Azithromax

Azithromax is an antibacterial drug used systemically. It belongs to the category of lincomycins, streptogramins and macrolides.

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Indications Azithromax

It is used in the treatment of infectious pathologies caused by bacteria sensitive to azithromycin:

• diseases of the upper respiratory system, as well as ENT organs: tonsillitis, inflammation of the middle ear, as well as sinusitis with pharyngitis;
• pathologies in the lower respiratory tract: community-acquired pneumonia and bacterial bronchitis;
• infectious diseases in the subcutaneous layer and on the skin: impetigo, erysipelas, as well as secondary infection dermatitis;
• STDs: cervicitis, as well as uncomplicated urethritis;
• to prevent the spread of Mycobacterium avium bacteria in people with HIV infection (used in combination with the substance rifabutin or as monotherapy).

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Release form

Released in tablets (250 or 600 mg), which are packed in a bottle (30 pieces) or a blister (6 pieces). Inside a separate pack there is 1 bottle or 1 blister plate with tablets.

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Pharmacodynamics

Azithromycin is a macrolide antibiotic (specifically, a subgroup of azalides). It has antibacterial properties - it is synthesized with the ribosomal 50s-unit of the pathogenic microbe and inhibits protein binding.

The active ingredient has a wide range of antimicrobial effectiveness. The medicine is active against the following bacteria:

• gram-positive cocci – pneumococcus, Streptococcus pyogenes and Streptococcus agalactiae, as well as S. Viridans, Staphylococcus aureus and streptococci types C, F, and G;
• gram-negative microbes - Ducray bacillus, Legionella pneumophila, Haemophilus influenzae, Haemophilus parainfluenzae, Moraxella catarrhalis, whooping cough bacillus and parapertussis bacillus, gonococcus and Campylobacter jejuni, as well as Helicobacter pylori and Gardnerella vaginalis;
• individual anaerobes – clostridia, Bacteroides bivius, peptococci and peptostreptococci, as well as Mycoplasma pneumoniae, Borrelia burgdorferi, Chlamydia trachomatis, Listeria monocytogenes, Treponema pallidum and Ureaplasma urealyticum.

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Pharmacokinetics

After internal use, the active ingredient is quickly absorbed and distributed within the body. It reaches peak plasma levels after 2-3 hours. It quickly passes into tissues, accumulating in them in values that significantly exceed plasma levels (up to 50 times). The bioavailability level is 37%. Taking tablets with food does not affect the absorption of the substance.

The average half-life of the component is about 68 hours. In case of drug use in dosages within 250-1000 mg, the indicators in the blood depend on the dose size. The long half-life of the substance, as well as its large distribution volume in the body, are due to the fact that the drug passes into the cellular cytoplasm, and is also stored in lysosomal complexes of phospholipids.

The drug is excreted mainly with bile (most of it is excreted unchanged). Approximately 6% of the dosage is excreted unchanged in the urine after a therapeutic course lasting 7 days.

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Dosing and administration

Taken orally. Taking it with food does not affect the absorption of the medicine, so it is allowed to take the tablets with or without food.

Dose sizes for adolescents weighing 45 kg and older and adults.

Infectious diseases of the respiratory system, subcutaneous layers and skin: a single dose of 500 mg per day, and then during the next 4 days take 250 mg of the medicine daily (the total dose per course is 1.5 g) or 500 mg once a day for 3 days.

Pathologies of the urogenital tract: to eliminate urethritis and cervicitis of non-gonococcal origin caused by the bacterium Clamydia trachomatis, it is necessary to take 1 g of the drug once (4 tablets of 250 mg). To treat gonococcal cervicitis or urethritis, it is necessary to take 2 g of the drug once (8 tablets of 250 mg).

For the prevention of the spread of microbes from the Mycobacterium avium group: 1200 mg of the drug (2 tablets of 600 mg) should be taken once a week. Azithromax may be combined with an appropriate dose of rifabutin.

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Use Azithromax during pregnancy

It is prohibited to use Azithromax during pregnancy or lactation.

Contraindications

Among the contraindications:

• the presence of hypersensitivity to erythromycin with azithromycin and other components of the drug or other macrolide antibiotics;
• It is prohibited to use in people suffering from acute renal failure or severe liver dysfunction;
• children whose weight does not reach 45 kg;
• combined use with ergot alkaloids.

