Azithromycin

Provider Level

RN/Paramedic

Class

Macrolide antibiotic

Mechanism of Action

Inhibits microbial protein synthesis by binding to the 50S ribosomal subunit of susceptible microorganisms, preventing translocation of peptide chains.

Indications

Treatment of infections caused by susceptible organisms, including community-acquired pneumonia, acute bacterial exacerbations of chronic obstructive pulmonary disease, and pelvic inflammatory disease. Often utilized in interfacility transport for sepsis or pneumonia management.

Contraindications

Known hypersensitivity to azithromycin, erythromycin, or any macrolide or ketolide antibiotic. History of cholestatic jaundice or hepatic dysfunction associated with prior use of azithromycin.

Routes

PO, IV

Onset / Duration

Onset: Rapid for IV, 1-2 hours for PO. Duration: Prolonged due to extensive tissue distribution; terminal elimination half-life is approximately 68 hours.

Adverse Effects

Nausea, vomiting, diarrhea, abdominal pain, injection site reactions (pain, inflammation), QT prolongation, Torsades de Pointes, hepatotoxicity, and severe allergic reactions (e.g., anaphylaxis, Stevens-Johnson syndrome).

Precautions & Interactions

Use with caution in patients with a history of prolonged QT interval, concurrent use of other QT-prolonging drugs, uncompensated heart failure, or electrolyte abnormalities (hypokalemia, hypomagnesemia). Use with caution in patients with severe hepatic or renal impairment.

Special Considerations

Authorized for RN/Paramedic levels primarily during interfacility transports. Intravenous formulation must be reconstituted and diluted according to manufacturer guidelines, and administered as an infusion (typically over 60 minutes). Never administer as an IV push or bolus.