Azithromycin

A Drug Study Presented to the Nursing Department to San Pedro College

In Partial Fulfillment of the Requirements in NCM 207 – RLE
PEDIATRIC ROTATION

Submitted to:
Rodeliza Faith Guillermo, RN, MN
Clinical Instructor

Submitted by:
Shaina Alyssa C. Mentang, St.N
BSN 2B - group 2 – Subgroup 2

May 12, 2022

Generic Name: Azithromycin

Brand Name: Zithromax, Zmax

Drug Classification:
Therapeutic: agents for atypical mycobacterium, anti-infectives
Pharmacologic: macrolides

Mechanism of Action: Binds to ribosomal receptor sites of

susceptible organisms, inhibiting RNAdependent protein synthesis.
Therapeutic Effect: Bacteriostatic or bactericidal, depending on drug dosage.

Indications: Treatment of the following infections due to susceptible organisms: Upper

respiratory tract infections, including streptococcal pharyngitis, acute bacterial exacerbations of
chronic bronchitis and tonsillitis, Lower respiratory tract infections, including bronchitis and
pneumonia, Acute otitis media, Skin and skin structure infections, Nongonococcal urethritis,
cervicitis, gonorrhea, and chancroid. Prevention of disseminated Mycobacterium avium complex
(MAC) infection in patients with advanced HIV infection. Extended-release suspension (ZMax)
Acute bacterial sinusitis and community-acquired pneumonia in adults. Unlabeled Use:
Prevention of bacterial endocarditis. Treatment of cystic fibrosis lung disease. Treatment and
post-exposure prophylaxis of pertussis in infants.
Suggested Dosage:
Usual Dosage Range
PO: CHILDREN 6 MOS AND OLDER: 5–12 mg/kg (maximum: 500 mg) once daily or 30
mg/kg (maximum: 1,500 mg) as single dose. (Zmax): 60 mg/kg as a single dose. NEONATES:
10–20 mg/kg once daily. IV: ADULTS, ELDERLY: 250–500 mg once daily CHILDREN,
NEONATES: 10 mg/kg once daily.

MAC Prevention
PO: CHILDREN: 20 mg/kg once weekly. Maximum: 1,200 mg/dose or 5 mg/kg once daily.
Maximum: 250 mg/dose.

MAC Treatment
PO: CHILDREN: 10–12 mg/kg/day (maximum: 500 mg) with ethambutol.

Otitis Media
PO: CHILDREN 6 MOS AND OLDER: 30 mg/kg as single dose (maximum: 1,500 mg) or 10
mg/kg/day for 3 days (maximum: 500 mg) or 10 mg/kg on day 1 (maximum: 500 mg), then 5
mg/kg on days 2–5 (maximum: 250 mg). Pharyngitis, Tonsillitis
PO: ADULTS, ELDERLY, CHILDREN: 12 mg/kg (maximum: 500 mg) on day 1, then 6 mg/kg
(maximum: 250 mg) on days 2–5.
Dosage in Renal/Hepatic Impairment
Use caution.

Contraindication:
Contraindicated in: Hypersensitivity to azithromycin, erythromycin, or other macrolide anti-
infectives; History of cholestatic jaundice or hepatic dysfunction with prior use of azithromycin;
QT interval prolongation, hypokalemia, hypomagnesemia, or bradycardia; Concurrent use of
quinidine, procainamide, dofetilide, amiodarone, or sotalol. Use Cautiously in: Severe liver
impairment (dose adjustment may be required); Severe renal impairment (CCr 10 mL/min);
Myasthenia gravis (may worsen symptoms); Geri: May haveqrisk of QT interval prolongation;
OB, Lactation:Safety not established; Pedi: Neonates (qrisk of infantile hypertrophic pyloric
stenosis at up to 42 days of life).

Side Effects: Occasional: Systemic: Nausea, vomiting, diarrhea, abdominal pain. Ophthalmic:
Eye irritation. Rare: Systemic: Headache, dizziness, allergic reaction.

Adverse Effects: Antibiotic-associated colitis, other superinfections may result from altered
bacterial balance in GI tract. Acute in terstitial nephritis, hepatotoxicity occur rarely

Drug Interaction: DRUG: Allopurinol may increase activity, toxicity. May increase
immunosuppressive effect of baricitinib, fingolimod, mercaptopurine. May decrease the
therapeutic effect of BCG (intravesical), vaccines (live). May increase adverse effects of
natalizuma vaccines (live). HERBAL: Echinacea may diminish therapeutic effect. FOOD: None
known. LAB VALUES: May decrease Hgb, serum albumin, uric acid, leukocytes, platelet count.
May increase serum ALT, AST, alkaline phosphatase, amylase, bilirubin.

Nursing Responsibilities:
1. Administer on an empty stomach 1 hr before or 2–3 hr after meals.
R: Food affects the absorption of this drug.
2. Instruct patients to take medication as directed and to finish the drug completely, even if
they are feeling better. Take missed doses as soon as possible unless almost time for next
dose; do not double doses.
R: The medication may not be as effective as it is expected to be if there are missed doses, and
double doses may overdose the patient.
3. Advise patient to use sunscreen and protective clothing.
R: This is to prevent photosensitivity reactions.
4. Instruct the mother of patient to notify health care professional if fever and diarrhea develop,
especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without
advice of health care professional.
R: Diarrhea is common with antibiotics. Rarely, a severe form called C diff–associated diarrhea
(CDAD) may happen. Sometimes, this has led to a deadly bowel problem. CDAD may happen
during or a few months after taking antibiotics.
5. Monitor patient for signs of anaphylaxis.
 R: This can be life-threatening and requires immediate medical attention
6. Monitor signs like red, swollen, blistered, or peeling skin (with or without fever); red or
irritated eyes; or sores in your mouth, throat, nose, or eyes.
R: A severe skin reaction (Stevens-Johnson syndrome/toxic epidermal necrolysis) may happen.
It can cause severe health problems that may not go away, and sometimes death.
7. Advise the mother of patient to inform the physician if vision problems occur in the child.
R: Extremely low blood pressure causing lightheadedness, dizziness, blurred vision, or loss of
consciousness (passing out) also occurs commonly.
8. Emphasize the importance of follow-up exams and lab tests
R: This is to monitor the patient’s condition and determine if there are further interventions
needed to be done.

REFERENCES:

Davis’s Drug Guide for Nurses. (2022) Vincristine. Retrieved from:

https://nursing.unboundmedicine.com/nursingcentral/view/Davis-Drug-
Guide/109802/all/vincristine_liposome#5

Kizior, R.J. (2019). Saunders Nursing Drug Handbook. Pp. 1219-1221. Illinois: Elsevier. MIMS.
(2022). Vincristine. Retrieved from:
https://www.mims.com/philippines/drug/info/vincristine%20sulfate?mtype=generic
Memorial Sloan Kettering Cancer Center. (n/d). Azithromycin. Retrieved from:
https://www.mskcc.org/cancer-care/patient-education/azithromycin-systemic-01
Reference:

Anonymous (2020) Everyday health Retrieved from:

https://www.everydayhealth.com/drugs/penicillin-g-
benzathine?fbclid=IwAR3qmtZDcParb4zSUSJHTNDqtVkXKHoMI-
3Ri7qjhSbGExfUV4XEndFVz5A

William A. Gartlan et al (2021) Benzathine Penicillin Retrieved from:

https://www.ncbi.nlm.nih.gov/books/NBK507723/?fbclid=IwAR2PktwU2nIyEE6Mdqz8Fv4uZU1
04Bqtim2_t9eaym9hTggUQB9ybkDRNm0

Drug Handbook 2021