AZITHROMYCIN MONOHYDRATE

Details

Stereochemistry	ABSOLUTE
Molecular Formula	C38H72N2O12.H2O
Molecular Weight	766.9998
Optical Activity	UNSPECIFIED
Defined Stereocenters	18 / 18
E/Z Centers	0
Charge	0

SHOW SMILES / InChI

Structure Search

SMILES

O.[H][C@@]1(C[C@@](C)(OC)[C@@H](O)[C@H](C)O1)O[C@H]2[C@H](C)[C@@H](O[C@]3([H])O[C@H](C)C[C@@H]([C@H]3O)N(C)C)[C@](C)(O)C[C@@H](C)CN(C)[C@H](C)[C@@H](O)[C@](C)(O)[C@@H](CC)OC(=O)[C@@H]2C

InChI

InChIKey=HQUPLSLYZHKKQT-WVVFQGGUSA-N

InChI=1S/C38H72N2O12.H2O/c1-15-27-38(10,46)31(42)24(6)40(13)19-20(2)17-36(8,45)33(52-35-29(41)26(39(11)12)16-21(3)48-35)22(4)30(23(5)34(44)50-27)51-28-18-37(9,47-14)32(43)25(7)49-28;/h20-33,35,41-43,45-46H,15-19H2,1-14H3;1H2/t20-,21-,22+,23-,24-,25+,26+,27-,28+,29-,30+,31-,32+,33-,35+,36-,37-,38-;/m1./s1

HIDE SMILES / InChI

Molecular Formula	H2O
Molecular Weight	18.0153
Charge	0
Count

Stereochemistry	ACHIRAL
Additional Stereochemistry	No
Defined Stereocenters	0 / 0
E/Z Centers	0
Optical Activity	NONE

Molecular Formula	C38H72N2O12
Molecular Weight	748.9845
Charge	0
Count

Stereochemistry	ABSOLUTE
Additional Stereochemistry	No
Defined Stereocenters	18 / 18
E/Z Centers	0
Optical Activity	UNSPECIFIED

Description
Sources: http://www.accessdata.fda.gov/drugsatfda_docs/label/2016/050710s043,050711s040,050784s027lbl.pdf

Azithromycin is one of the world's best-selling antibiotics, used to treat or prevent certain bacterial infections: Acute bacterial exacerbations of chronic bronchitis in adults; acute bacterial sinusitis in adults; uncomplicated skin and skin structure infections in adults; urethritis and cervicitis in adults; genital ulcer disease in men; acute otitis media in pediatric patients; community-acquired pneumonia in adults and pediatric patients; pharyngitis/tonsillitis in adults and pediatric patients. Azithromycin should not be used in patients with pneumonia who are judged inappropriate for oral therapy because of moderate to severe illness or risk factors. A team of researchers at the Croatian pharmaceutical company Pliva, discovered azithromycin in 1980. It was patented in 1981. In 1986, Pliva and Pfizer signed a licensing agreement, which gave Pfizer exclusive rights for the sale of azithromycin in Western Europe and the United States. Pliva put its azithromycin on the market in Central and Eastern Europe under the brand name of Sumamed in 1988. Pfizer launched azithromycin under Pliva's license in other markets under the brand name Zithromax in 1991. Azithromycin is a semi-synthetic macrolide antibiotic of the azalide class. Like other macrolide antibiotics, azithromycin inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit of the bacterial 70S ribosome. Binding inhibits peptidyl transferase activity and interferes with amino acid translocation during the process of translation. Its effects may be bacteriostatic or bactericidal depending of the organism and the drug concentration. Its long half-life, which enables once daily dosing and shorter administration durations, is a property distinct from other macrolides.

Originator

Approval Year

Targets

Primary Target	Pharmacology	Condition	Potency
Bacterial 70S ribosome 179 Target ID: CHEMBL2363135 Sources: https://www.ncbi.nlm.nih.gov/pubmed/12000992	Inhibitor 8297

