DRUGSWHEN

Azithromycin
therapeutic
indications

MOMENTO PRODUCED
MEDICO BY
 DRUGSWHEN

Azithromycin
therapeutic
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indications
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MOMENTO PRODUCED
MEDICO BY
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MOMENTO
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MEDICO

Copyright © 2016 Momento Medico Group

©

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from the publisher The publisher and the authors have made every effort to ensure the accuracy of this
book, but cannot accept responsibility for any errors or omissions. Readers are advised to check the most
current product information provided by the manufacturer of each drug to be administered to verify
the recommended dose, the method and duration of administrations, and contraindications. It is the
responsibility of the treating physician, relying on experience and knowledge of the patient, to determine
dosages and the best treatment for each individual patient.
INDEX
• Upper respiratory tract infections
–  Otitis media........................................................... 4
–  Acute bacterial sinusitis ......................................... 8
– Pharyngotonsillitis ................................................ 11

• Lower respiratory tract infections

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–  Acute bacterial bronchitis ...................................... 14

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–  Bacterial pneumonia ............................................. 17
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• Odontostomatological infections........................ 21
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• Skin and soft tissue infections............................. 23

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• Non-gonococcal urethritis
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(due to Chlamydia trachomatis).................................. 28

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• Chlamydial genital infections

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in women ............................................................... 31
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• Chancroid
(due to Haemophilus ducreyi)..................................... 33

• References.............................................................. 35
4 Upper respiratory tract infections

OTITIS MEDIA
DEFINITION AND ETIOLOGY
• Otitis media is an infection of the middle ear. The etiology
may be bacterial or viral.
• Otitis media is primarily a disease that occurs most often in
children, yet it can also affect adults.

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• 75% of children have at least one episode of otitis media

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by the time they are 3 years of age.
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• Nearly half of these children will have three or more
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episodes of otitis media by the time they are 3 years of age.
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CLINICAL PICTURE
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The symptoms most commonly associated with acute otitis

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media are:
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• Fever
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• Otalgia
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• Irritability
• Otorrhea
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• Drowsiness
• Anorexia and vomiting.

DIAGNOSIS
Acute otitis media is a purulent middle ear process: as such,
otoscopic signs and symptoms consistent with a purulent
middle ear effusion in association with systemic signs of illness
are required for diagnosis.

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Upper respiratory tract infections 5

INSTRUMENTAL DIAGNOSIS
Pneumatic otoscopy is the standard method for the diagnosis
of otitis media (Figure 1).

A B

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Figure 1.
A= Normal tympanic membrane (TM); B= Mild bulging of the
TM; C= Moderate bulging of the TM; D= Severe bulging of
the TM.

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6 Upper respiratory tract infections

THERAPY
Recommendations for the initial treatment of
uncom­plicated acute otitis media (AOM):

Age Otorrhea Unilateral Bilaterala Unilaterala

with or bilateral AOM without AOM without
a

AOM AOM with otorrhea otorrhea

severe
symptomsb

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6 months Antibiotic- Antibiotic- Antibiotic- Antibiotic-
to 2 y therapy therapy therapy
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or additional
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observation
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≥2 y Antibiotic- Antibiotic- Antibiotic- Antibiotic-

therapy therapy therapy therapy
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or additional or additional
observation observationc
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a
Applies only to children with well-documented AOM with high certainty of diagnosis.
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b
A toxic-appearing child, persistent otalgia >48 h, temperature ≥39 °C (102.2 °F) in the past 48 h, or if there
is uncertain access to follow-up after the visit.
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c
This plan of initial management provides a opportunity for shared decision-making with the child’s family
for those categories appropriate for additional observation. If observation is offered, a mechanism must be in
place to ensure follow-up and begin antibiotics if the child worsens or fails to improve within 48 to 72 h of
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AOM onset. (Lieberthal AS et al. 2013).

TREATMENT OF AOM
• The physician should prescribe antibiotics for bilateral
AOM to all children younger than 2 years, even without
severe symptoms (i.e. mild otalgia for less than 48 hours,
temperature <39 °C).

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Upper respiratory tract infections 7

• AZITHROMYCIN is indicated for the treatment of AOM in

children at a dose of 10 mg/kg/day for 3 consecutive days,
or 30 mg/kg as a single dose. Children weighing ≥45 kg
can assume the same dose as adults: 500 mg once daily
for 3 consecutive days.

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8 Upper respiratory tract infections

ACUTE BACTERIAL SINUSITIS

DEFINITION AND ETIOLOGY
• Acute rhinosinusitis is an inflammation of the mucous
membrane lining the paranasal sinuses, which can last for
up to 4 weeks.
• It can be caused by different etiological factors: allergens,

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environmental irritants, and viral, bacterial or fungal
infections.

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• Most cases of acute sinusitis are due to uncomplicated viral
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infections.
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CLINICAL PICTURE
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SYMPTOMS OF ACUTE BACTERIAL RHINOSINUSITIS

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MAJOR SYMPTOMS MINOR SYMPTOMS

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Facial pain (pressure or fullness) Headache

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Nasal obstruction Halitosis

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Purulent nasal discharge Fatigue

Discolored post-nasal discharge Dental pain
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Hyposmia/anosmia Cough
Ear pain/pressure

DIAGNOSIS
According to the Centers for Disease Control and Prevention
(CDC) recommendations, the diagnosis of acute bacterial
rhinosinusitis requires the presence of:

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Upper respiratory tract infections 9

• Symptoms lasting for 7 days, or more

• Purulent nasal discharge
and
• One of the following signs:
–– maxillary pain
–– facial tenderness (especially unilateral)
–– tooth tenderness (especially unilateral).

