• Basic Info
• Top Questions
• Clinical Info
• Interactions

Uses

Acute Otitis Media (AOM)

Treatment of AOM caused by H. influenzae, M. catarrhalis, or S. pneumoniae.

Not a drug of first choice; considered an alternative for patients with type I penicillin hypersensitivity. S. pneumoniae resistant to amoxicillin may also be resistant to azithromycin and the drug may not be effective for AOM that fails to respond to amoxicillin.

Pharyngitis and Tonsillitis

Treatment of pharyngitis or tonsillitis caused by susceptible Streptococcus pyogenes (group A β-hemolytic streptococci) when first-line therapy cannot be used. Often effective in eradicating susceptible S. pyogenes from the nasopharynx, but efficacy in the prevention of subsequent rheumatic fever has not been established to date.

CDC, AAP, IDSA, AHA, and others recommend oral penicillin V or IM penicillin G benzathine as treatments of choice; oral cephalosporins and oral macrolides are considered alternatives. Amoxicillin sometimes used instead of penicillin V, especially for young children.

Consider that strains of S. pyogenes resistant to macrolides are common is some areas of the world (e.g., Japan, Finland) and azithromycin-resistant strains have been reported in the US. (See Selection and Use of Anti-infectives under Cautions),

GI Infections

Treatment of symptomatic enteric infections caused by Campylobacter jejuni†. Recommended by CDC, NIH, IDSA, AAP, and others as a drug of choice.

Treatment of cryptosporidiosis† in HIV-infected adults, adolescents, or children. Anti-infectives may suppress the infection, but none has been found to reliably eradicate Cryptosporidium. CDC, NIH, IDSA, and others state that the most appropriate treatment for cryptosporidiosis in HIV-infected individuals is the use of potent antiretroviral agents (to restore immune function) and symptomatic treatment of diarrhea.

Treatment of shigellosis† caused by susceptible strains of Shigella dysenteriae, S. boydii, S. flexneri, or S. sonnei. Usual drugs of choice are fluoroquinolones (ciprofloxacin, levofloxacin, norfloxacin); alternatives are azithromycin, ampicillin, ceftriaxone, co-trimoxazole. Because of increasing resistance, select anti-infective based on susceptibility patterns of locally circulating Shigella.

Treatment of travelers’ diarrhea†. Generally self-limited and may resolve within 3–4 days without anti-infective treatment; if diarrhea is moderate or severe or associated with fever or bloody stools, short-term anti-infectives may be indicated. Fluoroquinolones (ciprofloxacin, levofloxacin, norfloxacin, ofloxacin) usually recommended. Azithromycin is an alternative in children, pregnant women, and those who do not respond to a fluoroquinolone within 48 hours; may be a drug of choice for travelers in areas with high prevalence of fluoroquinolone-resistant Campylobacter (e.g., Thailand, Nepal).

Treatment of diarrhea caused by enterotoxigenic Escherichia coli† (ETEC). Optimal therapy not established, but AAP and others suggest an anti-infective (e.g., azithromycin, co-trimoxazole, a fluoroquinolone) if diarrhea is severe or intractable and if causative organism is susceptible.

Treatment of dysentery caused by enteroinvasive E. coli† (EIEC). AAP suggests that an oral anti-infective (e.g., azithromycin, ciprofloxacin, co-trimoxazole) can be used if causative organism is susceptible.

Treatment of diarrhea associated with enteroaggregative E. coli† (EAEC). A drug of choice, especially in children with severe or persistent illness.

Role of anti-infectives in treatment of hemorrhagic colitis caused by shiga toxin-producing E. coli† (STEC; formerly known as enterohemorrhagic E. coli [EHEC] or verotoxin-producing E. coli) unclear; most experts do not recommend use of anti-infectives in children with enteritis caused by E. coli 0157:H7.

Respiratory Tract Infections

Treatment of acute bacterial sinusitis caused by susceptible Haemophilus influenzae, Moraxella catarrhalis, or Streptococcus pneumoniae.

Treatment of mild to moderate acute bacterial exacerbations of chronic obstructive pulmonary disease (COPD) caused by H. influenzae, M. catarrhalis, or S. pneumoniae.