Conditions

Condition	Modality	Highest Phase	Product
Acute bacterial exacerbation of chronic bronchitis 31 Sources: http://www.accessdata.fda.gov/drugsatfda_docs/label/2016/050710s043,050711s040,050784s027lbl.pdf	Curative	Approved 8429	ZITHROMAX Approved Use Azithromycin Tablets, USP are indicated for the treatment of patients with mild to moderate infections (pneumonia: see WARNINGS ) caused by susceptible strains of the designated microorganisms in the specific conditions listed below. As recommended dosages, durations of therapy and applicable patient populations vary among these infections, please see DOSAGE AND ADMINISTRATION for specific dosing recommendations. Adults Acute bacterial exacerbations of chronic obstructive pulmonary disease due to Haemophilus influenzae, Moraxella catarrhalis or Streptococcus pneumoniae. Acute bacterial sinusitis due to Haemophilus influenzae, Moraxella catarrhalis or Streptococcus pneumoniae. Community-acquired pneumonia due to Chlamydophila pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae or Streptococcus pneumoniae in patients appropriate for oral therapy. NOTE: Azithromycin should not be used in patients with pneumonia who are judged to be inappropriate for oral therapy because of moderate to severe illness or risk factors such as any of the following: patients with cystic fibrosis, patients with nosocomially acquired infections, patients with known or suspected bacteremia, patients requiring hospitalization, elderly or debilitated patients, or patients with significant underlying health problems that may compromise their ability to respond to their illness (including immunodeficiency or functional asplenia). Pharyngitis/tonsillitis caused by Streptococcus pyogenes as an alternative to first-line therapy in individuals who cannot use first-line therapy. NOTE: Penicillin by the intramuscular route is the usual drug of choice in the treatment of Streptococcus pyogenes infection and the prophylaxis of rheumatic fever. Azithromycin is often effective in the eradication of susceptible strains of Streptococcus pyogenes from the nasopharynx. Because some strains are resistant to azithromycin, susceptibility tests should be performed when patients are treated with azithromycin. Data establishing efficacy of azithromycin in subsequent prevention of rheumatic fever are not available. Uncomplicated skin and skin structure infections due to Staphylococcus aureus, Streptococcus pyogenes, or Streptococcus agalactiae. Abscesses usually require surgical drainage. Urethritis and cervicitis due to Chlamydia trachomatis or Neisseria gonorrhoeae. Genital ulcer disease in men due to Haemophilus ducreyi (chancroid). Due to the small number of women included in clinical trials, the efficacy of azithromycin in the treatment of chancroid in women has not been established. Azithromycin, at the recommended dose, should not be relied upon to treat syphilis. Antimicrobial agents used in high doses for short periods of time to treat non-gonococcal urethritis may mask or delay the symptoms of incubating syphilis. All patients with sexually-transmitted urethritis or cervicitis should have a serologic test for syphilis and appropriate cultures for gonorrhea performed at the time of diagnosis. Appropriate antimicrobial therapy and follow-up tests for these diseases should be initiated if infection is confirmed. Appropriate culture and susceptibility tests should be performed before treatment to determine the causative organism and its susceptibility to azithromycin. Therapy with azithromycin may be initiated before results of these tests are known; once the results become available, antimicrobial therapy should be adjusted accordingly. To reduce the development of drug-resistant bacteria and maintain the effectiveness of azithromycin and other antibacterial drugs, azithromycin should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy. Pediatric Patients: (See PRECAUTIONS—Pediatric Use and CLINICAL STUDIES IN PEDIATRIC PATIENTS .) Acute otitis media caused by Haemophilus influenzae, Moraxella catarrhalis or Streptococcus pneumoniae. (For specific dosage recommendation, see DOSAGE AND ADMINISTRATION .) Community-acquired pneumonia due to Chlamydophila pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae or Streptococcus pneumoniae in patients appropriate for oral therapy. (For specific dosage recommendation, see DOSAGE AND ADMINISTRATION .) NOTE: Azithromycin should not be used in pediatric patients with pneumonia who are judged to be inappropriate for oral therapy because of moderate to severe illness or risk factors such as any of the following: patients with cystic fibrosis, patients with nosocomially acquired infections, patients with known or suspected bacteremia, patients requiring hospitalization, or patients with significant underlying health problems that may compromise their ability to respond to their illness (including immunodeficiency or functional asplenia). Pharyngitis/tonsillitis caused by Streptococcus pyogenes as an alternative to first-line therapy in individuals who cannot use first-line therapy. (For specific dosage recommendation, see DOSAGE AND ADMINISTRATION .) NOTE: Penicillin by the intramuscular route is the usual drug of choice in the treatment of Streptococcus pyogenes infection and the prophylaxis of rheumatic fever. Azithromycin is often effective in the eradication of susceptible strains of Streptococcus pyogenes from the nasopharynx. Because some strains are resistant to azithromycin, susceptibility tests should be performed when patients are treated with azithromycin. Data establishing efficacy of azithromycin in subsequent prevention of rheumatic fever are not available. Appropriate culture and susceptibility tests should be performed before treatment to determine the causative organism and its susceptibility to azithromycin. Therapy with azithromycin may be initiated before results of these tests are known; once the results become available, antimicrobial therapy should be adjusted accordingly. Launch Date 1991
Acute bacterial sinusitis 26 Sources: http://www.accessdata.fda.gov/drugsatfda_docs/label/2016/050710s043,050711s040,050784s027lbl.pdf	Curative	Approved 8429	ZITHROMAX Approved Use Azithromycin Tablets, USP are indicated for the treatment of patients with mild to moderate infections (pneumonia: see WARNINGS ) caused by susceptible strains of the designated microorganisms in the specific conditions listed below. As recommended dosages, durations of therapy and applicable patient populations vary among these infections, please see DOSAGE AND ADMINISTRATION for specific dosing recommendations. Adults Acute bacterial exacerbations of chronic obstructive pulmonary disease due to Haemophilus influenzae, Moraxella catarrhalis or Streptococcus pneumoniae. Acute bacterial sinusitis due to Haemophilus influenzae, Moraxella catarrhalis or Streptococcus pneumoniae. Community-acquired pneumonia due to Chlamydophila pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae or Streptococcus pneumoniae in patients appropriate for oral therapy. NOTE: Azithromycin should not be used in patients with pneumonia who are judged to be