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Drug Study

Azithromycin (Zithromax): All You Need To Know



Azithromycin (Zithromax) is a macrolide antibiotic that works as a bacteriostatic or bactericidal in susceptible bacteria.

Drug Class

Macrolide antibiotic

Therapeutic Actions

Bacteriostatic or bactericidal in susceptible bacteria.


  • Treatment of LRIs(Lower Respiratory Infections): Acute bacterial exacerbations of COPD due to H. influenzae, Moraxella catarrhalis, S. pneumoniae; community-acquired pneumonia due to S. pneumoniae, H. influenzae
  • Treatment of LRIs: Streptococcal pharyngitis and tonsillitis due to Streptococcus pyogenes in those who cannot take penicillins
  • Treatment of uncomplicated skin infections due to Staphylococcus aureus, S. pyogenes, Streptococcus agalactiae
  • Treatment of nongonococcal urethritis and cervicitis due to C. trachomatis; treatment of PID
  • Treatment of acute sinusitis
  • Treatment of otitis media caused by H. influenzae, M. catarrhalis, S. pneumoniae in children > 6 mo
  • Treatment of pharyngitis and tonsillitis in children > 2 yr who cannot use first-line therapy
  • Prevention and treatment of disseminated Mycobacterium avium complex (MAC) in patients with advanced AIDS
  • Unlabeled uses: Uncomplicated gonococcal infections caused by N. gonorrhoeae; gonococcal pharyngitis caused by N. gonorrhoeae; chlamydial infections caused by C. trachomatis; prophylaxis after a sexual attack.

Contraindications and cautions

  • Contraindicated with hypersensitivity to azithromycin, erythromycin, or any macrolide antibiotic.
  • Use cautiously with gonorrhea or syphilis, pseudomembranous colitis, hepatic or renal impairment, lactation.

Available forms

Tablets—250, 600 mg; powder for injection—500 mg; powder for oral suspension—100 mg/5 mL, 200 mg/5 mL, 1 g/packet


  • Mild to moderate acute bacterial exacerbations of COPD, pneumonia, pharyngitis, and tonsillitis (as second-line): 500 mg PO single dose on the first day, followed by 250 mg PO daily on days 2–5 for a total dose of 1.5 g or 500 mg/day PO for 3 days.
  • Nongonococcal urethritis and cervicitis due to C. trachomati: A single 1-g PO dose.
  • Gonococcal urethritis and cervicitis: A single dose of 2 g PO.
  • Disseminated MAC infections: For prevention, 1,200 mg PO taken once weekly. For treatment, 600 mg/day PO with etambutol.
  • Acute sinusitis: 500 mg/day PO for 3 days.


  • Otitis media: Initially, 10 mg/kg PO as a single dose, then 5 mg/kg on days 2–5 or 30 mg/kg PO as a single dose.
  • Community-acquired pneumonia: 10 mg/kg PO as a single dose on first day, then 5 mg/kg PO on days 2–5.
  • Pharyngitis or tonsillitis: 12 mg/kg/day PO on days 1–5.
  • Acute sinusitis: 10 mg/kg/day PO for 3 days.

Adverse effects

  • CNS: Dizziness, headache, vertigo, somnolence, fatigue
  • GI: Diarrhea, abdominal pain, nausea, dyspepsia, flatulence, vomiting, melena, pseudomembranous colitis
  • Other: Superinfections, angioedema, rash, photosensitivity, vaginitis

Patient education

  • Take the full course prescribed. Do not take with antacids. Take with food if GI upset occurs.
  • You may experience these side effects: Stomach cramping, discomfort, diarrhea; fatigue, headache (medication may help); additional infections in the mouth or vagina (consult with a health care provider for treatment).
  • Report severe or watery diarrhoea, severe nausea or vomiting, rash or itching, mouth sores, vaginal sores.
  • Educate patient to take the drug on an empty stomach 1 hr before or 2–3 hr after meals. Food affects the absorption of this drug.

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