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Azithromycin
Paul A. Pham, Pharm.D. and John G. Bartlett, M.D.
06-17-2008
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Available formulation in Zambia: tablets: 250 mg, 500 mg, and 600 mg.
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MAC prophylaxis: 1200 mg once weekly.
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MAC treatment: 600 mg once daily + ethambutol 15 mg/kg/d.
- No drug-drug interactions with PIs, NNRTIs, and rifamycins.
Zambia Information Author: Paul A. Pham, Pharm.D.
- Treatment and prophylaxis of disseminated M. avium infection (treatment requires co-administration with ethambutol).
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Community-acquired pneumonia of mild severity (20%-30% of S. pneumonia strains resistant to azithromycin).
- Pharyngitis/tonsillitis; acute bacterial sinusitis.
- Acute bacterial exacerbations of chronic obstructive pulmonary disease (Z-pack and Tri-pack).
- Uncomplicated skin and skin structure infections.
- Urethritis and cervicitis (caused by GC and C. trachomatis).
- Genital ulcer disease.
brand
name
| generic
| Mfg
| brand
forms
| cost*
|
|
Zithromax
| Azithromycin | Pfizer | PO
Z-Pak
250 mg x 6 tabs | $47.72 per pack |
|
|
|
| PO
T ri-pack
6-250 mg tabs (500 mg x 3 days) | $47.72 |
|
|
|
| PO
tablet
250 mg | $8 |
|
|
|
| PO
tablet
500, 600 mg | $16;$19 |
|
|
|
| IV
vial
500 mg | $35.83 |
|
|
|
| PO
powder packet
1g | $24.15 |
|
|
|
| PO
suspension
100 mg/5 mL; 200 mg/5 mL (15mL) | $44.90 |
|
|
|
| PO
Zmax (SR suspension)
2gm/60ml | $63.49 |
*Prices represent cost per unit specified and are representative of "Average Wholesale Price" (AWP).
AWP Prices were obtained and gathered by Lakshmi Vasist Pharm D using the Red Book, manufacturer's
information, and the McKesson database.
^Dosage is indicated in mg unless otherwise noted.
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CAP: Z-pack 500 mg 1st d, then 250 mg once-daily x 4 days; 500 mg IV once-daily . or Zmax 2 gm x 1
- Acute bacterial sinusitis; acute exacerbations of chronic bronchitis: Tri-pak 500 mg PO daily x 3d or Z-pack 500mg 1st day, then 250 mg once-daily x 4 days or Zmax 2gm x1
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MAC prophylaxis: 1200 mg (two 600 mg tabs or suspension) qwk.
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MAC treatment: 600 mg once-daily + ethambutol 15mg/kg/d.
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Toxoplasmosis: 900-1200 mg po once-daily + pyrimethamine 200 mg PO x 1, then 50-75 mg PO once-daily + leucovorin 10-20 mg once-daily x 6 wks, then half dose of each
- Gonococcal urethritis or cervicitis: 2 g PO x 1 (poor GI tolerability).
- Genital ulcer disease (chancroid) or non-gonococcal urethritis (C. trachomatis) or cervicitis: 1 g PO x 1.
- Early Syphilis: 2g PO x 1 (poor GI tolerability). High rates of macrolide resistance reported in San Francisco (CID 2006; 42:337).
Usual dose.
No data, but probably usual dose likely due to high biliary excretion.
No data, but probably usual dose likely due to high biliary excretion.
HD: no data, but usual dose likely.
Usual regimen.
No data.
- GI intolerance:diarrhea, nausea, and abdominal pain in up to 14% of pts.
- Reversible dose-dependent hearing loss in 5% with mean exposure of 59 gm.
- Erythema multiforme
- Vaginitis
- Transaminase elevation
Unlike other macrolides, azithromycin does not significantly inhibit CYP3A4.
- Pimozide: avoid concurrent administration due to potential for QTc prolongation and cardiac arrhythmia.
- Theophylline: serum levels of theophylline may be increased. Monitor theophylline levels with co-administration.
- Warfarin: INR may be increased with co-administration. Monitor INR closely.
- Cyclosporin: close monitoring of cyclosporine levels is indicated. Azithromycin did not affect cyclosporine in report of 6 pts (Nephron 1996:73:724).
- No significant interactions with PIs, NNRTIs, RAL, MVC, and ENF.
Indicated for MAC prophylaxis and treatment in HIV-infected pts. Clarithromycin may have a slight advantage over azithromycin in terms of MAC Cx clearance. Unlike other macrolides, not likely to interact with PIs and NNRTIs. Significance of rising macrolide-resistance in S. pneumoniae (~25% U.S. isolates) of uncertain clinical significance for the treatment of ambulatory respiratory tract infections.
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