inappropriate for oral therapy because of moderate to severe illness or risk factors such as any of the following: patients with cystic fibrosis, patients with nosocomially acquired infections, patients with known or suspected bacteremia, patients requiring hospitalization, elderly or debilitated patients, or patients with significant underlying health problems that may compromise their ability to respond to their illness (including immunodeficiency or functional asplenia). Pharyngitis/tonsillitis caused by Streptococcus pyogenes as an alternative to first-line therapy in individuals who cannot use first-line therapy. NOTE: Penicillin by the intramuscular route is the usual drug of choice in the treatment of Streptococcus pyogenes infection and the prophylaxis of rheumatic fever. Azithromycin is often effective in the eradication of susceptible strains of Streptococcus pyogenes from the nasopharynx. Because some strains are resistant to azithromycin, susceptibility tests should be performed when patients are treated with azithromycin. Data establishing efficacy of azithromycin in subsequent prevention of rheumatic fever are not available. Uncomplicated skin and skin structure infections due to Staphylococcus aureus, Streptococcus pyogenes, or Streptococcus agalactiae. Abscesses usually require surgical drainage. Urethritis and cervicitis due to Chlamydia trachomatis or Neisseria gonorrhoeae. Genital ulcer disease in men due to Haemophilus ducreyi (chancroid). Due to the small number of women included in clinical trials, the efficacy of azithromycin in the treatment of chancroid in women has not been established. Azithromycin, at the recommended dose, should not be relied upon to treat syphilis. Antimicrobial agents used in high doses for short periods of time to treat non-gonococcal urethritis may mask or delay the symptoms of incubating syphilis. All patients with sexually-transmitted urethritis or cervicitis should have a serologic test for syphilis and appropriate cultures for gonorrhea performed at the time of diagnosis. Appropriate antimicrobial therapy and follow-up tests for these diseases should be initiated if infection is confirmed. Appropriate culture and susceptibility tests should be performed before treatment to determine the causative organism and its susceptibility to azithromycin. Therapy with azithromycin may be initiated before results of these tests are known; once the results become available, antimicrobial therapy should be adjusted accordingly. To reduce the development of drug-resistant bacteria and maintain the effectiveness of azithromycin and other antibacterial drugs, azithromycin should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy. Pediatric Patients: (See PRECAUTIONS—Pediatric Use and CLINICAL STUDIES IN PEDIATRIC PATIENTS .) Acute otitis media caused by Haemophilus influenzae, Moraxella catarrhalis or Streptococcus pneumoniae. (For specific dosage recommendation, see DOSAGE AND ADMINISTRATION .) Community-acquired pneumonia due to Chlamydophila pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae or Streptococcus pneumoniae in patients appropriate for oral therapy. (For specific dosage recommendation, see DOSAGE AND ADMINISTRATION .) NOTE: Azithromycin should not be used in pediatric patients with pneumonia who are judged to be inappropriate for oral therapy because of moderate to severe illness or risk factors such as any of the following: patients with cystic fibrosis, patients with nosocomially acquired infections, patients with known or suspected bacteremia, patients requiring hospitalization, or patients with significant underlying health problems that may compromise their ability to respond to their illness (including immunodeficiency or functional asplenia). Pharyngitis/tonsillitis caused by Streptococcus pyogenes as an alternative to first-line therapy in individuals who cannot use first-line therapy. (For specific dosage recommendation, see DOSAGE AND ADMINISTRATION .) NOTE: Penicillin by the intramuscular route is the usual drug of choice in the treatment of Streptococcus pyogenes infection and the prophylaxis of rheumatic fever. Azithromycin is often effective in the eradication of susceptible strains of Streptococcus pyogenes from the nasopharynx. Because some strains are resistant to azithromycin, susceptibility tests should be performed when patients are treated with azithromycin. Data establishing efficacy of azithromycin in subsequent prevention of rheumatic fever are not available. Appropriate culture and susceptibility tests should be performed before treatment to determine the causative organism and its susceptibility to azithromycin. Therapy with azithromycin may be initiated before results of these tests are known; once the results become available, antimicrobial therapy should be adjusted accordingly. Launch Date 1991
Skin structure infections 18 Sources: http://www.accessdata.fda.gov/drugsatfda_docs/label/2016/050710s043,050711s040,050784s027lbl.pdf	Curative	Approved 8429	ZITHROMAX Approved Use Azithromycin Tablets, USP are indicated for the treatment of patients with mild to moderate infections (pneumonia: see WARNINGS ) caused by susceptible strains of the designated microorganisms in the specific conditions listed below. As recommended dosages, durations of therapy and applicable patient populations vary among these infections, please see DOSAGE AND ADMINISTRATION for specific dosing recommendations. Adults Acute bacterial exacerbations of chronic obstructive pulmonary disease due to Haemophilus influenzae, Moraxella catarrhalis or Streptococcus pneumoniae. Acute bacterial sinusitis due to Haemophilus influenzae, Moraxella catarrhalis or Streptococcus pneumoniae. Community-acquired pneumonia due to Chlamydophila pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae or Streptococcus pneumoniae in patients appropriate for oral therapy. NOTE: Azithromycin should not be used in patients with pneumonia who are judged to be inappropriate for oral therapy because of moderate to severe illness or risk factors such as any of the following: patients with cystic fibrosis, patients with nosocomially acquired infections, patients with known or suspected bacteremia, patients requiring hospitalization, elderly or debilitated patients, or patients with significant underlying health problems that may compromise their ability to respond to their illness (including immunodeficiency or functional asplenia). Pharyngitis/tonsillitis caused by Streptococcus pyogenes as an alternative to first-line therapy in individuals who cannot use first-line therapy. NOTE: Penicillin by the intramuscular route is the usual drug of choice in the treatment of Streptococcus pyogenes infection and the prophylaxis of rheumatic fever. Azithromycin is often effective in the eradication of susceptible strains of Streptococcus pyogenes from the nasopharynx. Because some strains are resistant to azithromycin, susceptibility tests should be performed when patients are treated with azithromycin. Data establishing efficacy of azithromycin in subsequent prevention of rheumatic fever are not available. Uncomplicated skin and skin structure infections due to