ribosomal subunit resulting in blockage of transpeptidation
Pharmacodynamics/Kinetics
Absorption: Oral: Rapid; Ophthalmic: Negligible
Distribution: Extensive tissue; distributes well into skin, lungs, sputum, tonsils, and cervix; penetration into CSF is poor; I.V.: 33.3 L/kg; Oral: 31.1 L/kg
Protein binding (concentration dependent): Oral, I.V.: 7% to 51%
Metabolism: Hepatic
Bioavailability: Oral: 38%, decreased by 17% with extended release suspension; variable effect with food (increased with immediate or delayed release oral suspension, unchanged with tablet)
Half-life elimination: Oral, I.V.: Terminal: Immediate release: 68-72 hours; Extended release: 59 hours
Time to peak, serum: Oral: Immediate release: 2-3 hours; Extended release: 5 hours
Excretion: Oral, I.V.: Biliary (major route); urine (6%)
Dosage
Note: Extended release suspension (Zmax™) is not interchangeable with immediate release formulations. Use should be limited to approved indications. All doses are expressed as immediate release azithromycin unless otherwise specified.
Usual dosage range:
Children ?6 months: Oral: 5-12 mg/kg given once daily (maximum: 500 mg/day) or 30 mg/kg as a single dose (maximum: 1500 mg)
Children ?1 year and Adults: Ophthalmic: Instill 1 drop into affected eye(s) twice daily (8-12 hours apart) for 2 days, then 1 drop once daily for 5 days
Adolescents ?16 years and Adults:
Oral: 250-600 mg once daily or 1-2 g as a single dose
I.V.: 250-500 mg once daily
Indication-specific dosing:
Children: Oral:
Bacterial sinusitis: 10 mg/kg once daily for 3 days (maximum: 500 mg/day)
Cat scratch disease (unlabeled use): <45.5 kg: 10 mg/kg as a single dose, then 5 mg/kg once daily for 4 days
Community-acquired pneumonia: 10 mg/kg on day 1 (maximum: 500 mg/day) followed by 5 mg/kg/day once daily on days 2-5 (maximum: 250 mg/day)
Disseminated
M. avium
(unlabeled use):
HIV-infected patients: 5 mg/kg/day once daily (maximum: 250 mg/day) or 20 mg/kg (maximum: 1200 mg) once weekly given alone or in combination with rifabutin
Treatment and secondary prevention in HIV-negative patients: 5 mg/kg/day once daily (maximum: 250 mg/day) in combination with ethambutol, with or without rifabutin
Prophylaxis against infective endocarditis (unlabeled use): 15 mg/kg 30-60 minutes before procedure (maximum: 500 mg). Note: American Heart Association (AHA) guidelines now recommend prophylaxis only in patients undergoing invasive procedures and in whom underlying cardiac conditions may predispose to a higher risk of adverse outcomes should infection occur. As of April 2007, routine prophylaxis for GI/GU procedures is no longer recommended by the AHA.
Otitis media:
1-day regimen: 30 mg/kg as a single dose (maximum: 1500 mg)
3-day regimen: 10 mg/kg once daily for 3 days (maximum: 500 mg/day)
5-day regimen: 10 mg/kg on day 1 (maximum: 500 mg/day) followed by 5 mg/kg/day once daily on days 2-5 (maximum: 250 mg/day)
Pharyngitis, tonsillitis: Children ?2 years: 12 mg/kg/day once daily for 5 days (maximum: 500 mg/day)
Pertussis (CDC guidelines):
Children <6 months: 10 mg/kg/day for 5 days
Children ?6 months: 10 mg/kg on day 1 (maximum: 500 mg/day) followed by 5 mg/kg/day once daily on days 2-5 (maximum: 250 mg/day)
Uncomplicated chlamydial urethritis or cervicitis (unlabeled use): Children ?45 kg: 1 g as a single dose
Children ?1 year and Adults: Ophthalmic:
Bacterial conjunctivitis: Instill 1 drop into affected eye(s) twice daily (8-12 hours apart) for 2 days, then 1 drop once daily for 5 days
Adolescents ?16 years and Adults:
Bacterial sinusitis: Oral: 500 mg/day for a total of 3 days
Extended release suspension (Zmax™): 2 g as a single dose
Cat scratch disease (unlabeled use): Oral: >45.5 kg: 500 mg as a single dose, then 250 mg once daily for 4 days
Chancroid due to
H. ducreyi
: Oral: 1 g as a single dose
Community-acquired pneumonia:
Oral (Zmax™): 2 g as a single dose
I.V.: 500 mg as a single dose for at least 2 days, follow I.V. therapy by the oral route with a single daily dose of 500 mg to complete a 7- to 10-day course of therapy.
