Antimicrobials
Azithromycin
Guidelines for use
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1. Spectrum of Activity
Active against:
- Streptococci
- S. aureus (erythromycin sensitive strains, most cloxacillin sensitive strains)
- Moraxella catarrhalis
- H. influenzae
- Mycoplasma pneumoniae
- Chlamydia pneumoniae
- Chlamydia trachomatis
- Legionella
- N. gonorrhoeae
- Oral anaerobes (moderate activity)
Not active against:
- Enterococci
- Methicillin-resistant S. aureus
- B. fragilis
2. Clinical Use
Appropriate Uses:
- Empiric therapy for community-acquired pneumonia requiring admission to hospital; must be used in combination with a beta-lactam antibiotic (e.g., ceftriaxone)
- Monotherapy for outpatient treatment of community-acquired pneumonia
- Sexually transmitted infections caused by Chlamydia trachomatis
Inappropriate Uses:
- Meningitis and other CNS infections
- Monotherapy in severe infections where septicemia is suspected
- Combination therapy with levofloxacin
3. Precautions
- Hypersensitivity to clarithromycin or erythromycin
- Pregnancy: Not expected to increase risk of major congenital malformations
- Breastfeeding: Not expected to cause adverse effects in breastfed infants. Monitor nursing infant for GI symptoms.
4. Adverse Effects
- Nausea, vomiting, diarrhea, abdominal pain
- Rash
- Local inflammation, pain at injection site (IV formulation)
5. Dosage
Usual Dosage*:
- Oral: 500 mg on day 1, then 250 - 500 mg PO daily
- IV: 500 mg IV daily, then when suitable for step-down to oral therapy, give 250 - 500 mg PO daily
*Dosage for sexually transmitted infections is 1 g PO as a single dose
Renal insufficiency: No dosage adjustment in renal insufficiency
6. Administration
- Intermittent Infusion: Infuse over at least 60 minutes
- Continuous Infusion: Not applicable
- Please refer to IV drug monograph on pharmacy intranet page for additional administration information.