Staphylococcus aureus, Streptococcus pyogenes, or Streptococcus agalactiae. Abscesses usually require surgical drainage. Urethritis and cervicitis due to Chlamydia trachomatis or Neisseria gonorrhoeae. Genital ulcer disease in men due to Haemophilus ducreyi (chancroid). Due to the small number of women included in clinical trials, the efficacy of azithromycin in the treatment of chancroid in women has not been established. Azithromycin, at the recommended dose, should not be relied upon to treat syphilis. Antimicrobial agents used in high doses for short periods of time to treat non-gonococcal urethritis may mask or delay the symptoms of incubating syphilis. All patients with sexually-transmitted urethritis or cervicitis should have a serologic test for syphilis and appropriate cultures for gonorrhea performed at the time of diagnosis. Appropriate antimicrobial therapy and follow-up tests for these diseases should be initiated if infection is confirmed. Appropriate culture and susceptibility tests should be performed before treatment to determine the causative organism and its susceptibility to azithromycin. Therapy with azithromycin may be initiated before results of these tests are known; once the results become available, antimicrobial therapy should be adjusted accordingly. To reduce the development of drug-resistant bacteria and maintain the effectiveness of azithromycin and other antibacterial drugs, azithromycin should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy. Pediatric Patients: (See PRECAUTIONS—Pediatric Use and CLINICAL STUDIES IN PEDIATRIC PATIENTS .) Acute otitis media caused by Haemophilus influenzae, Moraxella catarrhalis or Streptococcus pneumoniae. (For specific dosage recommendation, see DOSAGE AND ADMINISTRATION .) Community-acquired pneumonia due to Chlamydophila pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae or Streptococcus pneumoniae in patients appropriate for oral therapy. (For specific dosage recommendation, see DOSAGE AND ADMINISTRATION .) NOTE: Azithromycin should not be used in pediatric patients with pneumonia who are judged to be inappropriate for oral therapy because of moderate to severe illness or risk factors such as any of the following: patients with cystic fibrosis, patients with nosocomially acquired infections, patients with known or suspected bacteremia, patients requiring hospitalization, or patients with significant underlying health problems that may compromise their ability to respond to their illness (including immunodeficiency or functional asplenia). Pharyngitis/tonsillitis caused by Streptococcus pyogenes as an alternative to first-line therapy in individuals who cannot use first-line therapy. (For specific dosage recommendation, see DOSAGE AND ADMINISTRATION .) NOTE: Penicillin by the intramuscular route is the usual drug of choice in the treatment of Streptococcus pyogenes infection and the prophylaxis of rheumatic fever. Azithromycin is often effective in the eradication of susceptible strains of Streptococcus pyogenes from the nasopharynx. Because some strains are resistant to azithromycin, susceptibility tests should be performed when patients are treated with azithromycin. Data establishing efficacy of azithromycin in subsequent prevention of rheumatic fever are not available. Appropriate culture and susceptibility tests should be performed before treatment to determine the causative organism and its susceptibility to azithromycin. Therapy with azithromycin may be initiated before results of these tests are known; once the results become available, antimicrobial therapy should be adjusted accordingly. Launch Date 1991
Urethritis 18 Sources: http://www.accessdata.fda.gov/drugsatfda_docs/label/2016/050710s043,050711s040,050784s027lbl.pdf	Curative	Approved 8429	ZITHROMAX Approved Use Azithromycin Tablets, USP are indicated for the treatment of patients with mild to moderate infections (pneumonia: see WARNINGS ) caused by susceptible strains of the designated microorganisms in the specific conditions listed below. As recommended dosages, durations of therapy and applicable patient populations vary among these infections, please see DOSAGE AND ADMINISTRATION for specific dosing recommendations. Adults Acute bacterial exacerbations of chronic obstructive pulmonary disease due to Haemophilus influenzae, Moraxella catarrhalis or Streptococcus pneumoniae. Acute bacterial sinusitis due to Haemophilus influenzae, Moraxella catarrhalis or Streptococcus pneumoniae. Community-acquired pneumonia due to Chlamydophila pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae or Streptococcus pneumoniae in patients appropriate for oral therapy. NOTE: Azithromycin should not be used in patients with pneumonia who are judged to be inappropriate for oral therapy because of moderate to severe illness or risk factors such as any of the following: patients with cystic fibrosis, patients with nosocomially acquired infections, patients with known or suspected bacteremia, patients requiring hospitalization, elderly or debilitated patients, or patients with significant underlying health problems that may compromise their ability to respond to their illness (including immunodeficiency or functional asplenia). Pharyngitis/tonsillitis caused by Streptococcus pyogenes as an alternative to first-line therapy in individuals who cannot use first-line therapy. NOTE: Penicillin by the intramuscular route is the usual drug of choice in the treatment of Streptococcus pyogenes infection and the prophylaxis of rheumatic fever. Azithromycin is often effective in the eradication of susceptible strains of Streptococcus pyogenes from the nasopharynx. Because some strains are resistant to azithromycin, susceptibility tests should be performed when patients are treated with azithromycin. Data establishing efficacy of azithromycin in subsequent prevention of rheumatic fever are not available. Uncomplicated skin and skin structure infections due to Staphylococcus aureus, Streptococcus pyogenes, or Streptococcus agalactiae. Abscesses usually require surgical drainage. Urethritis and cervicitis due to Chlamydia trachomatis or Neisseria gonorrhoeae. Genital ulcer disease in men due to Haemophilus ducreyi (chancroid). Due to the small number of women included in clinical trials, the efficacy of azithromycin in the treatment of chancroid in women has not been established. Azithromycin, at the recommended dose, should not be relied upon to treat syphilis. Antimicrobial agents used in high doses for short periods of time to treat non-gonococcal urethritis may mask or delay the symptoms of incubating syphilis. All patients with sexually-transmitted urethritis or cervicitis should have a serologic test for syphilis and appropriate cultures for gonorrhea performed at the time of diagnosis. Appropriate antimicrobial therapy and follow-up tests for these diseases should be initiated if infection is confirmed. Appropriate culture and susceptibility tests should be performed before treatment to determine the causative organism and its susceptibility to azithromycin. Therapy with azithromycin may be initiated before results of these tests are known; once the results become