Disseminated
M. avium
complex disease in patients with advanced HIV infection (unlabeled use): Oral:
Prophylaxis: 1200 mg once weekly (may be combined with rifabutin)
Treatment: 600 mg daily (in combination with ethambutol 15 mg/kg)
Prophylaxis against infective endocarditis (unlabeled use): Oral: 500 mg 30-60 minutes prior to the procedure. Note: American Heart Association (AHA) guidelines now recommend prophylaxis only in patients undergoing invasive procedures and in whom underlying cardiac conditions may predispose to a higher risk of adverse outcomes should infection occur. As of April 2007, routine prophylaxis for GI/GU procedures is no longer recommended by the AHA.
Mild-to-moderate respiratory tract, skin, and soft tissue infections: Oral: 500 mg in a single loading dose on day 1 followed by 250 mg/day as a single dose on days 2-5
Alternative regimen: Bacterial exacerbation of COPD: 500 mg/day for a total of 3 days
Pelvic inflammatory disease (PID): I.V.: 500 mg as a single dose for 1-2 days, follow I.V. therapy by the oral route with a single daily dose of 250 mg to complete a 7-day course of therapy
Pertussis (CDC guidelines): Oral: 500 mg on day 1 followed by 250 mg/day on days 2-5 (maximum: 500 mg/day)
Urethritis/cervicitis: Oral:
Due to C. trachomatis: 1 g as a single dose
Due to N. gonorrhoeae: 2 g as a single dose
Dosage adjustment in renal impairment: Use caution in patients with Clcr <10 mL/minute
Dosage adjustment in hepatic impairment: Use with caution due to potential for hepatotoxicity (rare). Specific guidelines for dosing in hepatic impairment have not been established.
Dental Usual Dosing
Prophylaxis against infective endocarditis (unlabeled use): Oral:
Children: 15 mg/kg 30-60 minutes before procedure (maximum: 500 mg). Note: American Heart Association (AHA) guidelines now recommend prophylaxis only in patients undergoing invasive procedures and in whom underlying cardiac conditions may predispose to a higher risk of adverse outcomes should infection occur. As of April 2007, routine prophylaxis for GI/GU procedures is no longer recommended by the AHA.
Adolescents ?16 years and Adults: 500 mg 30-60 minutes prior to the procedure. Note: American Heart Association (AHA) guidelines now recommend prophylaxis only in patients undergoing invasive procedures and in whom underlying cardiac conditions may predispose to a higher risk of adverse outcomes should infection occur. As of April 2007, routine prophylaxis for GI/GU procedures is no longer recommended by the AHA.
Bacterial sinusitis: Oral:
Children ?6 months: 10 mg/kg once daily for 3 days (maximum: 500 mg/day)
Adolescents ?16 years and Adults: 500 mg/day for a total of 3 days
Extended release suspension (Zmax™): 2 g as a single dose
Orofacial infections: Adolescents ?16 years and Adults: Oral: 500 mg/day, then 250 mg days 2-5
Treatment of periodontal disease: 500 mg once daily for 4-7 days
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.
Administration: I.V.
Other medications should not be infused simultaneously through the same I.V. line.
Administration: Other
Ophthalmic: Shake bottle once prior to each administration. Wash hands before and after instillation.
Administration: I.V. Detail
Infusate concentration and rate of infusion for azithromycin for injection should be either 1 mg/mL over 3 hours or 2 mg/mL over 1 hour.
Monitoring Parameters
Liver function tests, CBC with differential
Dietary Considerations
Oral suspension, immediate release, may be administered with or without food.
Oral suspension, extended release, should be taken on an empty stomach (at least 1 hour before or 2 hours following a meal).
Tablet may be administered with food to decrease GI effects.
Sodium content:
Injection: 114 mg (4.96 mEq) per vial
Oral suspension, immediate release: 3.7 mg per 100 mg/5 mL of constituted suspension; 7.4 mg per 200 mg/5 mL of constituted suspension; 37 mg per 1 g single-dose packet
Oral suspension, extended release: 148 mg per 2 g constituted suspension
Tablet: 0.9 mg/250 mg tablet; 1.8 mg/500 mg tablet; 2.1 mg/600 mg tablet
Patient Education
Do not take any new prescription or OTC medications or herbal products during therapy without consulting prescriber. If administered by infusion; report immediately any redness, swelling, or pain at infusion site. If self-administered, take exactly as directed according to formulation. Take all of prescribed medication and do not discontinue without consulting prescriber until prescription is completed. Oral: Take extended release suspension 1 hour before or 2 hours after meals; immediate release suspension and tablets may be taken with or without food; tablet form may be taken with meals to decrease GI effects. Do not take with antacids that contain aluminum or magnesium. Maintain adequate hydration (2-3 L/day of fluids) unless instructed to restrict fluid intake. If taken to treat a sexually-transmitted disease, follow advice of prescriber related to sexual intercourse and preventing transmission. May cause transient abdominal distress, diarrhea, and headache. Report signs of additional infections (eg, sores in mouth or vagina, vaginal discharge, unresolved fever, severe vomiting, or loose or foul-smelling stools). Breast-feeding precaution: Consult prescriber if breast-feeding.
