azithromycin

Adult Dosing .

Dosage forms:  TAB: 250 mg, 500 mg, 600 mg; TAB (3-day pack): 500 mg x3; TAB (5-day pack): 250 mg x6; POWDER: 1 g per packet; SUSPENSION: 100 mg per 5 mL, 200 mg per 5 mL; INJ: various

infections, bacterial

[500 mg PO x1 on day 1, then 250 mg PO q24h x4 days]

pharyngitis/tonsillitis, streptococcal

[500 mg PO x1 on day 1, then 250 mg PO q24h x4 days]

COPD exacerbation, acute bacterial

[500 mg PO x1 on day 1, then 250 mg PO q24h x4 days]

Alt: 500 mg PO q24h x3 days

pneumonia, community-acquired

[500 mg PO x1 on day 1, then 250 mg PO q24h x4 days]

Alt: 500 mg IV q24h x2 or more days, then 500 mg PO q24h; Info: may give 500 mg PO/IV q24h for at least 5 days as part of multi-drug regimen; refer to IDSA guidelines

infections, chlamydial

[pregnant patients]

Dose: 1 g PO x1; Info: 1st-line agent

[non-pregnant patients]

Dose: 1 g PO x1; Info: not 1st-line agent

infections, uncomplicated gonococcal

[2 g PO x1]

Info: for infections of cervix, urethra, rectum; give with gentamicin; not 1st-line agent

PID

[500 mg IV q24h x1-2 days, then 250 mg PO/IV q24h x12-14 days]

Info: for patients with cephalosporin allergy and low gonorrhea risk; give with metronidazole

urethritis, non-gonococcal

[1 g PO x1]

Alt: 500 mg PO x1 on day 1, then 250 mg PO q24h x4 days; Info: not 1st-line agent

chancroid

[1 g PO x1]

MAC tx, disseminated

[500-600 mg PO q24h]

Info: not 1st-line agent; use with ethambutol

MAC prophylaxis, primary

[1200 mg PO qwk]

Alt: 600 mg PO 2x/wk

MAC prophylaxis, secondary (off-label)

[500-600 mg PO q24h]

Info: not 1st-line agent; use with ethambutol

endocarditis prophylaxis, dental (off-label)

[500 mg PO x1]

Start: 30-60min before procedure; Info: see Infectious Disease: Endocarditis Prophylaxis, Adult table

COPD exacerbation risk reduction (off-label)

[250 mg PO q24h]

Alt: 500 mg PO 3x/wk; Info: for patients with exacerbation history; search 'gold' for epocrates COPD GOLD decision tools

cervicitis, presumptive (off-label)

[1 g PO x1]

Info: not 1st-line agent

lymphogranuloma venereum (off-label)

[1000 mg PO qwk for at least 3wk]

Info: not 1st-line agent

granuloma inguinale (off-label)

[1000 mg PO qwk for at least 3wk]

Alt: 500 mg PO qd for at least 3wk; Info: may extend tx if not healed after 3wk; 1st-line agent

salmonellosis, acute (off-label)

[1 g PO q24h x1 day, then 500 mg PO q24h x2-6 days]

Info: may extend tx x1wk if immunocompromised

shigellosis, severe (off-label)

[1000-1500 mg PO q24h]

Info: duration varies with infection severity; refer to CDC guidance

campylobacteriosis (off-label)

[500 mg PO q24h x3 days]

typhoid fever, adjunct tx (off-label)

[10 mg/kg/dose PO q24h x1wk]

babesiosis (off-label)

[mild-moderate infection, immunocompetent patients]

Dose: 500 mg PO x1 on day 1, then 250 mg PO q24h x6-9 days; Info: give with atovaquone as 1st-line regimen

[severe infection, immunocompetent patients]

Dose: 500-1000 mg IV q24h x7-10 days; Info: give with atovaquone as 1st-line regimen; switch to azithromycin 250-500 mg PO q24h for step-down tx

[immunocompromised patients]

Dose: 500-1000 mg IV q24h for at least 6wk; Info: give with atovaquone as 1st-line regimen; switch to azithromycin 500-1000 mg PO q24h for step-down tx

pertussis (off-label)

[500 mg PO x1 on day 1, then 250 mg PO q24h x4 days]

Lyme disease (off-label)

[500 mg PO q24h x7 days]

Info: for early localized disease; not 1st-line agent; search 'Lyme' for epocrates Lyme Disease Diagnosis & Treatment decision tool

meningococcal prophylaxis (off-label)

[10 mg/kg/dose PO x1]

Max: 500 mg; Info: for close contacts of patients with invasive meningococcal disease; not 1st-line agent

renal dosing

[see below]

CrCl >10: no adjustment; CrCl <10: not defined, caution advised

HD/PD: no adjustment; no supplement

hepatic dosing

[see below]

hepatic impairment: not defined, caution advised

Peds Dosing .

Dosage forms:  TAB: 250 mg, 500 mg, 600 mg; TAB (3-day pack): 500 mg x3; TAB (5-day pack): 250 mg x6; POWDER: 1 g per packet; SUSPENSION: 100 mg per 5 mL, 200 mg per 5 mL; INJ: various

pharyngitis/tonsillitis, streptococcal

[2 yo and older]

Dose: 12 mg/kg/dose PO x1 on day 1, then 6 mg/kg/dose PO q24h x4 days; Max: 500 mg for 1st dose, 250 mg for subsequent doses

community-acquired pneumonia, atypical

[mild infection, >3 mo]

Dose: 10 mg/kg/dose PO x1 on day 1, then 5 mg/kg/dose PO q24h x4 days; Max: 500 mg for 1st dose, 250 mg for subsequent doses

[moderate-severe infection, >3 mo (off-label)]

