azithromycin Nursing Considerations & Management

Drug Name

Generic Name: azithromycin

Brand Name:  Zithromax, Zmax

Classification: Macrolide

Pregnancy Category B

Dosage & Route
  • 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 transpeptidation by binding to 50s ribosomal subunit of susceptible organisms and disrupting RNA-dependent protein synthesis at the chain elongation step.
  • 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 > 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
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.
  • Contraindicated with hypersensitivity to azithromycin, erythromycin, or any macrolide antibiotic.
  • Use cautiously with gonorrhea or syphilis, pseudomembranous colitis, hepatic or renal impairment, lactation.
Nursing considerations
  • 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
  • Culture site of infection before therapy.
  • Administer on an empty stomach 1 hr before or 2–3 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
  • 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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