Ophthalmic: Store under refrigeration. Shake bottle once prior to each administration. Wash hands before and after installation. Tilt head back, invert bottle, and gently squeeze bottle to instill prescribed amount into the affected eye(s). Contact lenses should not be worn during treatment of ophthalmic infection. You may experience mild eye irritation (if persistent, contact prescriber).
Geriatric Considerations
Dosage adjustment does not appear to be necessary in the elderly. Considered to be one of the drugs of choice in the outpatient treatment of community-acquired pneumonia in elderly. Evaluate the patient's ability to self-administer the ophthalmic product.
Additional Information
Zithromax® tablets and immediate release suspension may be interchanged (eg, two Zithromax® 250 mg tablets may be substituted for one Zithromax® 500 mg tablet or the tablets may be substituted with the immediate release suspension); however, the extended release suspension (Zmax™) is not bioequivalent with Zithromax® and therefore should not be interchanged.
Cardiovascular Considerations
The clinical implications of the association between infection (Chlamydia and cytomegalovirus) and coronary artery disease (CAD) is unknown. A recent trial showed no difference in clinical events in azithromycin-treated patients who had CAD and positive C. pneumoniae antibodies.
Dental Health: Effects on Dental Treatment
No significant effects or complications reported
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
No information available to require special precautions
Mental Health: Effects on Mental Status
Macrolides have been reported to cause nightmares, confusion, anxiety, and mood lability; may rarely cause dizziness, agitation, nervousness, and insomnia
Mental Health: Effects on Psychiatric Treatment
Contraindicated with pimozide; may increase concentration of bromocriptine, carbamazepine, and triazolam
Nursing: Physical Assessment/Monitoring
Assess results of culture and sensitivity tests and patient's allergy history prior to beginning therapy. Assess potential for interactions with other pharmacological agents patient may be taking. I.V.: See administration specifics. Evaluate results of laboratory tests (LFTs, CBC with diff), therapeutic effectiveness, and adverse effects. Instruct patients being treated for STDs about preventing transmission. Teach patient appropriate use (according to formulation and purpose for use), possible side effects/appropriate interventions, and adverse symptoms to report.
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Note: Strength expressed as base
Injection, powder for reconstitution, as dihydrate: 500 mg
Zithromax®: 500 mg [contains sodium 114 mg (4.96 mEq) per vial]
Injection, powder for reconstitution, as hydrogencitrate: 500 mg
Injection, powder for reconstitution, as monohydrate: 500 mg
Microspheres for oral suspension, extended release, as dihydrate:
Zmax™: 2 g [single-dose bottle; contains sodium 148 mg per bottle; cherry and banana flavor]
Powder for oral suspension, as monohydrate: 100 mg/5 mL (15 mL); 200 mg/5 mL (15 mL, 22.5 mL, 30 mL)
Powder for oral suspension, immediate release, as dihydrate:
Zithromax®: 100 mg/5 mL (15 mL) [contains sodium 3.7 mg/ 5 mL; cherry creme de vanilla and banana flavor]; 200 mg/5 mL (15 mL, 22.5 mL, 30 mL) [contains sodium 7.4 mg/5 mL; cherry creme de vanilla and banana flavor]; 1 g/packet (3s, 10s) [single-dose packet; contains sodium 37 mg per packet; cherry creme de vanilla and banana flavor]
Solution, ophthalmic:
AzaSite™: 1% (2.5 mL) [contains benzalkonium chloride]
Tablet, as dihydrate:
Zithromax®: 250 mg [contains sodium 0.9 mg per tablet]; 500 mg [contains sodium 1.8 mg per tablet]; 600 mg [contains sodium 2.1 mg per tablet]
Zithromax® TRI-PAK™ [unit-dose pack]: 500 mg (3s) [contains sodium 1.8 mg per tablet]
Zithromax® Z-PAK® [unit-dose pack]: 250 mg (6s) [contains sodium 0.9 mg per tablet]
Tablet, as monohydrate: 250 mg, 500 mg, 600 mg
Pricing: U.S. (www.drugstore.com)
Pack (Zithromax)
1 g (3): $103.39
Solution (AzaSite)
1% (2.5): $64.99
Suspension (reconstituted) (Azithromycin)
200 mg/5 mL (15): $32.27
Suspension (reconstituted) (Zithromax)
100 mg/5 mL (15): $47.24
200 mg/5 mL (15): $46.19
200 mg/5 mL (22.5): $46.99
200 mg/5 mL (30): $46.19
Tablets (Azithromycin)
250 mg (6): $25.99
250 mg (30): $98.99
500 mg (3): $44.32
500 mg (30): $438.00
600 mg (30): $399.94
Tablets (Zithromax)
250 mg (30): $297.66
500 mg (30): $559.88
600 mg (30): $660.48
Tablets (Zithromax Tri-Pak)
500 mg (3): $62.99
Tablets (Zithromax Z-Pak)
250 mg (6): $62.24
References
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American Thoracic Society, “Guidelines for the Initial Management of Adults With Community-Acquired Pneumonia: Diagnosis, Assessment of Severity, and Initial Antimicrobial Therapy,” Am Rev Respir Dis, 1993, 148(5):1418-26.
