Antimicrobials

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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.