Azithromycin is a widely prescribed macrolide antibiotic commonly known as Zithromax or Z-pak. It is used to treat various bacterial infections and has become one of the most frequently prescribed antibiotics in clinical practice. This comprehensive guide covers essential nursing considerations, patient teachings, and clinical information about azithromycin.
Generic and Brand Names
Generic name: Azithromycin
Brand names: Zithromax, AzaSite, Zmax, Azasite, Z-pak
Classification
Pharmacologic class: Macrolide antibiotic
Therapeutic class: Anti-infective, Antimicrobial
Mechanism of Action
Azithromycin binds to the 50S ribosomal subunit of susceptible bacteria, inhibiting bacterial protein synthesis. This action prevents bacteria from growing and multiplying, allowing the body’s immune system to eliminate the infection. Unlike some bactericidal antibiotics, azithromycin is generally bacteriostatic.
Indications for Use
- Upper respiratory tract infections
- Lower respiratory tract infections
- Skin and soft tissue infections
- Sexually transmitted infections
- Otitis media
- Community-acquired pneumonia
- Pharyngitis/tonsillitis
- Sinusitis
- Bronchitis
Precautions and Contraindications
- Hypersensitivity to azithromycin or any macrolide antibiotics
- Severe liver disease
- History of cholestatic jaundice/hepatic dysfunction
- Patients with prolonged QT interval
- Myasthenia gravis (may worsen symptoms)
- Pregnancy category B
- Use with caution in nursing mothers
Drug Interactions
- Antacids containing aluminum or magnesium
- Ergot derivatives
- Warfarin and other anticoagulants
- Digoxin
- Nelfinavir
- Statins (increased risk of myopathy)
- Other QT-prolonging medications
Adverse Effects
Common:
- Gastrointestinal disturbances (nausea, vomiting, diarrhea)
- Abdominal pain
- Headache
- Dizziness
Serious:
- QT interval prolongation
- Severe allergic reactions
- Hepatotoxicity
- Clostridium difficile-associated diarrhea
- Stevens-Johnson syndrome (rare)
- Hearing loss or tinnitus (rare)
Administration Guidelines
Available preparations:
- Oral tablets (250mg, 500mg, 600mg)
- Oral suspension
- Extended-release suspension
- IV formulation
- Ophthalmic solution
Common adult dosing:
- Community-acquired pneumonia: 500mg on day 1, followed by 250mg daily for 4 days
- Sinusitis: 500mg daily for 3 days
- Sexually transmitted infections: Single 1g dose
- IV dosing: 500mg daily
Pediatric dosing:
- Based on weight and indication (10-20 mg/kg/day)
Nursing Considerations
Assessment
- Obtain complete health history, including allergies to antibiotics
- Assess current symptoms and infection characteristics
- Obtain baseline vital signs and temperature
- Review current medications for potential interactions
- Assess cardiac history and risk factors for QT prolongation
- Evaluate liver function tests if available
Implementation
- Administer oral doses 1 hour before or 2 hours after meals
- Space doses from antacids by at least 2 hours
- For IV administration, infuse over at least 60 minutes
- Monitor for signs of allergic reactions during the first dose
- Assess patient response to therapy daily
- Document temperature and symptom improvement
Monitoring
- Monitor for signs of superinfection
- Watch for signs of hepatic dysfunction
- Assess for ototoxicity in patients receiving high doses
- Monitor ECG in high-risk patients
- Track gastrointestinal symptoms
Patient Teaching
- Take medication as prescribed for the entire duration, even if you are feeling better.
- Take on an empty stomach (1 hour before or 2 hours after meals)
- Do not take with antacids
- Report severe diarrhea, especially if bloody
- Avoid sun exposure due to increased photosensitivity
- Use appropriate birth control during treatment
- Report unusual heart rhythms or severe side effects
- Store at room temperature away from moisture
- Shake the oral suspension well before each use
- Complete the entire course of antibiotics unless directed otherwise by a healthcare provider.
Signs of Treatment Success
- Reduction in fever and other infection symptoms
- Improvement in energy levels
- Return of normal appetite
- Resolution of specific infection symptoms
Warning Signs to Report
- Severe diarrhea
- Yellowing of skin or eyes
- Irregular heartbeat
- Severe skin reactions
- Hearing changes
- Persistent nausea/vomiting
This list is not all-inclusive. Please consult with a healthcare provider or pharmacist for complete information about azithromycin.
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Bc, J. B. D. A., Rosenthal, L., & Yeager, J. J. (2021). Study Guide for Lehne’s Pharmacology for Nursing Care. Saunders.
- Firth A, Prathapan P. Azithromycin: The First Broad-spectrum Therapeutic. Eur J Med Chem. 2020 Dec 1;207:112739. doi: 10.1016/j.ejmech.2020.112739. Epub 2020 Aug 19. PMID: 32871342; PMCID: PMC7434625.
- Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
- Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
- Sun YW, Cen YH, Chen MH, Yan XK, Jin XF. Safety profiles and adverse reactions of azithromycin in the treatment of pediatric respiratory diseases: A systematic review and meta-analysis. Medicine (Baltimore). 2023 Dec 1;102(48):e36306. doi: 10.1097/MD.0000000000036306. PMID: 38050289; PMCID: PMC10695561.
- Wang H, Zhao M, Liu S, Wang X. Efficacy and safety of reduning injection combined with azithromycin in the treatment of mycoplasma pneumonia among children: A systematic review and meta-analysis. Phytomedicine. 2022 Nov;106:154402. doi: 10.1016/j.phymed.2022.154402. Epub 2022 Aug 21. PMID: 36029644.
