Azithromycin 250mg dose
Nongonococcal urethritis, cervicitis, chancroid: 1g as a single dose. Urethritis, cervicitis due to N. MAC prevention alone or combined with rifabutin : mg once weekly.
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MAC treatment combined with ethambutol : mg once daily. Use oral susp not packets. Pneumonia: oral treatment is for mild, community-acquired cases suitable for outpatient therapy only. Known QT prolongation, proarrhythmic conditions, clinically significant bradycardia: avoid. Allergic symptoms may recur after initial successful symptomatic treatment. Myasthenia gravis.
Hepatic or renal impairment. Nursing mothers: monitor infants. Avoid concomitant aluminum- or magnesium-containing antacids. Monitor with digoxin, colchicine, phenytoin, warfarin. Monitor for azithromycin toxicity eg, liver dysfunction, ototoxicity with nelfinavir. Concomitant Class 1A eg, quinidine, procainamide , or Class III eg, dofetilide, amiodarone, sotalol antiarrhythmics, or others known to prolong the QT interval: avoid.
There are no pharmacokinetic data available from studies in hepatically- or renally-impaired individuals. The effect of azithromycin on the plasma levels or pharmacokinetics of theophylline administered in multiple doses adequate to reach therapeutic steady-state plasma levels is not known. Nucleic acid synthesis is not affected. Azithromycin concentrates in phagocytes and fibroblasts as demonstrated by in vitro incubation techniques.
In vivo studies suggest that concentration in phagocytes may contribute to drug distribution to inflamed tissues.
NOTE: Azithromycin demonstrates cross-resistance with erythromycin-resistant gram-positive strains. Most strains of Enterococcus faecalis and methicillin-resistant staphylococci are resistant to azithromycin.
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- What is azithromycin??
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Azithromycin has been shown to be active in vitro and in the prevention and treatment of disease caused by the following microorganisms:. The following in vitro data are available, but their clinical significance is unknown. Azithromycin exhibits in vitro minimal inhibitory concentrations MICs of 2. Campylobacter jejuni. The in vitro potency of azithromycin is markedly affected by the pH of the microbiological growth medium during incubation. Thus, the initial pH of the growth medium should be 7.
Quantitative methods are used to determine minimal inhibitory concentrations that provide reproducible estimates of the susceptibility of bacteria to antimicrobial compounds. One such standardized procedure uses a standardized dilution method 1 broth, agar or microdilution or equivalent with azithromycin powder.
The MIC values should be interpreted according to the following criteria:. A report of "Susceptible" indicates that the pathogen is likely to respond to monotherapy with azithromycin. A report of "Intermediate" indicates that the result should be considered equivocal, and, if the microorganism is not fully susceptible to alternative, clinically feasible drugs, the test should be repeated.
This category also provides a buffer zone which prevents small uncontrolled technical factors from causing major discrepancies in interpretation. A report of "Resistant" indicates that usually achievable drug concentrations are unlikely to be inhibitory and that other therapy should be selected. Measurement of MIC or MBC and achieved antimicrobial compound concentrations may be appropriate to guide therapy in some infections.
Standardized susceptibility test procedures require the use of laboratory control microorganisms. Standard azithromycin powder should provide the following MIC values:. Quantitative methods that require measurement of zone diameters also provide reproducible estimates of the susceptibility of bacteria to antimicrobial compounds. Interpretation involves the correlation of the diameter obtained in the disk test with the minimal inhibitory concentration MIC for azithromycin. As with standardized dilution techniques, diffusion methods require the use of laboratory control microorganisms.
Azithromycin has demonstrated in vitro activity against Mycobacterium avium complex MAC organisms.
While gene probe techniques may be used to distinguish between M. Azithromycin has also been shown to be active against phagocytized M. Various in vitro methodologies employing broth or solid media at different pHs, with and without oleic acid-albumin dextrose-catalase OADC , have been used to determine azithromycin MIC values for Mycobacterium avium complex strains. At pH 7. The relationship between azithromycin and clarithromycin MIC values has not been established. In general, azithromycin MIC values were observed to be 2 to 32 fold higher than clarithromycin independent of the susceptibility method employed.
