AzithromycinNursing considerations

Side effects by what to assess

Sources: [1][2][3][4][5][6][7][8][9][10][11]

ALT (liver enzyme)

Why

Hepatotoxicity

When

If signs of hepatitis appear

Act on

Stop azithromycin if hepatitis develops

Normal

4 to 36 U/L.

Sources: [1][2]

ECG (rhythm and QT interval)

Why

QT prolongation

When

In patients with QT risk factors or on other QT-prolonging drugs

Act on

Weigh risks against benefits with known QT prolongation

Sources: [1]

INR (prothrombin time)

Why

Enhanced warfarin effect

When

During combined use

Act on

Monitor prothrombin time carefully

Normal

INR 0.8 to 1.1 when not on a blood thinner. On warfarin, the usual target is 2.0 to 3.0.

Sources: [1][2]

Magnesium

Why

Uncorrected hypomagnesemia raises torsades risk

When

In patients at risk for arrhythmia

Normal

1.7 to 2.2 mg/dL.

Sources: [1][2]

Potassium

Why

Uncorrected hypokalemia raises torsades risk

When

In patients at risk for arrhythmia

Normal

3.7 to 5.2 mEq/L.

Sources: [1][2]

High-alert status

Azithromycin is not on the ISMP acute care high-alert list.

Sources: [1]

Narrow therapeutic index

The label does not describe a narrow therapeutic index or direct dosing by measured blood levels of the drug.

Sources: [1][2]

Boxed warning

None on the current oral or IV Zithromax labels.

Sources: [1][2]

Antidote or reversal

No antidote. Overdose causes mainly nausea, diarrhea, and vomiting; give symptom-based supportive care.

Sources: [1]

Patient teaching

• Take with or without food
• Do not take aluminum or magnesium antacids at the same time
• Stop and call the prescriber at any sign of an allergic reaction
• Parents: call if an infant has vomiting, irritability with feeding, diarrhea, or rash
• Watery or bloody stools, even 2 or more months later, need prompt medical attention
• Finish the full course even after feeling better; it does not treat viral infections

Sources: [1]

Sound-alike and look-alike names

None listed in the ISMP list of confused drug names.

Sources: [1]

Adult dose

Community-acquired pneumonia (oral), second-line pharyngitis, uncomplicated skin infection

500 mg once on Day 1, then 250 mg daily on Days 2 to 5.

Acute bacterial exacerbation of chronic bronchitis

500 mg daily for 3 days, or the 5-day regimen above.

Acute bacterial sinusitis

500 mg daily for 3 days.

Non-gonococcal urethritis or cervicitis; chancroid

Single 1 gram dose.

Gonococcal urethritis or cervicitis

Single 2 gram dose.

Community-acquired pneumonia, IV

500 mg IV daily for at least 2 days, then 500 mg by mouth daily to complete 7 to 10 days in total.

Pelvic inflammatory disease, IV

500 mg IV daily for 1 or 2 days, then 250 mg by mouth daily to complete 7 days.

Sources: [1][2][3]

Renal adjustment

No dose adjustment is given. Exposure barely changes with GFR 10 to 80 mL/min; with GFR below 10, peak level and AUC rose by 61% and 35%.

Sources: [1]

Hepatic adjustment

No dose adjustment is given; pharmacokinetics in hepatic impairment have not been established. Azithromycin is mainly cleared in bile. Contraindicated after prior azithromycin-related cholestatic jaundice.

Sources: [1][2]

Mechanism

Binds the 23S rRNA of the bacterial 50S ribosomal subunit, blocking protein synthesis and assembly of the subunit. It is cross-resistant with erythromycin; resistance usually comes from methylation of the ribosomal target. It is taken up widely into tissues and released slowly, giving a terminal half-life of about 68 hours.

Sources: [1][2]