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INSTRUMENTAL DIAGNOSIS

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Radiological imaging is not required for the diagnosis of
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uncomplicated acute bacterial rhinosinusitis. When performed,
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radiological imaging must always be interpreted in the light of
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clinical findings, as radiographic images cannot differentiate

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bacterial infections from other infections, and changes in

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radiographic images can occur in viral upper respiratory tract

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infections.
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TREATMENT
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AZITHROMYCIN is indicated for the treatment of sinusitis,

at a dosage of 500 mg once daily for 3 consecutive days in
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adults, 10 mg/kg/day for 3 consecutive days in children.

KEY CLINICAL RECOMMENDATIONS

Since most acute sinusitis cases are caused by viral upper
respiratory tract infections, and because acute bacterial
rhinosinusitis and viral rhinosinusitis are difficult to differentiate,
the diagnosis of acute bacterial rhinosinusitis should be reserved
for patients with symptoms lasting 7 days or more.

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 DIAGNOSI STRUMENTALE
Non è richiesta la radiografia per la diagnosi di sinu
Quando eseguita, l’rx deve essere interpretata alla
10
(figura 1) 4. Upper respiratory tract infections

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Mucoperiosteal start=0&nd
thickening

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Mucoperiosteal
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Air-fluid levels
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Air-fluid levels
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Figura 1. P
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Figure 1.
Water’s projection. Air fluid levels and mucosal thickening in both
maxillary sinuses.
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Upper respiratory tract infections 11

PHARYNGOTONSILLITIS
DEFINITION AND ETIOLOGY
• Acute pharyngitis is one of the most common infections
encountered by pediatricians and family physicians.
• Most children with acute pharyngotonsillitis have symptoms
that can be attributed to infection with a respiratory virus,
such as adenovirus, influenza virus, parainfluenza virus,
rhinovirus, and respiratory syncytial virus (RSV). However, in

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approximately 30 to 40% of cases, acute pharyngotonsillitis

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is of bacterial etiology. G
• Group A Beta-Hemolytic Streptococcus (GABHS) is the
microorganism responsible for 37% of cases of acute
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pharyngitis in children older than 5 years. Other bacterial causes

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of pharyngitis are Group C Streptococcus (5% of total cases),

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C. pneumoniae (1%), M. pneumoniae (1%), and anaerobic

species (1%).
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Table 1.
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Signs and symptoms suggesting Group A Beta-Hemolytic

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Streptococcus (GABHS) pharyngitis, sensitivity and specificity.

SIGNS AND SYMPTOMS SENSITIVITY (%) SPECIFICITY (%)
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Absence of cough 51-79 36-68

Anterior cervical nodes
55-82 34-73
swollen or enlarged
Headache 48 50-80
Myalgia 49 60
Palatine petechiae 7 95
Pharyngeal exudates 26 88
Temperature >38 °C 22-58 52-92
Tonsillar exudates 36 85

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12 Upper respiratory tract infections

CLINICAL PICTURE
DIAGNOSIS
• Laboratory testing is not indicated in all patients with
pharyngitis.
Figure 1.

ALGORITHM FOR THE DIAGNOSIS OF BACTERIAL

(GABHS) PHARYNGOTONSILLITIS

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Factors suggesting GABHS Factors suggesting
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pharyngotonsillitis viral etiology

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• Epidemiology (eg, age) • Conjunctivitis

• Acute sore pain • Cough
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• Dysphagia • Anterior stomatitis

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• Pharyngeal erythema with

• Discrete ulcerative lesions
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exudate
• Diarrhea
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• Cervical lymphadenitis
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• Close contact with a case of • Rhinitis

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GABHS pharyngitis
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If Negative
Throat swab and rapid Throat
antigen detection test culture
If Negative

If Positive Symptomatic
Antibiotic therapy therapy

Algorithm for the diagnosis of GABHS pharyngotonsillitis: modified from IDSA Practice Guidelines

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Upper respiratory tract infections 13

• GABHS pharyngitis may be suspected on the basis of

clinical signs and symptoms.
TREATMENT
• Antibiotic therapy is recommended for streptococcal
pharyngitis (I-A).
• When selecting an appropriate antimicrobial agent, it
is important to consider efficacy, safety, antimicrobial

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spectrum, dosage and mode of administration, as well as
treatment costs.
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• AZITHROMYCIN is indicated for the treatment of
pharyngitis at a dosage of 500 mg once daily for 3
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consecutive days in adults, 10 mg/kg/day for 3 days in

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children.
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• Ibuprofen and acetaminophen are recommended for the

relief of pain and fever associated with discomfort in
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children with acute pharyngotonsillitis (I-A).

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• There is no sufficient evidence to recommend any type of

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supportive therapy (aerosol therapy, mucolytics, antihistamines,

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antitussives, immunostimulants, and alternative therapies) in

children with acute pharyngitis (VI-E).
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