KEY POINTS
- Azithromycin (Zithromax, Zmax) is a macrolide antibiotic that works on susceptible bacteria by inhibiting RNA-dependent protein synthesis at the chain elongation step. It binds to the 50S ribosomal subunit, which blocks transpeptidation.
- Commonly used for community acquired pneumonia, as it has activity versus atypical organisms and Streptococcus pneumoniae
- Beware macrolide resistance in Streptococcus pneumoniae
- Commonly used for MAC prophylaxis in patients with a CD4 cell count <50
- Dose is commonly 1200mg once weekly for this indication
- May be used to treat Chlamydia and/or Gonococcal infections
- Beware macrolide resistance in Neisseria gonorrhoeae
- A common target for IV to PO conversion programs due to good bioavailability
- Beware QTc prolongation, especially in patients with existing cardiac disease
- Has anti-inflammatory properties and is sometimes used for this purpose, rather than for its antimicrobial effects
RESOURCES
- Azithromycin Package Insert (Oral)
- Azithromycin Package Insert (Injection)
- IDSA Practice Guidelines
- CDC STD Guideline
- GOLD Guidelines
- AIDSinfo.nih.gov Opportunistic Infections Guidelines
- FDA Warning On Azithromycin & Potentially Fatal Heart Rhythms
- FDA Warning On Azithromycin & Risk For Cardiovascular Death
- Azithromycin For Asthma (JAMA 2016)
- Azithromycin & Anti-Inflammatory Effects (JAC 2005)
