Names and pronunciation
(ay-zi-thro-my′sin) AzaSite, Zithromax, Zmax
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Individual generic drug information
Extracted information for azithromycin only.
(ay-zi-thro-my′sin) AzaSite, Zithromax, Zmax
Source page 137
Func. class.: Antiinfective
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Chem. class.: Macrolide
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Do not confuse: azithromycin/erythromycin Zithromax/Zinacef
Source page 138
ACTION: Binds to 50S ribosomal sub- units of susceptible bacteria and sup- presses protein synthesis; much greater spectrum of activity than erythromycin; more effective against gram-negative organisms
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USES: Mild to moderate infections of the upper respiratory tract, lower respi- ratory tract; uncomplicated skin and skin structure infections caused by Bacillus anthracis, Bacteroides bivius, Borde tella pertussis, Borrelia burgdorferi, Campylobacter jejuni, CDC coryne form group G, Chlamydia trachomatis, Chlamydophila pneumoniae, Clostrid ium perfringens, Gardnerella vagina lis, Haemophilus ducreyi, influenzae (beta-lactamase negative/positive), Heli cobacter pylori, Klebsiella granuloma tis, Legionella pneumophila, Moraxella catarrhalis, Mycobacterium avium- intracellulare, Mycoplasma genitalium/ hominis/pneumoniae, Neisseria gonor rhoeae, Peptostreptococcus sp., Pre votella bivia, Rickettsia tsutsugamushi, Salmonella typhi, Staphylococcus aureus (MSSA)/epidermidis, Streptococcus sp., Toxoplasma gondii, Treponema palli dum, Ureaplasma urealyticum, Vibrio cholerae, Viridans streptococci; PO: acute pharyngitis/tonsillitis (group A streptococ- cal); acute skin/soft tissue infections; com- munity-acquired pneumonia; Ophthal- mic: bacterial conjunctivitis
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Unlabeled uses: Babesiosis, cholera, COPD, cystic fibrosis, dental abscess/infec- tion, granuloma inguinale, Lyme disease, lymphogranuloma venereum, MAC, peri- odontitis, pertussis, prostatitis, shigellosis, syphilis, typhoid fever
Source page 138
Extracted information for azithromycin only.
CONTRAINDICATIONS: Hyper- sensitivity to azithromycin, erythromycin, any macrolide, hepatitis, jaundice Precautions: Pregnancy, breastfeeding; geriatric patients; renal/hepatic/cardiac disease; <6 mo for otitis media; <2 yr for pharyngitis, tonsillitis, QT prolongation, ulcerative colitis, torsades de pointes, sunlight exposure, sodium restriction, myasthenia gravis, CDAD, contact lenses, hypokalemia, hypomagnesemia
Source page 138
SIDE EFFECTS CNS: Dizziness, headache, seizures, fatigue CV: Palpitations, chest pain, QT prolonga- tion, torsades de pointes (rare) EENT: Hearing loss, tinnitus GI: Nausea, diarrhea, hepatotoxicity, abdominal pain, stomatitis, heartburn, dyspepsia, flatulence, melena, cholestatic jaundice, CDAD GU: Vaginitis, nephritis HEMA: Anemia, leukopenia, thrombocy- topenia INTEG: Rash, urticaria, pruritus, photo- sensitivity, pain at injection site SYST: Angioedema, Stevens-Johnson syndrome, toxic epidermal necrolysis
Source page 139
INTERACTIONS Increase: ergot toxicity—ergotamine Increase: dysrhythmias—pimozide; fatal reaction, do not use concurrently Increase: QT prolongation—amiodarone, quiNIDine, nilotinib, droperidol, metha- done, propafenone, fluoroquinolones, lithium, paliperidone Increase: effects of oral anticoagulants, digoxin, theophylline, methylPREDNISo- lone, cycloSPORINE, bromocriptine, diso- pyramide, triazolam, carBAMazepine, phenytoin, tacrolimus, nelfinavir Decrease: clearance of triazolam Decrease: absorption of azithromycin— aluminum, magnesium antacids, sepa- rate by ≥2 hr Drug/Lab Test Increase: CPK, ALT, AST, bilirubin, BUN, creatinine, alkaline phosphatase, potas- sium, blood glucose Drug/Food Decrease: absorption—food (suspension) Decrease: blood glucose, potassium, sodium NURSING CONSIDERATIONS
Source pages 139, 140
Extracted information for azithromycin only.