available, antimicrobial therapy should be adjusted accordingly. To reduce the development of drug-resistant bacteria and maintain the effectiveness of azithromycin and other antibacterial drugs, azithromycin should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy. Pediatric Patients: (See PRECAUTIONS—Pediatric Use and CLINICAL STUDIES IN PEDIATRIC PATIENTS .) Acute otitis media caused by Haemophilus influenzae, Moraxella catarrhalis or Streptococcus pneumoniae. (For specific dosage recommendation, see DOSAGE AND ADMINISTRATION .) Community-acquired pneumonia due to Chlamydophila pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae or Streptococcus pneumoniae in patients appropriate for oral therapy. (For specific dosage recommendation, see DOSAGE AND ADMINISTRATION .) NOTE: Azithromycin should not be used in pediatric patients with pneumonia who are judged to be inappropriate for oral therapy because of moderate to severe illness or risk factors such as any of the following: patients with cystic fibrosis, patients with nosocomially acquired infections, patients with known or suspected bacteremia, patients requiring hospitalization, or patients with significant underlying health problems that may compromise their ability to respond to their illness (including immunodeficiency or functional asplenia). Pharyngitis/tonsillitis caused by Streptococcus pyogenes as an alternative to first-line therapy in individuals who cannot use first-line therapy. (For specific dosage recommendation, see DOSAGE AND ADMINISTRATION .) NOTE: Penicillin by the intramuscular route is the usual drug of choice in the treatment of Streptococcus pyogenes infection and the prophylaxis of rheumatic fever. Azithromycin is often effective in the eradication of susceptible strains of Streptococcus pyogenes from the nasopharynx. Because some strains are resistant to azithromycin, susceptibility tests should be performed when patients are treated with azithromycin. Data establishing efficacy of azithromycin in subsequent prevention of rheumatic fever are not available. Appropriate culture and susceptibility tests should be performed before treatment to determine the causative organism and its susceptibility to azithromycin. Therapy with azithromycin may be initiated before results of these tests are known; once the results become available, antimicrobial therapy should be adjusted accordingly. Launch Date 1991
Acute otitis media 28 Sources: http://www.accessdata.fda.gov/drugsatfda_docs/label/2016/050710s043,050711s040,050784s027lbl.pdf	Curative	Approved 8429	ZITHROMAX Approved Use Azithromycin Tablets, USP are indicated for the treatment of patients with mild to moderate infections (pneumonia: see WARNINGS ) caused by susceptible strains of the designated microorganisms in the specific conditions listed below. As recommended dosages, durations of therapy and applicable patient populations vary among these infections, please see DOSAGE AND ADMINISTRATION for specific dosing recommendations. Adults Acute bacterial exacerbations of chronic obstructive pulmonary disease due to Haemophilus influenzae, Moraxella catarrhalis or Streptococcus pneumoniae. Acute bacterial sinusitis due to Haemophilus influenzae, Moraxella catarrhalis or Streptococcus pneumoniae. Community-acquired pneumonia due to Chlamydophila pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae or Streptococcus pneumoniae in patients appropriate for oral therapy. NOTE: Azithromycin should not be used in patients with pneumonia who are judged to be inappropriate for oral therapy because of moderate to severe illness or risk factors such as any of the following: patients with cystic fibrosis, patients with nosocomially acquired infections, patients with known or suspected bacteremia, patients requiring hospitalization, elderly or debilitated patients, or patients with significant underlying health problems that may compromise their ability to respond to their illness (including immunodeficiency or functional asplenia). Pharyngitis/tonsillitis caused by Streptococcus pyogenes as an alternative to first-line therapy in individuals who cannot use first-line therapy. NOTE: Penicillin by the intramuscular route is the usual drug of choice in the treatment of Streptococcus pyogenes infection and the prophylaxis of rheumatic fever. Azithromycin is often effective in the eradication of susceptible strains of Streptococcus pyogenes from the nasopharynx. Because some strains are resistant to azithromycin, susceptibility tests should be performed when patients are treated with azithromycin. Data establishing efficacy of azithromycin in subsequent prevention of rheumatic fever are not available. Uncomplicated skin and skin structure infections due to Staphylococcus aureus, Streptococcus pyogenes, or Streptococcus agalactiae. Abscesses usually require surgical drainage. Urethritis and cervicitis due to Chlamydia trachomatis or Neisseria gonorrhoeae. Genital ulcer disease in men due to Haemophilus ducreyi (chancroid). Due to the small number of women included in clinical trials, the efficacy of azithromycin in the treatment of chancroid in women has not been established. Azithromycin, at the recommended dose, should not be relied upon to treat syphilis. Antimicrobial agents used in high doses for short periods of time to treat non-gonococcal urethritis may mask or delay the symptoms of incubating syphilis. All patients with sexually-transmitted urethritis or cervicitis should have a serologic test for syphilis and appropriate cultures for gonorrhea performed at the time of diagnosis. Appropriate antimicrobial therapy and follow-up tests for these diseases should be initiated if infection is confirmed. Appropriate culture and susceptibility tests should be performed before treatment to determine the causative organism and its susceptibility to azithromycin. Therapy with azithromycin may be initiated before results of these tests are known; once the results become available, antimicrobial therapy should be adjusted accordingly. To reduce the development of drug-resistant bacteria and maintain the effectiveness of azithromycin and other antibacterial drugs, azithromycin should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy. Pediatric Patients: (See PRECAUTIONS—Pediatric Use and CLINICAL STUDIES IN PEDIATRIC PATIENTS .) Acute otitis media caused by Haemophilus influenzae, Moraxella catarrhalis or Streptococcus pneumoniae. (For specific dosage recommendation, see DOSAGE AND ADMINISTRATION .) Community-acquired pneumonia due to Chlamydophila pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae or Streptococcus pneumoniae in patients appropriate for oral therapy. (For specific dosage recommendation, see DOSAGE AND ADMINISTRATION .) NOTE: Azithromycin should not be used in pediatric patients with pneumonia who are judged to be inappropriate for oral therapy because of moderate to severe illness or risk factors such as any of the following: patients with cystic fibrosis, patients with nosocomially acquired infections, patients with known or suspected bacteremia, patients requiring hospitalization, or patients with significant underlying health problems