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Azithromycin (Zithromax ®)
Usual oral dose: 500mg x 1, then 250mg po qd x 4 days.
Chlamydia: 1 gram po x 1.
MAC prevention: 1200mg once a week.
Uncomplicated gonococcal infection: 2 grams po x 1.
CAP: 500mg IV qd x 2 days or more then 500mg po qd.
PID: 500mg IV x 1-2days, then 250mg (IV/PO) for total of 7 days.
Mild to moderate respiratory tract, skin, and soft tissue infections: 500 mg orally in a single loading dose on day 1 followed by 250 mg/day as a single dose on days 2-5. Alternative regimen: Bacterial exacerbation of COPD: 500 mg/day for a total of 3 days
Bacterial sinusitis: 500 mg orally once daily x 3 days.
Extended release suspension (Zmax): 2 grams x 1.
Oral (Zmax™): 2 g as a single dose.
I.V.: 500 mg IV qd at least 2 days, then 500 mg orally ( to complete a 7 to 10 day course of therapy).
Due to C. trachomatis: 1 gram orally x 1.
Due to N. gonorrhoeae: 2 grams orally x 1.
Chancroid due to H. ducreyi: 1 gram orally x 1.
Pelvic inflammatory disease (PID): 500 mg IV qd x 1-2 days, then 250 mg orally once daily to complete a 7 day course of therapy.
Disseminated MAC disease in patient with advanced HIV infection: Prophylaxis: 1200 mg orally once weekly (may be combined with rifabutin). Treatment: 600 mg orally once daily in combination with ethambutol 15 mg/kg.
Endocarditis, prophylaxis (unlabeled use): Oral: 500 mg 1 hour prior to the procedure
Pertussis (CDC guidelines): Oral: 500 mg on day 1 followed by 250 mg/day on days 2-5 (maximum: 500 mg/day)
Renal Dosing: No adjustments required in renal failure. Hemodialysis: No adjustments required in renal failure.
Tablet: 250 mg, 500 mg, 600 mg.
Zithromax® TRI-PAK - 500 mg (Unit dose package: 3 tabs)
Zithromax® Z-PAK - 250 mg (Unit dose package: 6 tabs)
Oral Suspension: 100 mg/5 ml (15 ml); 200 mg/5 ml (15 ml, 22.5 ml, 30 ml) ; 1 gram - single dose packet. Zmax: 2 gram single-dose bottle (extended release formulation).
Injection (powder for reconstitution): 500mg vial.
Clarithromycin (Biaxin ® )
Usual dosage range: Oral: 250-500 mg every 12 hours or 1000 mg (two 500 mg extended release tablets) once daily for 7-14 days.
Acute exacerbation of chronic bronchitis:
M. catarrhalis and S. pneumoniae: 250 mg every 12 hours for 7-14 days or 1000 mg (two 500 mg extended release tablets) once daily for 7 days.
H. influenzae: 500 mg every 12 hours for 7-14 days or 1000 mg (two 500 mg extended release tablets) for 7 days.
H. parainfluenzae: 500 mg every 12 hours for 7 days or 1000 mg (two 500 mg extended release tablets) for 7 days.
Acute maxillary sinusitis: Oral: 500 mg every 12 hours or 1000 mg (two 500 mg extended release tablets) once daily for 14 days.
Endocarditis, prophylaxis: Oral: 500 mg 1 hour prior to procedure
Mycobacterial infection (prevention and treatment): Oral: 500 mg twice daily (use with other antimycobacterial drugs, eg, ethambutol or rifampin)
Peptic ulcer disease: Eradication of Helicobacter pylori: Oral: Dual or triple combination regimen with bismuth subsalicylate, tetracycline, clarithromycin, and an H2-receptor; or combination of omeprazole and clarithromycin; 500 mg every 8-12 hours for 10-14 days.
Pertussis (CDC guidelines): Oral: 500 mg twice daily for 7 days
Pharyngitis, tonsillitis: Oral: 250 mg every 12 hours for 10 days.
C. pneumoniae, M. pneumoniae, and S. pneumoniae: 250 mg every 12 hours for 7-14 days or 1000 mg (two 500 mg extended release tablets) once daily for 7 days.
H. influenzae: 250 mg every 12 hours for 7 days or 1000 mg (two 500 mg extended release tablets) once daily for 7 days.
Skin and skin structure infection, uncomplicated: Oral: 250 mg every 12 hours for 7-14 days.
[CRCL >30 ]: No changes.
[<30 ]: Half the normal dose or double the dosing interval.
Hemodialysis: 250 mg q12-24 hours. Schedule dose after HD on dialysis days.
Granules for oral suspension:
Biaxin®: 125 mg/5 mL, 250 mg/5 mL
Tablet: 250 mg, 500 mg
Biaxin®: 250 mg, 500 mg
Tablet, extended release:
Biaxin® XL: 500 mg
ADMINISTRATION — Clarithromycin may be given with or without meals. Give every 12 hours rather than twice daily to avoid peak and trough variation.
Biaxin® XL: Should be given with food. Do not crush or chew extended release tablet.
(Oral): 500mg to 1g po q12h or 250mg to 1gm q6h.
(IV ): 250mg to 1 gm q6h. Max 4 grams/day.
Children and Adults:
Ophthalmic: Instill 1 /2" (1.25 cm) 2-6 times/day depending on the severity of the infection
Topical: Apply over the affected area twice daily after the skin has been thoroughly washed and patted dry
Treatment of susceptible infections:
Base: 250-500 mg every 6-12 hours
Ethylsuccinate: 400-800 mg every 6-12 hours
I.V. (lactobionate): 15-20 mg/kg/day divided every 6 hours or 500 mg to 1 g every 6 hours, or given as a continuous infusion over 24 hours (maximum: 4 g/24 hours)
Preop bowel preparation: Oral: 1 g erythromycin base at 1, 2, and 11 PM on the day before surgery combined with mechanical cleansing of the large intestine and oral neomycin
Gastrointestinal prokinetic (unlabeled use): Erythromycin has been used as a prokinetic agent to improve gastric emptying time and intestinal motility. In adults, 200 mg was infused I.V. initially followed by 250 mg orally 3 times/day 30 minutes before meals. Lower dosages have been used in some trials.
[>10 ml/min]: No change.
[<10 ] 50-75% of usual dose at same interval. Max 2 grams/day. [Hemo]: 50-75% of usual dose at same interval. Max 2 grams/day. No supplement.
Capsule, delayed release, enteric-coated pellets, as base (Eryc®): 250 mg
Granules for oral suspension, as ethylsuccinate (E.E.S.®): 200 mg/5 mL (100 mL, 200 mL)
Injection, powder for reconstitution, as lactobionate (Erythrocin®): 500 mg, 1 g
Tablet, chewable, as ethylsuccinate (EryPed®): 200 mg [fruit flavor] [DSC]
Tablet, delayed release, enteric coated, as base (Ery-Tab®): 250 mg, 333 mg, 500 mg
Tablet [film coated], as base: 250 mg, 500 mg
Tablet [film coated], as ethylsuccinate (E.E.S.®): 400 mg
Tablet [film coated], as stearate: 250 mg
Erythrocin®: 250 mg, 500 mg
Tablet [polymer-coated particles], as base (PCE®): 333 mg, 500 mg
Listed dosages are for - Adult patients ONLY. PLEASE READ THE
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David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc.