ISSN 2398-2977      

Azithromycin

pequis
Contributor(s):

Patricia Dowling

Scott Weese


Introduction

Name

  • Azithromycin.

Class of drug

  • Broad spectrum semisynthetic azalide antimicrobial.
  • Azithromycin differs from macrolides in its structural composition by having a 15-member macrocyclic lactone ring containing a methylated nitrogen atom.

Description

Chemical name

  • (2R,3S,4R,5R,8R,10R,11R,12S,13S,14R)-11-[(2S,3R,4S,6R)-4-(dimethylamino)-3-hydroxy-6-methyloxan-2-yl]oxy-2-ethyl-3,4,10-trihydroxy-13-[(2R,4R,5S,6S)-5-hydroxy-4-methoxy-4,6-dimethyloxan-2-yl]oxy-3,5,6,8,10,12,14-heptamethyl-1-oxa-6-azacyclopentadecan-15-one.

Molecular formula

  • C38H72N2O12.

Molecular weight

  • 748.99.

Physical properties

  • White, crystalline powder.
  • It can be diluted in water at up to 39 mg/mL.

Storage requirements

  • Store at temperatures <30°C/86°F.
  • Reconstituted product for oral suspension can be stored up to 10 days.
  • Reconstituted injectable solutions are stable for 24 h.

Uses

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Indications

  • Primarily used in the treatment of Rhodococcus equi infections Rhodococcus equi infection in foals.
  • Shows good in vitro activity against beta-hemolytic streptococci and coagulase-positive Staphylococcus spp Staphylococcus spp.
  • Shows good in vitro activity against respiratory gram-negative pathogens, eg Pasteurella spp Pasteurella multocida, but has poor activity against gram negative enteric bacteria, eg E. coli Escherichia coli.
  • Use is mainly limited to foals because of the anecdotally high risk of antimicrobial-associated colitis Colon: colitis in adult horses. Use in adults has been reported but should be done with caution, with owner awareness of the risks and only when there are no other viable treatment options. The main indication is refractory abscesses where the spectrum and penetration ability of azithromycin may be superior to other options.

Administration

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Pharmacokinetics

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Precautions

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Interactions

with other drugs

  • Separate administration of azithromycin and antacids.

Adverse Reactions

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Further Reading

Publications

Refereed Papers

  • Recent references from PubMed and VetMedResource.
  • Huber L, Giguere S, Slovis N M et al (2019) Emergence of Resistance to Macrolides and Rifampin in Clinical Isolates of Rhodococcus equi from Foals in Central Kentucky, 1995 to 2017. Antimicrob Agents Chemother, 63, 1-6 PubMed.
  • Giguere S (2017) Treatment of Infections Caused by Rhodococcus equi. Vet Clin North Am Equine Pract 33, 67-85 PubMed.
  • Jacks S, Giguere S, Gronwall P R et al (2001) Pharmacokinetics of azithromycin and concentration in body fluids and bronchoalveolar cells in foals. Am J Vet Res 62, 1870-1875 PubMed.
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