Neonatal Drug Therapy Manual

Azithromycin

Disclaimer: Official controlled document is the CHEO and Ottawa Hospital online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Updated March 5, 2024 - 2:32pm

Alternate Name(s): 
Zithromax
Classification: 
Macrolide Antibiotic
Original Date: 
December 2016
Indications: 
  • Treatment of infections due to susceptible organisms including Bordetella pertussis and Chlamydia trachomatis
Administration: 
  • IV intermittent infusion: over 1 hour
    • Intravenous administration should only be considered when oral therapy not suitable
  • PO
Dosage: 

IV/PO

  • 10 mg/kg/dose once daily for 5 days
Side Effects: 
  • CVS: ventricular arrhythmia, prolongation of QTc interval, bradycardia
  • GI: diarrhea, vomiting, infantile hypertrophic stenosis (extremely rare)
  • Hematologic: anemia, leukopenia, thrombocytopenia
  • Hepatic: cholestatic hepatitis, jaundice, LFT's increased
  • Local: venous irritation, inflammation (with IV administration)
  • Renal: interstitial nephritis
Parameters to Monitor: 
  • Liver function tests
  • WBC with differential
  • Injection site
Reconstitution and Stability: 
  • Azithromycin 500 mg vial
    • Add 4.8 mL of SWFI
    • Take 1 mL (100 mg) and add to 49 mL D5W
    • Final concentration: 2 mg/mL*

* Infusion of Azithromycin with a concentration greater than 2 mg/mL will result in a local infusion site reaction and should be avoided.

Compatibility: 

- Solutions Compatible: D5W, 0.45%NaCl, 0.9%NaCl, D5W/0.45%NaCl, D5W/0.9%NaCl

- Y-site Compatible (when azithromycin is diluted in D5W): calcium gluconate, cefotaxime (up to 20 mg/mL), dobutamine, dopamine, epinephrine (up to 50 mcg/mL), fentanyl, gentamicin, heparin, morphine, potassium chloride, tobramycin

Incompatible: midazolam

Notes: 
  • Oral bioavailability of the oral suspension is increased by feeds
References: 

- Taketomo CK, Hodding JH, Kraus DM. Pediatric Dosage Handbook 22nd Edition. Hudson: Lexi-Comp Inc;2015

- Pickering LK, ed 2012 Red Book: Report of the Committee on Infectious Diseases. Elk Grove Village, IL: American Academy of Pediatrics; 2012

- American Society of Health-System Pharmacists (ASHP).  Handbook on Injectable Drugs. 19th Edition, Bethesda: ASHP 2017

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