Treatment of mild to moderate community-acquired pneumonia (CAP) caused by susceptible S. pneumoniae, H. influenzae, Mycoplasma pneumoniae, or Chlamydophila pneumoniae (Chlamydia pneumoniae) when oral therapy is indicated.

Treatment of CAP caused by susceptible C. pneumoniae, H. influenzae, M. catarrhalis, Legionella pneumophila, M. pneumoniae, Staphylococcus aureus, or S. pneumoniae when initial IV therapy is indicated.

Treatment of Legionnaires’ disease† caused by L. pneumophila. Drugs of choice are macrolides (usually azithromycin) or fluoroquinolones with or without rifampin.

Treatment of pertussis† caused by Bordetella pertussis. Erythromycin traditionally has been drug of choice for treatment and postexposure prophylaxis of pertussis, but other macrolides (azithromycin, clarithromycin) appear to be as effective and may be associated with better compliance because they are better tolerated.

Skin and Skin Structure Infections

Treatment of uncomplicated skin and skin structure infections caused by susceptible S. aureus, S. pyogenes, or S. agalactiae (group B streptococci).

Babesiosis

Treatment of babesiosis† caused by Babesia microti.

Regimens of choice for moderate to severe babesiosis are atovaquone in conjunction with azithromycin or quinine in conjunction with clindamycin; also consider exchange transfusions in severely ill patients with high levels of parasitemia (>10%).

Bartonella Infections

Treatment of infections caused by B. henselae† (e.g., cat scratch disease, bacillary angiomatosis, peliosis hepatitis). Cat scratch disease generally self-limited in immunocompetent individuals and may resolve spontaneously in 2–4 months; some clinicians suggest that anti-infectives be considered for acutely or severely ill patients with systemic symptoms, particularly those with hepatosplenomegaly or painful lymphadenopathy, and such therapy probably is indicated in immunocompromised patients. Anti-infectives also indicated in patients with B. henselae infections who develop bacillary angiomatosis, neuroretinitis, or Parinaud’s oculoglandular syndrome. Optimum regimens have not been identified; some clinicians recommend azithromycin, ciprofloxacin, erythromycin, doxycycline, rifampin, co-trimoxazole, gentamicin, or third generation cephalosporins.

Treatment of bacteremia caused by Bartonella quintana†; used in conjunction with ceftriaxone. Optimum anti-infective regimens have not been identified.

Chancroid

Treatment of chancroid (genital ulcers caused by Haemophilus ducreyi). Recommended by CDC and others as a drug of choice.

Safety and efficacy established in men (not women), but has been effective for and is recommended by CDC for treatment of chancroid in women†.

Chlamydial Infections

Treatment of uncomplicated urethritis and cervicitis caused by C. trachomatis. Recommended by CDC and others as a drug of choice for nongonococcal urethritis (NGU).

A drug of choice for presumptive treatment of coexisting chlamydial infection in patients being treated for gonorrhea.

Some clinicians suggest that azithromycin is a drug of choice for treatment of urogenital chlamydial infections in pregnant women.

Treatment of ocular trachoma†. A drug of choice.

Treatment of chlamydial pneumonia in infants or chlamydial conjunctivitis in neonates.

Alternative to tetracyclines for treatment of psittacosis† caused by C. psittaci, especially in children <8 years of age who should not receive tetracyclines.

Has been used to treat adults with CAD who have elevated anti-C. pneumoniae antibody titers† (a possible risk factor for MI or CAD) in an attempt to reduce recurrent ischaemic events; efficacy not proven to date.

Gonorrhea

Treatment of uncomplicated urethritis and/or cervicitis caused by susceptible strains of Neisseria gonorrhoeae.

Not recommended for routine treatment of gonorrhea. CDC and others state azithromycin can be used as an alternative for treatment of uncomplicated gonorrhea when fluoroquinolones are not recommended (e.g., gonorrhea was acquired in areas where quinolone-resistant N. gonorrhoeae [QRNG] reported) and the patient is hypersensitive to cephalosporins.

Granuloma Inguinale (Donovanosis)

Alternative for treatment of granuloma inguinale† (donovanosis) caused by Calymmatobacterium granulomatis. CDC recommends doxycycline or co-trimoxazole as drugs of choice.