Centers for Disease Control and Prevention, “Update to CDC's Sexually Transmitted Diseases Treatment Guidelines, 2006: Fluoroquinolones No Longer Recommended for Treatment of Gonococcal Infections,” MMWR Recomm Rep, 2007, 56(14):332-6.
Clauzel AM, Visier S, and Michel FB, “Efficacy and Safety of Azithromycin in Lower Respiratory Tract Infections,” Eur Respir J, 1990, 3(Suppl 10):89.
Coates P, Daniel R, Houston AC, et al, “An Open Study to Compare the Pharmacokinetics, Safety, and Tolerability of a Multiple-Dose Regimen of Azithromycin in Young and Elderly Volunteers,” Eur J Clin Microbiol Infect Dis, 1991, 10(10):850-2.
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Guay DR, “Pharmacokinetics of the New Macrolides,” Infect Med, 1992, 9:9-13.
Hammerschlag MR, Golden NH, Oh MK, et al, “Single Dose of Azithromycin for the Treatment of Genital Chlamydial Infections in Adolescents,” J Pediatr, 1993, 122(6):961-5.
Hoffler D, Koeppe P, and Paeske B, “Pharmacokinetics of Azithromycin in Normal and Impaired Renal Function,” Infection, 1995, 23(6):356-61.
Ljutic D and Rumboldt Z, “Possible Interaction Between Azithromycin and Cyclosporin: A Case Report,” Nephron, 1995, 70(1):130.
Nahata MC, Koranyi KI, Gadgil SD, et al, “Pharmacokinetics of Azithromycin After Oral Administration of Multiple Doses of Suspension,” Antimicrob Agents Chemother, 1993, 37(2):314-16.
Peters DH, Friedel HA, and McTavish D, “Azithromycin: A Review of Its Antimicrobial Activity, Pharmacokinetic Properties and Clinical Efficacy,” Drugs, 1992, 44(5):750-99.
Starke JR and Correa AG, “Management of Mycobacterial Infection and Disease in Children,” Pediatr Infect Dis J, 1995, 14(6):455-69.
Steingrimsson O, Olafsson JH, Thorarinsson H, et al, “Azithromycin in the Treatment of Sexually Transmitted Disease,” J Antimicrob Chemother, 1990, 25(Suppl A):109-14.
Tartaglione TA, “Therapeutic Options for the Management and Prevention of Mycobacterium avium Complex Infection in Patients With the Acquired Immunodeficiency Syndrome,” Pharmacotherapy, 1996, 16(2):171-82.
Tiwari T, Murphy TV, and Moran J, “Recommended Antimicrobial Agents for the Treatment and Postexposure Prophylaxis of Pertussis: 2005 CDC Guidelines,” MMWR Recomm Rep, 2005, 54(RR-14):1-16.
Wahlstrom E, Zamora JU, and Teichman S, “Improvement in Cyclosporin-Associated Gingival Hyperplasia With Azithromycin Therapy,” N Engl J Med, 1995, 332(11):753-4.
Wilson W, Taubert KA, Gewitz M, et al, “Prevention of Infective Endocarditis. Guidelines From the American Heart Association. A Guideline From the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group,” Circulation, 2007, 115. Available at http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.106.183095v1; accessed August 6, 2007.
International Brand Names
Lexi-Comp.com
Last full review/revision August 2008
Content last modified August 2008
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