that may compromise their ability to respond to their illness (including immunodeficiency or functional asplenia). Pharyngitis/tonsillitis caused by Streptococcus pyogenes as an alternative to first-line therapy in individuals who cannot use first-line therapy. (For specific dosage recommendation, see DOSAGE AND ADMINISTRATION .) NOTE: Penicillin by the intramuscular route is the usual drug of choice in the treatment of Streptococcus pyogenes infection and the prophylaxis of rheumatic fever. Azithromycin is often effective in the eradication of susceptible strains of Streptococcus pyogenes from the nasopharynx. Because some strains are resistant to azithromycin, susceptibility tests should be performed when patients are treated with azithromycin. Data establishing efficacy of azithromycin in subsequent prevention of rheumatic fever are not available. Appropriate culture and susceptibility tests should be performed before treatment to determine the causative organism and its susceptibility to azithromycin. Therapy with azithromycin may be initiated before results of these tests are known; once the results become available, antimicrobial therapy should be adjusted accordingly. Launch Date 1991
Community-acquired pneumonia 47 Sources: http://www.accessdata.fda.gov/drugsatfda_docs/label/2016/050710s043,050711s040,050784s027lbl.pdf	Curative	Approved 8429	ZITHROMAX Approved Use Azithromycin Tablets, USP are indicated for the treatment of patients with mild to moderate infections (pneumonia: see WARNINGS ) caused by susceptible strains of the designated microorganisms in the specific conditions listed below. As recommended dosages, durations of therapy and applicable patient populations vary among these infections, please see DOSAGE AND ADMINISTRATION for specific dosing recommendations. Adults Acute bacterial exacerbations of chronic obstructive pulmonary disease due to Haemophilus influenzae, Moraxella catarrhalis or Streptococcus pneumoniae. Acute bacterial sinusitis due to Haemophilus influenzae, Moraxella catarrhalis or Streptococcus pneumoniae. Community-acquired pneumonia due to Chlamydophila pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae or Streptococcus pneumoniae in patients appropriate for oral therapy. NOTE: Azithromycin should not be used in patients with pneumonia who are judged to be inappropriate for oral therapy because of moderate to severe illness or risk factors such as any of the following: patients with cystic fibrosis, patients with nosocomially acquired infections, patients with known or suspected bacteremia, patients requiring hospitalization, elderly or debilitated patients, or patients with significant underlying health problems that may compromise their ability to respond to their illness (including immunodeficiency or functional asplenia). Pharyngitis/tonsillitis caused by Streptococcus pyogenes as an alternative to first-line therapy in individuals who cannot use first-line therapy. NOTE: Penicillin by the intramuscular route is the usual drug of choice in the treatment of Streptococcus pyogenes infection and the prophylaxis of rheumatic fever. Azithromycin is often effective in the eradication of susceptible strains of Streptococcus pyogenes from the nasopharynx. Because some strains are resistant to azithromycin, susceptibility tests should be performed when patients are treated with azithromycin. Data establishing efficacy of azithromycin in subsequent prevention of rheumatic fever are not available. Uncomplicated skin and skin structure infections due to Staphylococcus aureus, Streptococcus pyogenes, or Streptococcus agalactiae. Abscesses usually require surgical drainage. Urethritis and cervicitis due to Chlamydia trachomatis or Neisseria gonorrhoeae. Genital ulcer disease in men due to Haemophilus ducreyi (chancroid). Due to the small number of women included in clinical trials, the efficacy of azithromycin in the treatment of chancroid in women has not been established. Azithromycin, at the recommended dose, should not be relied upon to treat syphilis. Antimicrobial agents used in high doses for short periods of time to treat non-gonococcal urethritis may mask or delay the symptoms of incubating syphilis. All patients with sexually-transmitted urethritis or cervicitis should have a serologic test for syphilis and appropriate cultures for gonorrhea performed at the time of diagnosis. Appropriate antimicrobial therapy and follow-up tests for these diseases should be initiated if infection is confirmed. Appropriate culture and susceptibility tests should be performed before treatment to determine the causative organism and its susceptibility to azithromycin. Therapy with azithromycin may be initiated before results of these tests are known; once the results become available, antimicrobial therapy should be adjusted accordingly. To reduce the development of drug-resistant bacteria and maintain the effectiveness of azithromycin and other antibacterial drugs, azithromycin should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy. Pediatric Patients: (See PRECAUTIONS—Pediatric Use and CLINICAL STUDIES IN PEDIATRIC PATIENTS .) Acute otitis media caused by Haemophilus influenzae, Moraxella catarrhalis or Streptococcus pneumoniae. (For specific dosage recommendation, see DOSAGE AND ADMINISTRATION .) Community-acquired pneumonia due to Chlamydophila pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae or Streptococcus pneumoniae in patients appropriate for oral therapy. (For specific dosage recommendation, see DOSAGE AND ADMINISTRATION .) NOTE: Azithromycin should not be used in pediatric patients with pneumonia who are judged to be inappropriate for oral therapy because of moderate to severe illness or risk factors such as any of the following: patients with cystic fibrosis, patients with nosocomially acquired infections, patients with known or suspected bacteremia, patients requiring hospitalization, or patients with significant underlying health problems that may compromise their ability to respond to their illness (including immunodeficiency or functional asplenia). Pharyngitis/tonsillitis caused by Streptococcus pyogenes as an alternative to first-line therapy in individuals who cannot use first-line therapy. (For specific dosage recommendation, see DOSAGE AND ADMINISTRATION .) NOTE: Penicillin by the intramuscular route is the usual drug of choice in the treatment of Streptococcus pyogenes infection and the prophylaxis of rheumatic fever. Azithromycin is often effective in the eradication of susceptible strains of Streptococcus pyogenes from the nasopharynx. Because some strains are resistant to azithromycin, susceptibility tests should be performed when patients are treated with azithromycin. Data establishing efficacy of azithromycin in subsequent prevention of rheumatic fever are not available. Appropriate culture and susceptibility tests should be performed before treatment to determine the causative organism and its susceptibility to azithromycin. Therapy with azithromycin may be initiated before results of these tests are known; once the results become available, antimicrobial therapy should be adjusted accordingly. Launch Date 1991

