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Azithromycin is a macrolide antibiotic commonly used in outpatient clinics. At present, a clinical use is popular. Azithromycin is orally administered for 3 days and stopped for 4 days. Is this usage correct?

 

I. When can azithromycin be used?

Azithromycin against Gram-positive bacteria (Staphylococcus aureus, Group A hemolytic streptococcus, Streptococcus pneumoniae, etc.), Gram-negative bacteria (Haemophilus influenzae, Moraxella catarrhalis, etc.), atypical microorganisms (Chlamydia pneumoniae, Pneumococcal pneumoniae, etc. have good antibacterial activity.

Azithromycin is suitable for the following infections caused by the above sensitive bacteria: 1 upper respiratory tract infection such as sinusitis, pharyngitis, tonsillitis; 2 lower respiratory tract infections such as bronchitis and pneumonia; 3 acute otitis media; 4 skin and soft tissue infections.

Need to be reminded: Azithromycin is less effective against β-lactam antibiotics than the above bacteria, so azithromycin is not the drug of choice for the above bacterial infections (except for infections caused by Chlamydia pneumoniae and Mycoplasma pneumoniae).

Azithromycin is mainly excreted through the biliary tract in the original shape, mild to moderate renal insufficiency (glomerular filtration rate ≥ 10ml / min), no need to adjust the dose.

 

II. “Oral 3 days, stop 4 days”, is the usage reasonable?

1. It is reasonable for mild to moderate general infection caused by sensitive bacteria

The efficacy of azithromycin “three-day administration method” is equivalent to that of oral penicillin and cephalosporin antibiotics for 7 to 10 days, and the compliance of outpatients is higher.

This is because:

Azithromycin has unique pharmacokinetic characteristics with a half-life of 1.5 to 2 days and a long antibiotic effect.

For patients with faster elimination (half-life of 1.5 days), 12.5% ​​of azithromycin was still present in the body after 4 days of withdrawal; for patients with slower elimination (half-life of 2 days), about 25% of azithromycin was still present in the body after 4 days of withdrawal. .

Namely: After taking it for 3 consecutive days, although there is no medication for the next 4 days, the azithromycin in the body can continue to exert antibacterial effect.

2. Unreasonable for community-acquired pneumonia

When suspected pneumonia mycoplasma pneumonia:

Adults: Tetracyclines (doxycycline, minocycline), fluoroquinolones (levofloxacin, moxifloxacin) are preferred.

Children: Oral or intravenous azithromycin is preferred: once 10 mg/kg once daily, mild for 3 days for 1 course, severe cases for 5 to 7 days, and 2 to 3 days for the second course of treatment.

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