Lyme Disease

Alternate for treatment of early Lyme disease†; IDSA, AAP, and others recommend doxycycline, amoxicillin, or cefuroxime; macrolides may be less effective than these first-line agents.

Mycobacterium avium Complex (MAC) Infections

Primary prevention (primary prophylaxis) of disseminated MAC infection in adults, adolescents, and children† with advanced HIV infection. Recommended by USPHS/IDSA as a drug of choice for primary prevention of MAC in HIV-infected patients; can be used alone or in conjunction with rifabutin.

Treatment of disseminated MAC infection in HIV-infected adults, adolescents, and children. ATS, CDC, NIH, IDSA, and others recommend a regimen of clarithromycin (or azithromycin) and ethambutol and state that consideration may be given to adding a third drug (preferably rifabutin). Clarithromycin usually the preferred macrolide for initial treatment; azithromycin can be substituted if clarithromycin cannot be used because of drug interactions or intolerance and is preferred in pregnant women.

Prevention of recurrence (secondary prophylaxis) of disseminated MAC infection in HIV-infected adults, adolescents, and children†. USPHS/IDSA, CDC, NIH, IDSA, and others recommend a macrolide (clarithromycin or azithromycin) given with ethambutol (with or without rifabutin).

Treatment of pulmonary MAC infections in HIV-negative patients†. A multiple-drug regimen of clarithromycin (or azithromycin), ethambutol, and either rifabutin or rifampin usually recommended.

Pelvic Inflammatory Disease

Treatment of acute pelvic inflammatory disease (PID) caused by C. trachomatis, Mycoplasma hominis, or N. gonorrhoeae when initial IV therapy is considered necessary. If anaerobic bacteria are suspected, an anti-infective active against anaerobes should be used in conjunction with azithromycin. Azithromycin not included in CDC recommendations for treatment of PID.

Syphilis

Alternative for treatment of primary, secondary, or early latent syphilis in nonpregnant adults and adolescents hypersensitive to penicillin†.

Penicillin G is drug of choice for treatment of all stages of syphilis, but CDC, NIH, and IDSA state azithromycin can be considered for treatment of primary, secondary, or early latent syphilis† in nonpregnant adults and adolescents hypersensitive to penicillin if close follow-up can be ensured.

Use with caution and only if close follow-up can be ensured; efficacy not well documented (especially in HIV-infected individuals) and treatment failures reported.

Toxoplasmosis

Treatment of infections caused by Toxoplasma gondii, including toxoplasmic encephalitis† in HIV-infected patients and ocular toxoplasmosis†; usually used in conjunction with pyrimethamine.

The CDC, NIH, IDSA, and others usually recommend pyrimethamine in conjunction with sulfadiazine and leucovorin for treatment of toxoplasmosis in adults and children, especially immunocompromised patients (e.g., HIV-infected individuals). Azithromycin in conjunction with pyrimethamine and leucovorin is one of several alternative regimens that can be considered in adults when the regimen of choice cannot be used; this regimen has not been evaluated in children.

Typhoid Fever and Other Salmonella Infections

Treatment of uncomplicated typhoid fever† caused by susceptible Salmonella. Drugs of choice are fluoroquinolones (e.g., ciprofloxacin, ofloxacin), especially in areas with multidrug-resistant S. typhi (strains resistant to ampicillin, amoxicillin, chloramphenicol, co-trimoxazole); azithromycin and third generation cephalosporins (cefotaxime, ceftriaxone, cefixime) are alternatives, especially for fluoroquinolone-resistant strains.

Prevention of Bacterial Endocarditis

Alternative for prevention of α-hemolytic (viridans group) streptococcal endocarditis† in penicillin-allergic individuals undergoing certain dental, oral, respiratory tract, or esophageal procedures who have cardiac conditions that put them at high or moderate risk.

Consult most recent AHA recommendations for specific information on which cardiac conditions are associated with high or moderate risk of endocarditis and which procedures require prophylaxis.

Prophylaxis in Sexual Assault Victims

Empiric anti-infective prophylaxis in sexual assault victims†; used in conjunction with IM ceftriaxone and oral metronidazole.