C_max

Value	Dose	Analyte	Population
0.39 μg/L EXPERIMENT https://pubmed.ncbi.nlm.nih.gov/18252692/	500 mg single, oral dose: 500 mg route of administration: Oral experiment type: SINGLE co-administered:	AZITHROMYCIN ANHYDROUS serum	Homo sapiens population: UNHEALTHY age: ADULT sex: FEMALE / MALE food status: UNKNOWN
0.94 mg/L EXPERIMENT https://pubmed.ncbi.nlm.nih.gov/18252692/	2000 mg single, oral dose: 2000 mg route of administration: Oral experiment type: SINGLE co-administered:	AZITHROMYCIN ANHYDROUS serum	Homo sapiens population: UNHEALTHY age: ADULT sex: FEMALE / MALE food status: UNKNOWN
0.54 μg/mL DRUG LABEL https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/050710s44-050711s41-050784s28lbl.pdf	500 mg 1 times / day multiple, oral dose: 500 mg route of administration: Oral experiment type: MULTIPLE co-administered:	AZITHROMYCIN ANHYDROUS serum	Homo sapiens population: HEALTHY age: ADULT sex: FEMALE / MALE food status: UNKNOWN
0.5 μg/mL DRUG LABEL https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/050710s44-050711s41-050784s28lbl.pdf	500 mg single, oral dose: 500 mg route of administration: Oral experiment type: SINGLE co-administered:	AZITHROMYCIN ANHYDROUS unknown	Homo sapiens population: HEALTHY age: ADULT sex: MALE food status: FASTED

AUC

Value	Dose	Analyte	Population
0.94 mg × h/L EXPERIMENT https://pubmed.ncbi.nlm.nih.gov/18252692/	500 mg single, oral dose: 500 mg route of administration: Oral experiment type: SINGLE co-administered:	AZITHROMYCIN ANHYDROUS serum	Homo sapiens population: UNHEALTHY age: ADULT sex: FEMALE / MALE food status: UNKNOWN
10 mg × h/L EXPERIMENT https://pubmed.ncbi.nlm.nih.gov/18252692/	2000 mg single, oral dose: 2000 mg route of administration: Oral experiment type: SINGLE co-administered:	AZITHROMYCIN ANHYDROUS serum	Homo sapiens population: UNHEALTHY age: ADULT sex: FEMALE / MALE food status: UNKNOWN
17.4 μg × h/mL DRUG LABEL https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/050710s44-050711s41-050784s28lbl.pdf	500 mg 1 times / day multiple, oral dose: 500 mg route of administration: Oral experiment type: MULTIPLE co-administered:	AZITHROMYCIN ANHYDROUS serum	Homo sapiens population: HEALTHY age: ADULT sex: FEMALE / MALE food status: UNKNOWN
4.3 μg × h/mL DRUG LABEL https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/050710s44-050711s41-050784s28lbl.pdf	500 mg single, oral dose: 500 mg route of administration: Oral experiment type: SINGLE co-administered:	AZITHROMYCIN ANHYDROUS unknown	Homo sapiens population: HEALTHY age: ADULT sex: MALE food status: FASTED

T_1/2

Value	Dose	Co-administered	Analyte	Population
71.8 h DRUG LABEL https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/050710s44-050711s41-050784s28lbl.pdf	500 mg 1 times / day multiple, oral dose: 500 mg route of administration: Oral experiment type: MULTIPLE co-administered:		AZITHROMYCIN ANHYDROUS serum	Homo sapiens population: HEALTHY age: ADULT sex: FEMALE / MALE food status: UNKNOWN

F_unbound

Value	Dose	Co-administered	Analyte	Population
71% DRUG LABEL https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/050710s44-050711s41-050784s28lbl.pdf	500 mg 1 times / day multiple, oral dose: 500 mg route of administration: Oral experiment type: MULTIPLE co-administered:		AZITHROMYCIN ANHYDROUS serum	Homo sapiens population: HEALTHY age: ADULT sex: FEMALE / MALE food status: UNKNOWN
71% DRUG LABEL https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/050710s44-050711s41-050784s28lbl.pdf	500 mg single, oral dose: 500 mg route of administration: Oral experiment type: SINGLE co-administered:		AZITHROMYCIN ANHYDROUS unknown	Homo sapiens population: HEALTHY age: ADULT sex: MALE food status: FASTED

