Macrolides
ATC code: J01FA10 (Azithromycin)
Binds the 50S ribosomal subunit and inhibits bacterial protein synthesis. Bacteriostatic at standard concentrations, bactericidal at high levels. Broad spectrum: gram-positive cocci, select gram-negatives, and atypical pathogens – Mycoplasma pneumoniae, Chlamydia trachomatis, Legionella pneumophila. Accumulates intracellularly, providing a prolonged effect after a short course.
First line
First-line when atypical etiology is suspected in community-acquired pneumonia – Mycoplasma, Chlamydophila, Legionella. Also used in penicillin-allergic patients. Per /ATS 2019, azithromycin is given as outpatient monotherapy in patients without comorbidities or combined with a beta-lactam.
Second line
Second-line for acute bacterial sinusitis. First-line is amoxicillin or amoxicillin-clavulanate. Macrolides are given in penicillin allergy, but growing pneumococcal macrolide resistance limits their use.
Second line
Per the current CDC STI Treatment Guidelines 2021, first-line for uncomplicated chlamydial infection is doxycycline 100 mg twice daily for 7 days (better eradication, especially in rectal chlamydia and LGV). Azithromycin 1 g single oral dose is an alternative when doxycycline cannot be used (pregnancy, intolerance). Eradication with the single dose exceeds 90 % but is lower than with doxycycline.
Second line
Second-line for streptococcal pharyngitis, indicated only when the patient has a penicillin allergy. A 5-day course is standard. Penicillin V or amoxicillin remain first-choice per 2012.
1 pair found. Sorted from critical to minor.
Mechanism
Аддитивное удлинение QT-интервала, риск Torsades de Pointes.
Management
ЭКГ исходно и на 2–3-й день, контроль электролитов. У пожилых с CV-патологией – избегать.
FDA category B. Observational data have not shown an increased risk of congenital anomalies. Used when the benefit outweighs potential risk.
azithromycin is evaluated for the following indications with varying evidence strength: Community-acquired pneumonia (evidence tier A), Streptococcal pharyngitis (evidence tier B), Acute bacterial rhinosinusitis (evidence tier B). See the full indication matrix with dosing and citations above on this page.
Common side effects of azithromycin (≥ 1 in 100): Diarrhea, Nausea, Abdominal pain, Flatulence. See the Safety section for uncommon and serious reactions.
FDA category B. FDA category B. Observational data have not shown an increased risk of congenital anomalies. Used when the benefit outweighs potential risk.
azithromycin is contraindicated in: Hypersensitivity to macrolides; Severe hepatic impairment. Full list in the Safety section.