Azicine

Rx

Indications

• Treatment of infections caused by susceptible organisms; in lower respiratory tract infections including bronchitis and pneumonia, in oral and dental infections, in skin and soft tissue infections, in acute otitis media and in upper respiratory tract infections including sinusitis and pharyngitis/tonsillitis.
• Treatment of uncomplicated genital infections due to Chlamydia trachomatis. It is also indicated in the treatment of chancroid due to Haemophilus ducreyi and uncomplicated genital infections due to non-multiresistant Neisseria gonorrhoeae.
• Prophylaxis against Mycobacterium avium-intracellulare complex (MAC) infection or use in combination with ethambutol for the treatment of disseminated MAC (DMAC) infection in patients with advanced HIV infection.

Dosage

Adults and children weighing > 45 kg

• Treatment of sexually transmitted diseases caused by
  Chlamydia trachomatis and Haemophilus ducreyi: 1000 mg as a single oral dose.
  Susceptible Neisseria gonorrhoeae: 1000 mg or 2000 mg of azithromycin + 250 mg or 500 mg ceftriaxone.
• In patients with advanced HIV infection:
  Prophylaxis against MAC infections: 1200 mg once per week.
  Treatment of DMAC infections: 600 mg once a day, in combination with other antimycobacterial agents against MAC.
• For all other indications:
  The total dosage of 1500 mg should be given as 500 mg daily for 3 days or for 5 days with 500 mg given on the first day, then 250 mg daily from 2^nd to 5^th day.

Children

• The maximum recommended total dose for any treatment is 1500 mg.
• For children weight > 45 kg: 3-day regimen: dose as per adults; 5-day regimen: dose as per adults.
• Azithromycin capsule should only be administered to children weighing more than 45 kg.

Elderly

• The same dosage as in adult patients is used in the elderly. Elderly patients may be more susceptible to the development of torsades de pointes arrhythmia than younger patients.

In patients with renal impairment

• No dose adjustment is necessary in patients with mild to moderate renal impairment (GFR 10 – 80 ml/min). Caution should be exercised when azithromycin is administered to patients with severe renal impairment (GFR < 10 ml/min).

In patients with hepatic impairment

• The same dosage as in patients with normal hepatic function may be used in patients with mild to moderate hepatic impairment.

Usage

• Azicine should be given as a single daily dose. Azithromycin capsules can be taken with or without food.

Known hypersensitivity to azithromycin, erythromycin, any macrolide or ketolide antibiotic, or to any of the excipients.

• Reversible hearing impairment (associated with prolonged use of high doses); nausea, vomiting, diarrhea, loose stools, abdominal discomfort (pain/cramps) and flatulence; abnormal liver function; allergic reactions including rash and angioedema; moniliasis and vaginitis.
• Prophylaxis for DMAC: Diarrhea, abdominal pain, nausea, loose stools, flatulence, vomiting, dyspepsia, rash, pruritus, headache and arthralgia.
• Treatment of DMAC infection for prolonged periods: Abdominal pain, nausea, vomiting, diarrhea, flatulence, headache, abnormal vision and hearing impairment.

• Use with caution in patients with severe hepatic/renal impairment.
• There were reports about:
  • Rare serious allergic reactions. If an allergic reaction occurs, the drug should be discontinued and appropriate therapy should be instituted. Physicians should be aware that reappearance of the allergic symptoms may occur when symptomatic therapy is discontinued.
  • Abnormal liver function, hepatitis, cholestatic jaundice, hepatic necrosis, and hepatic failure have been reported, some of which have resulted in death. Discontinue azithromycin immediately if signs and symptoms of hepatitis occur.
  • Acute exacerbations of the symptoms of myasthenia gravis.
  • Infantile hypertrophic pyloric stenosis (IHPS) in neonates (treatment up to 42 days of life), contact physician if vomiting or irritability with feeding occurs.
  • Clostridium difficile-associated diarrhea (CDAD) must be considered in all patients who present with diarrhea following antibiotic use. CDAD may range in severity from mild diarrhea to fatal colitis.
• Observation for signs of super infection with non-susceptible organisms, including fungi is recommended.
• Azithromycin and ergot derivatives should not be co-administered.
• Consider the risk of QT prolongation, which can be fatal when prescribe for at-risk groups including:
  • Patients with congenital or documented QT prolongation.
  • Patients currently receiving treatment with other active substances known to prolong QT interval, such as antiarrhythmics of Classes IA and III, antipsychotic agents, antidepressants, and fluoroquinolones.
  • Patients with electrolyte disturbance, particularly in cases of hypokalemia and hypomagnesemia.
  • Patients with clinically relevant bradycardia, cardiac arrhythmia or cardiac insufficiency.
  • Elderly patients.
• Azicine contains lactose. Patients with rare hereditary problems of galactose intolerance, total lactase deficiency or glucose-galactose malabsorption should not take this medicine.
• Azithromycin should be used during pregnancy only if clearly needed. Caution should be exercised when azithromycin is administered to a nursing woman.
• Patients should be aware of how they react to drug before driving or operating machinery.