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Side effects Azithromax

Taking the pills may cause the following side effects:

• manifestations of allergy: anaphylaxis (rarely fatal) and swelling are observed occasionally, as well as urticaria, rash, Quincke's edema, vasculitis and serum syndrome;
• skin reactions: Lyell's syndrome or Stevens-Johnson syndrome are observed occasionally, as well as exfoliative dermatitis and erythema multiforme;
• disturbances in the functioning of the cardiovascular system: ventricular or sinus tachycardia and ventricular fibrillation develop sporadically, and a decrease in blood pressure and prolongation of the QT interval are also observed. Such manifestations disappear when the drug is discontinued;
• Gastrointestinal disorders: diarrhea is often observed. Dehydration, constipation, vomiting (which causes dehydration), nausea, anorexia, and changes in the color of the tongue occasionally occur. Pancreatitis and pseudomembranous colitis occur sporadically;
• functional liver disorders: liver failure (sometimes fatal), toxic hepatitis and intrahepatic cholestasis occur sporadically. Cases of liver necrosis are also observed;
• manifestations from the urogenital tract: vaginitis occasionally appears. Acute renal failure develops occasionally, as well as tubulointerstitial nephritis and nephrosis;
• reactions of the hematopoietic system: thrombocytopenia appears occasionally;
• manifestations from the nervous system: occasionally a feeling of nervousness or anxiety is observed, and convulsions also occur. Occasionally, dizziness, a feeling of excitement and increased activity appear, aggressive behavior and an epileptic seizure develop, and loss of consciousness is also observed;
• reactions of the sense organs: occasionally, visual or auditory disorders (tinnitus, hearing loss, and hearing loss) and taste buds develop;
• systemic disorders: paresthesia, pain in the joints or muscles are observed occasionally, and in addition, a feeling of weakness or asthenia develops;
• changes in laboratory test values: most often, a decrease in the level of lymphocytes, hemoglobin, as well as albumins with monocytes and sugar with hematocrit is observed. Potassium, creatinine, as well as GGT, CPK, AST, eosinophils, ALT, platelets and monocytes in the serum may also increase. Rarely, leuko- or neutropenia occurs, the indicator of alkaline phosphatase, platelets, LDH and bilirubin with phosphates in the serum decreases. Such disorders were curable in most cases.

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Overdose

In case of using large doses of the medicine, manifestations similar to side effects may develop. Overdose is expressed as follows: vomiting, diarrhea and nausea of a pronounced nature, as well as curable hearing disorder.

Treatment of the disorder will require gastric lavage, the use of activated charcoal, as well as symptomatic therapy that will help maintain the functioning of vital organs.

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Interactions with other drugs

Magnesium- and aluminum-containing antacids inhibit the absorption of azithromycin, which is why it is necessary to take these drugs at intervals of at least 2 hours.

The combination of the drug with warfarin requires constant monitoring of the PTT level during the therapeutic course. When warfarin is used simultaneously with macrolides, potentiation of the anticoagulant effect is observed.

In case of combined administration of Azithromax with cyclosporine, it is necessary to monitor the pharmacokinetics of the latter and adjust the dose in accordance with the indications.

When combined with nelfinavir, it is necessary to monitor the patient's condition in order to promptly identify the possible development of side effects.

The combination of macrolides with theophylline increases the latter's levels in plasma. The use of azithromycin does not affect the pharmacokinetic characteristics of theophylline, and does not depend on the dosage size (single intravenous injection or multiple doses of 300 mg of the drug every 12 hours). To obtain more accurate information about the level of theophylline in plasma, it is necessary to monitor the health of the patient during the combined use of the above drugs.

A single dose of 1 g of zidovudine in combination with multiple doses of azithromycin (600 or 1200 mg) does not affect the pharmacokinetic characteristics or excretion of zidovudine (along with its glucuronic derivative). However, the use of azithromycin leads to an increase in the levels of phosphorylated zidovudine inside mononuclear cells in the peripheral bloodstream.

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Storage conditions

Azithromax should be kept out of reach of small children. Temperature indicators – within 15-30°С.

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Shelf life

Azithromax can be used for a period of 5 years from the date of release of the drug.

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