The ability to correlate MIC values and plasma drug levels is difficult as azithromycin concentrates in macrophages and tissues. Complete cross-resistance between azithromycin and clarithromycin has been observed with Mycobacterium avium complex MAC isolates.
AZITHROMYCIN | Drug | BNF content published by NICE
In most isolates, a single point mutation at a position that is homologous to the Escherichia coli positions or on the 23S rRNA gene is the mechanism producing this cross-resistance pattern. These MIC values were determined employing the radiometric broth dilution susceptibility testing method with Middlebrook 7H12 medium. The clinical significance of azithromycin and clarithromycin cross-resistance is not fully understood at this time but preclinical data suggest that reduced activity to both agents will occur after M. The disk diffusion techniques and dilution methods for susceptibility testing against Gram-positive and Gram-negative bacteria should not be used for determining azithromycin MIC values against mycobacteria.
In vitro susceptibility testing methods and diagnostic products currently available for determining minimal inhibitory concentration MIC values against Mycobacterium avium complex MAC organisms have not been standardized or validated. Azithromycin MIC values will vary depending on the susceptibility testing method employed, composition and pH of media and the utilization of nutritional supplements.
Breakpoints to determine whether clinical isolates of M. The clinical relevance of azithromycin in vitro susceptibility test results for other mycobacterial species, including Mycobacterium tuberculosis , using any susceptibility testing method has not been determined.
Acute bacterial exacerbations of chronic obstructive pulmonary disease due to Haemophilus influenzae, Moraxella catarrhalis, or Streptococcus pneumoniae. Community-acquired pneumonia of mild severity due to Streptococcus pneumoniae or Haemophilus influenzae in patients appropriate for outpatient oral therapy. NOTE: Penicillin is the usual drug of choice in the treatment of Streptococcus pyogenes infection and the prophylaxis of rheumatic fever. Data establishing efficacy of azithromycin in subsequent prevention of rheumatic fever are not available.
Uncomplicated skin and skin structure infections due to Staphylococcus aureus, Streptococcus pyogenes, or Streptococcus agalactiae. Abscesses usually require surgical drainage. Antimicrobial agents used in high doses for short periods of time to treat non-gonococcal urethritis may mask or delay the symptoms of incubating gonorrhea or syphilis. All patients with sexually-transmitted urethritis or cervicitis should have a serologic test for syphilis and appropriate cultures for gonorrhea performed at the time of diagnosis. Appropriate antimicrobial therapy and follow-up tests for these diseases should be initiated if infection is confirmed.
Appropriate culture and susceptibility tests should be performed before treatment to determine the causative organism and its susceptibility to azithromycin. To reduce the development of drug-resistant bacteria and maintain the effectiveness of Zithromax azithromycin and other antibacterial drugs, Zithromax azithromycin should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy.
In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy. Rare serious allergic reactions, including angioedema and anaphylaxis, have been reported rarely in patients on azithromycin therapy. Despite initially successful symptomatic treatment of the allergic symptoms, when symptomatic therapy was discontinued, the allergic symptoms recurred soon thereafter in some patients without further azithromycin exposure.
These patients required prolonged periods of observation and symptomatic treatment. The relationship of these episodes to the long tissue half-life of azithromycin and subsequent prolonged exposure to antigen is unknown at present. If an allergic reaction occurs, the drug should be discontinued and appropriate therapy should be instituted.
Physicians should be aware that reappearance of the allergic symptoms may occur when symptomatic therapy is discontinued. In the treatment of pneumonia, azithromycin has only been shown to be safe and effective in the treatment of community-acquired pneumonia of mild severity due to Streptococcus pneumoniae or Haemophilus influenzae in patients appropriate for outpatient oral therapy. Azithromycin should not be used in patients with pneumonia who are judged to be inappropriate for outpatient oral therapy because of moderate to severe illness or risk factors such as any of the following: patients with nosocomially acquired infections, patients with known or suspected bacteremia, patients requiring hospitalization, elderly or debilitated patients, or patients with significant underlying health problems that may compromise their ability to respond to their illness including immunodeficiency or functional asplenia.
Pseudomembranous colitis has been reported with nearly all antibacterial agents and may range in severity from mild to life-threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhea subsequent to the administration of antibacterial agents.
Treatment with antibacterial agents alters the normal flora of the colon and may permit overgrowth of clostridia.