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.
Indications
- 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.
Contraindications
- 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
Assessment
- 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
Interventions
- 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.