Not recommended for first-line use; use in the rare circumstance of sustained ciprofloxacin-resistance in a community. Mobocertinib: (Major) Concomitant use of mobocertinib and azithromycin increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. 1 g PO once weekly or 500 mg PO once daily for at least 3 weeks and until all lesions have completely healed. 20 mg/kg/dose (Max: 1 g/dose) PO as a single dose. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Case reports indicate that QT prolongation and TdP can occur during donepezil therapy. Voriconazole has been associated with prolongation of the QT interval and rare cases of arrhythmias, including TdP. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. 10 to 20 mg/kg/dose (Max: 500 mg/dose) PO once daily for 7 days. Midostaurin: (Major) Concomitant use of midostaurin and azithromycin increases the risk of QT/QTc prolongation and torsade de pointes (TdP). 250 to 500 mg PO 3 days per week has been recommended to reduce the incidence of asthma exacerbations in patients with severe asthma who are optimized on inhaled corticosteroids/long-acting beta agonist therapy but who continue to have exacerbations. Antacids: (Moderate) Separate administration of immediate-release azithromycin and aluminum- and magnesium-containing antacids by 2 hours. To provide azithromycin over a concentration range of 1.0 - 2.0 mg/mL, transfer 5 mL of the 100 mg/mL azithromycin solution into the appropriate amount of any of the diluents listed below: Normal Saline (0.9% sodium chloride) One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. [34362], 10 to 12 mg/kg/dose (Max: 500 mg/dose) PO once daily as part of combination therapy as an alternative. Prolongation of the QTc interval and ventricular arrhythmias have been reported in patients treated with ivosidenib. Androgen deprivation therapy (i.e., degarelix) may prolong the QT/QTc interval. document.write(new Date().getFullYear()) PDR, LLC. The geriatric population may respond with a blunted natriuresis to salt loading. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. The likelihood of QTc prolongation may increase with increasing dose of the drug; therefore, the recommended dose should not be exceeded especially in patients with renal or hepatic impairment where the Cmax and AUC are slightly higher. 1 g PO once daily for 1 day, followed by 500 mg to 1 g PO once daily for 5 to 10 days. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available. If use together is medically necessary, obtain an ECG at baseline to assess initial QT interval and determine frequency of subsequent ECG monitoring, avoid any non-essential QT prolonging drugs, and correct electrolyte imbalances. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. [43975]Oral suspension (extended-release, bottles for reconstitution):Extended-release oral suspension (2 grams azithromycin) should be taken as a single dose at least 1 hour before or 2 hours after a meal.If a patient vomits within 5 minutes of the dose, the manufacturer recommends additional antibiotic treatment due to minimal absorption of the azithromycin dose. Napumpujte ho antioxidantmi a vitamnmi! [34361] [34362] [46963]. Following the oral administration of a single 1,000 mg dose of azithromycin, mean C max and AUC 0-120 increased by 5.1% and 4.2%, respectively in subjects with mild to moderate renal impairment (GFR 10 to 80 mL/min) compared to subjects with normal renal function (GFR >80 mL/min). Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. 500 mg PO once daily for 7 days. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. If use together is necessary, obtain an ECG at baseline to assess initial QT interval and determine frequency of subsequent ECG monitoring, avoid any non-essential QT prolonging drugs, and correct electrolyte imbalances. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. TdP and ventricular tachycardia have been reported with anagrelide. Consider adding a second antibiotic if lesions do not respond within the first few days of therapy. Norethindrone Acetate; Ethinyl Estradiol; Ferrous fumarate: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. 10 mg/kg/dose (Max: 500 mg/dose) PO on day 1, followed by 5 mg/kg/dose (Max: 250 mg/dose) PO once daily for at least 3 months as an alternative. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. Consider an initial 6-month trial. Relugolix: (Major) Concomitant use of relugolix and azithromycin increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. ZITHROMAX for injection should not be given as a bolus or as an intramuscular injection. Coadminister pravastatin and azithromycin cautiously due to a potential increased risk of myopathies. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. Posaconazole: (Major) Concomitant use of posaconazole and azithromycin increases the risk of QT/QTc prolongation and torsade de pointes (TdP). The total sodium content from dietary and non-dietary sources may be clinically important with regard to such diseases as congestive heart failure. [43974]Intravenous infusion:Do not administer intramuscularly or via IV bolus.Other intravenous substances, additives, or medications should not be added to azithromycin or infused simultaneously through the same IV line.For a dose of 500 mg in 250 mL (concentration = 2 mg/mL), infuse over 1 hour. [34362] [46963] FDA-approved labeling recommends IV therapy for at least 2 days then step-down to oral therapy to complete a 7- to 10-day treatment course. 500 mg PO on day 1, followed by 250 mg PO once daily for 4 days. 20 mg/kg/ dose daily IV for 3 days . Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. [27500], hyperkalemia / Delayed / 1.0-2.0pleural effusion / Delayed / 0-1.0uveitis / Delayed / 0-1.0eczema vaccinatum / Delayed / 0-1.0angioedema / Rapid / 0-1.0bronchospasm / Rapid / 0-1.0keratitis / Delayed / 0-1.0corneal erosion / Delayed / 0-1.0visual impairment / Early / 0-1.0lymphoma / Delayed / 0-1.0leukemia / Delayed / 0-1.0azotemia / Delayed / 0-1.0pancreatitis / Delayed / Incidence not knownhepatic necrosis / Delayed / Incidence not knownhepatic failure / Delayed / Incidence not knownC. Ophthalmic RouteThe systemic concentration of azithromycin after ocular administration is estimated to be below quantifiable limits (10 ng/mL or less). If use together is necessary, obtain an ECG at baseline to assess initial QT interval and determine frequency of subsequent ECG monitoring, avoid any non-essential QT prolonging drugs, and correct electrolyte imbalances. Initiate droperidol at a low dose and increase the dose as needed to achieve the desired effect. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. These highlights do not include all the You may also contact the U.S. Food and Drug Administration (FDA) directly to report adverse events or product quality concerns either online at. TdP, QT interval prolongation, and complete atrioventricular block have been reported with arsenic trioxide use. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available. Any antibiotic may cause diarrhea, nausea, vomiting, anorexia, and hypersensitivity reactions. [28855] Due to the high rate of resistance among S. pneumoniae isolates, macrolides are not recommended as empiric therapy. Dronedarone: (Contraindicated) Avoid concomitant use of dronedarone and azithromycin due to an increased risk for torsade de pointes (TdP) and QT/QTc prolongation. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. They may downregulate inflammatory responses and reduce the excessive cytokine production associated with respiratory viral infections; however, their direct effects on viral clearance are uncertain. 20 mg/kg/dose PO once daily for 3 days as an alternative. If coadministration is unavoidable, obtain an ECG and serum electrolytes prior to the start of treatment, after treatment initiation, and periodically during treatment. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. 12 mg/kg/dose PO once daily for 5 days as an alternative in patients allergic to penicillin. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. 3 DOSAGE FORMS AND STRENGTHS ZITHROMAX for injection is supplied as white to off-white lyophilized powder in a single-dose vial equivalent to 500 mg of azithromycin for intravenous administration. The timing of the switch to oral therapy should be done at the discretion of the physician and in accordance with clinical response. Most of the side effects that led people to stop taking the drug were gastrointestinal, such as . Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. 500 to 1,000 mg PO once daily for a total treatment duration of at least 7 to 10 days; duration may need to be extended in these patients. QT prolongation and torsade de pointes (TdP) have been spontaneously reported during azithromycin postmarketing surveillance. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. If use together is necessary, obtain an ECG at baseline to assess initial QT interval and determine frequency of subsequent ECG monitoring, avoid any non-essential QT prolonging drugs, and correct electrolyte imbalances. If use together is necessary, obtain an ECG at baseline to assess initial QT interval and determine frequency of subsequent ECG monitoring, avoid any non-essential QT prolonging drugs, and correct electrolyte imbalances. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. QT prolongation and torsade de pointes (TdP) have been spontaneously reported during azithromycin postmarketing surveillance. Bismuth Subsalicylate; Metronidazole; Tetracycline: (Major) Concomitant use of metronidazole and azithromycin increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Triptorelin: (Major) Concomitant use of triptorelin and azithromycin increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Pentamidine: (Major) Concomitant use of pentamidine and azithromycin increases the risk of QT/QTc prolongation and torsade de pointes (TdP). 10 mg/kg/dose (Max: 500 mg/dose) PO once daily for 1 day, followed by 5 mg/kg/dose (Max: 250 mg/dose) PO once daily for at least 7 to 10 days; duration may need to be extended in these patients. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. The pharmacodynamic interaction potential to prolong the QT interval of the electrocardiogram between lefamulin and other drugs that effect cardiac conduction is unknown. Sevoflurane: (Major) Avoid coadministration of azithromycin with halogenated anesthetics due to the increased risk of QT prolongation. Clozapine: (Major) Avoid coadministration of azithromycin with clozapine due to the increased risk of QT prolongation. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. Fluoxetine: (Major) Concomitant use of azithromycin and fluoxetine increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Primaquine: (Major) Concomitant use of primaquine and azithromycin increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. If use together is necessary, obtain an ECG at baseline to assess initial QT interval and determine frequency of subsequent ECG monitoring, avoid any non-essential QT prolonging drugs, and correct electrolyte imbalances. [28855] Because macrolides have limited efficacy against both H. influenzae and S. pneumoniae, these agents are not included in guidelines. 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