Dose: 10 mg/kg/dose IV q24h x2 days, then 5 mg/kg/dose PO q24h x3 days; Max: 500 mg/dose IV; 250 mg/dose PO

endocarditis prophylaxis, dental (off-label)

[15 mg/kg/dose PO x1]

Start: 30-60min before procedure; Info: see Infectious Disease: Endocarditis Prophylaxis, Pediatric table

infections, chlamydial (off-label)

[infants]

Dose: 20 mg/kg/dose PO qd x3 days; Info: not 1st-line agent

[preadolescents 8 yo and older or >45 kg]

Dose: 1 g PO x1; Info: 1st-line agent

[pregnant patients, adolescents]

Dose: 1 g PO x1; Info: 1st-line agent

[non-pregnant patients, adolescents]

Dose: 1 g PO x1; Info: not 1st-line agent

infections, uncomplicated gonococcal (off-label)

[adolescents]

Dose: 2 g PO x1; Info: for infections of cervix, urethra, rectum; give with gentamicin; not 1st-line agent

PID (off-label)

[adolescents]

Dose: 500 mg IV q24h x1-2 days, then 250 mg PO/IV q24h x12-14 days; Info: for patients with cephalosporin allergy and low gonorrhea risk; give with metronidazole

urethritis, non-gonococcal (off-label)

[preadolescents >45 kg and adolescents]

Dose: 1 g PO x1; Alt: 500 mg PO x1 on day 1, then 250 mg PO q24h x4 days; Info: not 1st-line agent

chancroid (off-label)

[preadolescents <45 kg]

Dose: 20 mg/kg/dose PO x1; Max: 1 g/dose

[preadolescents >45 kg and adolescents]

Dose: 1 g PO x1

MAC tx (off-label)

[1 mo-12 yo]

Dose: 10-12 mg/kg/dose PO q24h for at least 1mo; Max: 500 mg/day; Info: not 1st-line agent; use with ethambutol

[13 yo and older]

Dose: 500-600 mg PO q24h; Info: not 1st-line agent; use with ethambutol

MAC prophylaxis, primary (off-label)

[1 mo-12 yo]

Dose: 20 mg/kg/dose PO qwk; Max: 1200 mg/wk; Alt: 5 mg/kg/dose PO q24h, max 250 mg/day

[13 yo and older]

Dose: 1200 mg PO qwk; Alt: 600 mg PO 2x/wk

MAC prophylaxis, secondary (off-label)

[1 mo-12 yo]

Dose: 5 mg/kg/dose PO q24h; Max: 250 mg/day; Info: not 1st-line agent; use with ethambutol

[13 yo and older]

Dose: 500-600 mg PO q24h; Info: not 1st-line agent; use with ethambutol

cervicitis, presumptive (off-label)

[preadolescents >45 kg and adolescents]

Dose: 1 g PO x1; Info: not 1st-line agent

lymphogranuloma venereum (off-label)

[adolescents]

Dose: 1000 mg PO qwk for at least 3wk; Info: not 1st-line agent

granuloma inguinale (off-label)

[preadolescents >45 kg and adolescents]

Dose: 1000 mg PO qwk for at least 3wk; Alt: 500 mg PO qd for at least 3wk; Info: may extend tx if not healed after 3wk; 1st-line agent

salmonellosis, acute (off-label)

[10 mg/kg/dose PO q24h x3-7 days]

Max: 500 mg/day; Info: may extend tx x1wk if immunocompromised

shigellosis, severe (off-label)

[1 mo and older]

Dose: 6-20 mg/kg/dose PO q24h; Max: 1000 mg/day; Info: duration varies with infection severity; refer to CDC guidance

campylobacteriosis (off-label)

[1 mo and older]

Dose: 10 mg/kg/dose up to 500 mg PO q24h x3-5 days

typhoid fever, adjunct tx (off-label)

[10 mg/kg/dose PO q24h x1wk]

babesiosis (off-label)

[mild-moderate infection, immunocompetent patients]

Dose: 10 mg/kg/dose PO x1 on day 1, then 5 mg/kg/dose PO q24h x6-9 days; Max: 500 mg on day 1; 250 mg/day on days 2-10; Info: give with atovaquone as 1st-line regimen

[severe infection, immunocompetent patients]

Dose: 10 mg/kg/dose IV q24h x7-10 days; Max: 500 mg/day; Info: give with atovaquone as 1st-line regimen; switch to azithromycin 10 mg/kg/dose PO q24h for step-down tx

[immunocompromised patients]

Dose: 10 mg/kg/dose IV q24h for at least 6wk; Max: 500 mg/day; Info: give with atovaquone as 1st-line regimen; switch to azithromycin 10 mg/kg/dose PO q24h for step-down tx

pertussis (off-label)

[<6 mo]

Dose: 10 mg/kg/dose PO q24h x5 days; Info: 1st-line agent for patients <1 mo

[6 mo and older]

Dose: 10 mg/kg/dose PO x1 on day 1, then 5 mg/kg/dose PO q24h x4 days; Max: 500 mg for 1st dose, 250 mg for subsequent doses

Lyme disease (off-label)

[10 mg/kg/dose PO q24h x7 days]

Max: 500 mg/day; Info: for early localized disease; not 1st-line agent; search 'Lyme' for epocrates Lyme Disease Diagnosis & Treatment decision tool

meningococcal prophylaxis (off-label)

[10 mg/kg/dose PO x1]

Max: 500 mg; Info: for close contacts of patients with invasive meningococcal disease; not 1st-line agent

renal dosing

[see below]

CrCl >10: no adjustment; CrCl <10: not defined, caution advised

HD/PD: no adjustment; no supplement

hepatic dosing

[see below]

hepatic impairment: not defined, caution advised