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Drug Name azithromycin (ay zi thro my' sin) Zithromax, Zmax Pregnancy Category B Drug class Macrolide

Dosages PO Resp tract infections; Skin and soft tissue infections 500 mg once daily for 3 days. Uncomplicated genital chlamydial infections 1 g as a single dose. Uncomplicated gonorrhoea 2 g as a single dose. Prophylaxis of disseminated MAC infections 1.2 g once wkly. Treatment or secondary prophylaxis: W/ other antimycobacterials: 500 mg once daily. Typhoid 500 mg once daily for 7 days. Granuloma inguinale Initial: 1 g, then 500 mg/day until all lesions has healed completely.

Therapeutic Actions Azithromycin blocks transpeptidatio n by binding to 50s ribosomal subunit of susceptible organisms and disrupting RNAdependent protein synthesis at the chain elongation step.

Indications Treatment of lower respiratory infections: Acute bacterial exacerbations of COPD due to Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae; community-acquired pneumonia due to S. pneumoniae, H. influenzae Treatment of lower respiratory infections: Streptococcal pharyngitis and tonsillitis due to Streptococcus pyogenes in those who cannot take penicillins Treatment of uncomplicated skin infections due to Staphylococcus aureus, S. pyogenes, Streptococcus agalactiae Treatment of nongonococcal urethritis and cervicitis due to Chlamydia trachomatis; treatment of PID Treatment of acute sinusitis Treatment of otitis media caused by H. influenzae, M. catarrhalis, S. pneumoniae in children > 6 mo Treatment of pharyngitis and tonsillitis in children

Adverse effects Mild to moderate nausea, vomiting, abdominal pain, dyspepsia, flatulence, diarrhoea, cramping; angioedema, cholestatic jaundice; dizziness, headache, vertigo, somnolence; transient elevations of liver enzyme values.

Contraindications Contraindicated with hypersensitivity to azithromycin, erythromycin, or any macrolide antibiotic. Use cautiously with gonorrhea or syphilis, pseudomembra nous colitis, hepatic or renal impairment, lactation.

Nursing considerations Assessment History: Hypersensitivity to azithromycin, erythromycin, or any macrolide antibiotic; gonorrhea or syphilis, pseudomembranous colitis, hepatic or renal impairment, lactation Physical: Site of infection; skin color, lesions; orientation, GI output, bowel sounds, liver evaluation; culture and sensitivity tests of infection, urinalysis, LFTs, renal function tests Interventions Culture site of infection before therapy. Administer on an empty stomach 1 hr before or 23 hr after meals. Food affects the absorption of this drug. Prepare Zmax by adding 60 mL water to bottle, shake well. Counsel patients being treated for STDs about appropriate precautions and additional therapy.

Teaching points

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Nursing Notes and Community

> 2 yr who cannot use first-line therapy Prevention and treatment of disseminated Mycobacterium avium complex (MAC) in patients with advanced AIDS Treatment of patients with mild to moderate acute bacterial sinusitis caused by H. influenzae, Moracellis catarrhalis, S. pneumoniae (Zmax) Treatment of mild to moderate community acquired pneumonia caused by Chlamydophila pneumoniae, H. influenzae, Mycoplasma pneumoniae, S. pneumoniae (Zmax) Unlabeled uses: Uncomplicated gonococcal infections caused by N. gonorrhoeae; gonococcal pharyngitis caused by N. gonorrhoeae; chlamydial infections caused by C. trachomatis; prophylaxis after sexual attack

Take the full course prescribed. Do not take with antacids. Tablets and oral suspension can be taken with or without food. Prepare Zmax by adding 60 milliliters (1/4 cup) water to bottle, shake well, drink all at once. You may experience these side effects: Stomach cramping, discomfort, diarrhea; fatigue, headache (medication may help); additional infections in the mouth or vagina (consult with health care provider for treatment). Report severe or watery diarrhea, severe nausea or vomiting, rash or itching, mouth sores, vaginal sores.

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