DOSAGE AND ROUTES Most infections • Adult: PO 500 mg on day 1, then 250 mg/day on days 2-5 for a total dose of 1.5 g or 500 mg a day × 3 days • Child 2-15 yr: PO 10 mg/kg on day 1, then 5 mg/kg × 4 days MAC in HIV: Adult: PO 500-600 mg daily Cervicitis, chlamydia, chancroid, nongonococcal urethritis, syphilis • Adult: PO 1 g single dose Gonorrhea • Adult: PO 1 g single dose with ceftri- axine 250 mg IM Lower respiratory tract infections • Adult: PO 500 mg day 1, then 250 mg × 4 days • Child: PO 5-12 mg/kg/day × 5 days Bacterial conjunctivitis • Adult/child ≥1 yr: Ophthalmic Instill 1 drop in affected eye bid × 2 days, then 1 drop in eye daily × 5 days Lyme disease (unlabeled) • Adult: PO 500 mg/day × 7 days Traveler’s diarrhea • Adult: PO 1000 mg as a single dose Pertussis (unlabeled) • Adult: PO 500 mg on day 1, then 250 mg/day for 2-5 days • Infant ≥6 mo and child: PO 10 mg/ kg/day (max 500 mg) on day 1, then 5 mg/kg/day (max 250 mg) on days 2-5 • Infant <6 mo: PO 10 mg/kg/day × 5 days Cystic fibrosis (unlabeled) Adult: PO 500 mg (≥40 kg); 250 mg (<40 kg) 3×/wk or 250 mg daily COPD (unlabeled) Adult: PO 250-500 mg 3×/wk or 250 mg daily
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Available forms: Tablets 250, 500, 600 mg; powder for injection 500 mg; suspen- sion 100, 200 mg/5 mL, 1 g single-dose powder for suspension; extended-release powder for suspension 2 (ZMAX); oph- thalmic drops 1% solution
Source pages 138, 139
Administer: Ophthalmic route • Store in refrigerator • Do not touch dropper to eye PO route • Suspension 1 hr before meal or 2 hr after meal; reconstitute 1 g packet for sus- pension with 60 mL water, mix, rinse glass with more water and have patient drink to consume all medication; packets not for pediatric use • Store at room temperature Intermittent IV INFUSION route • Reconstitute 500 mg of product with 4.8 mL sterile water for injection (100 mg/mL); shake, dilute with 250 or 500 mL 0.9% NaCl, 0.45% NaCl, or LR to 1-2 mg/mL; diluted solution stable for 24 hr or 7 days if refrigerated • Give 1 mg/mL solution over 3 hr or 2 mg/mL solution over 1 hr; never give IM or as bolus • Reconstituted product is stable for 24 hr at room temperature or 7 days re- frigerated Y-site compatibilities: Acyclovir, alatrofloxa- cin, alemtuzumab, alfentanil, aminocaproic acid, aminophylline, amphotericin B lipo- some/lipid complex, ampicillin, ampicillin- sulbactam, anidulafungin, atenolol, bivaliru- din, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, CARBOplatin, carmustine, ceFAZolin, cefepime, cefoTEtan, cefOXitin, ceftaroline, cefTAZidime, ceftizoxime, cimetidine, cis- atracurium, CISplatin, cyclophosphamide, cycloSPORINE, cytarabine, DAPTOmycin, DAUNOrubicin liposome, dexamethasone, dexmedetomidine, dexrazoxane, digoxin, diltiaZEM, diphenhydrAMINE, DOBUT amine, DOCEtaxel, dolasetron, doripenem, doxacurium, DOXOrubicin liposomal, doxy- cycline, droperidol, enalaprilat, EPINEPH- rine, epiRUBicin, eptifibatide, ertapenem, esmolol, etoposide, etoposide phosphate, fenoldopam, fluconazole, fluorouracil, fos- carnet, fosphenytoin, gallium, ganciclovir, gatifloxacin, gemcitabine, granisetron, halo- peridol, heparin, hydrocortisone phosphate/ succinate, HYDROmorphone, hydrOXYzine, A IDArubicin, ifosfamide, inamrinone, irinote- can, isoproterenol, labetalol, lepirudin, magnesium sulfate, mannitol, meperidine, meropenem, mesna, mechlorethamine, methohexital, methotrexate, methylPRED- NISolone, metoclopramide, metroNIDA- ZOLE, milrinone, minocycline, mivacurium, nalbuphine, naloxone, nesiritide, nitroglyc- erin, nitroprusside, octreotide, ofloxacin, ondansetron, oxaliplatin, oxytocin, PACLi- taxel, palonosetron, pamidronate, pantopra- zole, PEMEtrexed, PENTobarbital, phenyl- ephrine, piperacillin, potassium acetate/ phosphates, procainamide, prochlorpera- zine, promethazine, propranolol, raNITI- dine, remifentanil, rocuronium, sodium acetate, succinylcholine, SUFentanil, sulfamethoxazole-trimethoprim, tacrolimus, telavancin, teniposide, thiotepa, ticarcillin, tigecycline, tirofiban, TPN, trimethobenza- mide, vancomycin, vasopressin, vecuro nium, verapamil, vinCRIStine, voriconazole, zidovudine, zoledronic acid
Source page 139
Extracted information for azithromycin only.
