AZITHROMYCIN

Azithromycin is an antibiotic used to prevent or treat infection caused by different types of bacteria, like the Mycobacterium avium complex. It can also be used to treat other kinds of infections, like traveler’s diarrhea, toxoplasmosis and sexually transmitted diseases. There are three different forms of azithromycin: tablet, injection and suspension.

 

GENERAL INFORMATIONS

  • macrolide family
  • usual dosage :
    • take 2 doses at once, then 1 dose 1 time per day for 4 days (zithromax)
    • take 200 mg as a single dose – fasting (z-max) 


INDICATIONS

Official indications accepted in Canada:Other possible indications:                   
  • Bronchitis and chronic bronchitis
  • Cellulite (child and adult)
  • Chancroid (adult)
  • Chlamydia (adult)
  • Mycabacterium avium complex – prevention (adult)
  • Gonorrhea (adult)
  • Infection (children and adults)
  • Cat bite (adult and child)
  • Otitis (children)
  • Pharyngitis / tonsillitis (child and adult)
  • Bacterial pneumonia (child and adult)
  • Shigellosis
  • Sinusitis (adult)
  • Urethritis
  • Cholera
  • Whooping cough (children and adults)
  • Traveler’s diarrhea (children and adults)
  • Typhoid fever (adult)
  • Malaria – prevention (adult)
  • Meningococcal meningitis – prevention (adult)
  

SIDE EFFECTS

The most common side effects are:

  • pain at the injection site (if the drug was taken by injection) (6.5%)
  • diarrhea (4.3 – 14%)
  • nausea (3-18%)
  • abdominal pain (1.9 – 7%)
  • decreased appetite (1.9%)
  • skin rash (1.9%)
  • elevated liver enzymes (1.6%)
  • vaginitis (0.2 – 8%)
  • vomiting (0-7%)
  • elevated serum creatinine (0-6%)
  • pseudomembranous colitis (0-1%)
  • photosensitivity (0-1%)

 

PRECAUTIONS

Pregnancy :

Limited clinical data suggest that azithromycin does not present a significant risk of fetal toxicity during pregnancy. The risk of complications is low, but more research is needed to conclude that there is no risk to the fetus. Also, it is recommended to take the medicine only from the second trimester.

Breastfeeding :

Azithromycin is compatible with breastfeeding. The few studies on the subject support the use of this medication. It does not seem to have an adverse effect on children.

Food :

If the drug is taken in tablet or suspension, azithromycin can be taken without regard to meals. If the mark of the drug is zithromax, it must be taken on an empty stomach.

Contraindications :

For people with impaired liver function, it is recommended to take azithromycin with caution as this condition increases the effect of the drug. The same principle applies for people with kidney failure. For individuals suffering from myasthenia gravis, the azithromycin taken should be monitored, because it may exacerbate symptoms of the disease. For those who suffers from a prolongation of the QT interval or have a history of this condition, azithromycin should be avoided if possible, as a prolongation of the QT interval increases the risk of fatal arrhythmias.

 

INTERACTIONS AND ALLERGIES

Interactions :Allergies:
  • aluminum salts
  • amiodarone
  • antacids
  • sodium bicarbonate
  • cyclosporine
  • dicumarol
  • digoxin
  • dispyramide
  • domperidone
  • magnesia
  • magnesium-salts
  • nicoumalone
  • quinidine
  • sotalol
  • tacrolimus
  • warfarin
  • clarithromycin
  • dirithromycin
  • erythromycin
  • roxithromycin
  • spiramycine
  • troleandomycin
  • josamycin
  • midecamycin
  • telithromycin

 

NOTICES AND WARNINGS

Canadian Adverse Reaction Newsletter – April 2014:

Drug hypersensibility syndrome (or DRESS) is a potential fatal condition. It has been reported in a low number of patients taking azithromycin. Early diagnosis and rapid drug withdrawal are important to achieve the best possible results in patients.

Health Canada – May 16, 2013 :

Rare cases of QT prolongation have been reported in patients receiving therapeutic doses of azithromycin. Caution should be exercised in patients with a prolonged QT interval, electrolyte imbalance (particularly hypokalemia and hypomagnesemia) or suffer from bradycardia, cardiac arrhythmia or clinically significant impairment. Caution should also be exercised in patients receiving drugs known to prolong the QT interval, such as Class IA or III antiarrhythmics, antipsychotics, antidepressants or fluoroquinolones. The elderly may be more sensitive to drug effects on the QT interval.

FDA – May 12, 2013 :

Azithromycin may be responsible for changes in the electrical activity of the heart, which could lead to a potentially fatal irregular heartbeat. The occurrence of this effect is increased in patients with the following risk factors: extension of the QT interval, hypokalemia, hypomagnesemia, slower heart rate or certain medications that regulate the heartbeat.

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