Assess: • I&O ratio; report hematuria, oliguria with renal disease • Hepatic studies: AST, ALT, CBC with differential • Renal studies: urinalysis, protein, blood • C&S before product therapy; product may be taken as soon as culture is taken; C&S may be repeated after treatment • QT prolongation, torsades de pointes: assess for patients with serious bradycar- dia, ongoing proarrhythmic conditions, or elderly; more common in these patients • Serious skin reactions: Stevens- Johnson syndrome, toxic epidermal necrolysis, angioedema; discontinue if rash develops, treat symptomatically • Superinfection: sore throat, mouth, tongue; fever, fatigue, diarrhea, anogeni- tal pruritus • CDAD: diarrhea, abdominal pain, fever, fatigue, anorexia; obtain CBC, serum albu- min • Bowel pattern before, during treatment • Respiratory status: rate, character; wheezing, tightness in chest: discontinue product • Cardiovascular death has occurred in those with serious bradycardia or ongoing hypokalemia, hypomagnesemia; avoid use • Pregnancy/breastfeeding: use only if clearly needed; cautious use in breast- feeding, excreted in breast milk
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Evaluate: • Therapeutic response: C&S negative for infection; decreased signs of infec- tion
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Patient and caregiver information: • To report sore throat, fever, fatigue, severe diarrhea, anal/genital itching (may indicate superinfection) • Not to take aluminum-magnesium– containing antacids simultaneously with this product (PO) • To notify nurse of diarrhea, dark urine, pale stools; yellow discoloration of eyes, skin; severe abdominal pain • To complete dosage regimen • To take ZMAX 1 hr before or 2 hr after a meal; shake well before use • To use protective clothing or stay out of the sun, photosensitivity may occur TREATMENT OF HYPERSEN- SITIVITY: Withdraw product, maintain airway; administer EPINEPHrine, ami nophylline, O2, IV corticosteroids See Appendix B
Source page 140
Extracted information for azithromycin only.
PHARMACOKINETICS PO: Peak 2-4 hr, duration 24 hr IV: Peak end of infusion; duration 24 hr; half-life 11-57 hr; excreted in bile, feces, urine primarily as unchanged product; may be inhibitor of P-glycoprotein
Source page 139
Filter the extracted dose blocks for this individual drug.
Most infections
• Child 2-15 yr: PO 10 mg/kg on day 1, then 5 mg/kg × 4 days MAC in HIV: Adult: PO 500-600 mg daily Cervicitis, chlamydia, chancroid, nongonococcal urethritis, syphilis
Candidate age grouping · source page 138
Most infections
• Child: PO 5-12 mg/kg/day × 5 days Bacterial conjunctivitis
Candidate age grouping · source page 138
Most infections
• Adult/child ≥1 yr: Ophthalmic Instill 1 drop in affected eye bid × 2 days, then 1 drop in eye daily × 5 days Lyme disease (unlabeled)
Candidate age grouping · source page 138
Most infections
• Infant ≥6 mo and child: PO 10 mg/ kg/day (max 500 mg) on day 1, then 5 mg/kg/day (max 250 mg) on days 2-5
Candidate age grouping · source page 138