Doses

Dose	Population	Adverse events
2 g 1 times / day single, oral Highest studied dose Dose: 2 g, 1 times / day Route: oral Route: single Dose: 2 g, 1 times / day Sources: https://www.nejm.org/doi/full/10.1056/nejm199209243271304	unhealthy, 25.2 (16-50) n = 237 Health Status: unhealthy Condition: urethral or endocervical infections with Chlamydia trachomatis. Age Group: 25.2 (16-50) Sex: M+F Population Size: 237 Sources: https://www.nejm.org/doi/full/10.1056/nejm199209243271304	Sources: https://www.nejm.org/doi/full/10.1056/nejm199209243271304
0.5 g 1 times / day single, intravenous Recommended Dose: 0.5 g, 1 times / day Route: intravenous Route: single Dose: 0.5 g, 1 times / day Sources: https://ascpt.onlinelibrary.wiley.com/doi/abs/10.1016/S0009-9236(97)90098-9	healthy, 42 (25-56) n = 12 Health Status: healthy Age Group: 42 (25-56) Population Size: 12 Sources: https://ascpt.onlinelibrary.wiley.com/doi/abs/10.1016/S0009-9236(97)90098-9	Sources: https://ascpt.onlinelibrary.wiley.com/doi/abs/10.1016/S0009-9236(97)90098-9
1 % 2 times / day multiple, ophthalmic Recommended Dose: 1 %, 2 times / day Route: ophthalmic Route: multiple Dose: 1 %, 2 times / day Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2007/050810s000_MedR.pdf Page: Study 003	unhealthy, adult n = 301 Health Status: unhealthy Condition: bacterial conjunctivitis Age Group: adult Sex: M+F Population Size: 301 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2007/050810s000_MedR.pdf Page: Study 003	Disc. AE: Sinusitis, Throat infection... AEs leading to discontinuation/dose reduction: Sinusitis Throat infection Upper respiratory tract infection Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2007/050810s000_MedR.pdf Page: Study 003
1 % 2 times / day multiple, ophthalmic Recommended Dose: 1 %, 2 times / day Route: ophthalmic Route: multiple Dose: 1 %, 2 times / day Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2007/050810s000_MedR.pdf Page: Study 004	unhealthy, adult n = 333 Health Status: unhealthy Condition: bacterial conjunctivitis Age Group: adult Sex: M+F Population Size: 333 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2007/050810s000_MedR.pdf Page: Study 004	Disc. AE: Iritis, Conjunctivitis bacterial... AEs leading to discontinuation/dose reduction: Iritis Conjunctivitis bacterial Conjunctivitis Irritability Herpes zoster Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2007/050810s000_MedR.pdf Page: Study 004
0.5 g 2 times / day multiple, intravenous Recommended Dose: 0.5 g, 2 times / day Route: intravenous Route: multiple Dose: 0.5 g, 2 times / day Sources: https://www.accessdata.fda.gov/drugsatfda_docs/label/2006/050809lbl.pdf	unknown, adult Health Status: unknown Age Group: adult Sex: M+F Sources: https://www.accessdata.fda.gov/drugsatfda_docs/label/2006/050809lbl.pdf	Other AEs: Angioedema, Anaphylaxis... Other AEs: Angioedema Anaphylaxis Stevens Johnson syndrome Toxic epidermal necrolysis Sources: https://www.accessdata.fda.gov/drugsatfda_docs/label/2006/050809lbl.pdf

AEs

AE	Significance	Dose	Population
Sinusitis	Disc. AE	1 % 2 times / day multiple, ophthalmic Recommended Dose: 1 %, 2 times / day Route: ophthalmic Route: multiple Dose: 1 %, 2 times / day Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2007/050810s000_MedR.pdf Page: Study 003	unhealthy, adult n = 301 Health Status: unhealthy Condition: bacterial conjunctivitis Age Group: adult Sex: M+F Population Size: 301 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2007/050810s000_MedR.pdf Page: Study 003
Throat infection	Disc. AE	1 % 2 times / day multiple, ophthalmic Recommended Dose: 1 %, 2 times / day Route: ophthalmic Route: multiple Dose: 1 %, 2 times / day Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2007/050810s000_MedR.pdf Page: Study 003	unhealthy, adult n = 301 Health Status: unhealthy Condition: bacterial conjunctivitis Age Group: adult Sex: M+F Population Size: 301 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2007/050810s000_MedR.pdf Page: Study 003
Upper respiratory tract infection	Disc. AE	1 % 2 times / day multiple, ophthalmic Recommended Dose: 1 %, 2 times / day Route: ophthalmic Route: multiple Dose: 1 %, 2 times / day Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2007/050810s000_MedR.pdf Page: Study 003	unhealthy, adult n = 301 Health Status: unhealthy Condition: bacterial conjunctivitis Age Group: adult Sex: M+F Population Size: 301 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2007/050810s000_MedR.pdf Page: Study 003
Conjunctivitis bacterial	Disc. AE	1 % 2 times / day multiple, ophthalmic Recommended Dose: 1 %, 2 times / day Route: ophthalmic Route: multiple Dose: 1 %, 2 times / day Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2007/050810s000_MedR.pdf Page: Study 004	unhealthy, adult n = 333 Health Status: unhealthy Condition: bacterial conjunctivitis Age Group: adult Sex: M+F Population Size: 333 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2007/050810s000_MedR.pdf Page: Study 004
Conjunctivitis	Disc. AE	1 % 2 times / day multiple, ophthalmic Recommended Dose: 1 %, 2 times / day Route: ophthalmic Route: multiple Dose: 1 %, 2 times / day Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2007/050810s000_MedR.pdf Page: Study 004	unhealthy, adult n = 333 Health Status: unhealthy Condition: bacterial conjunctivitis Age Group: adult Sex: M+F Population Size: 333 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2007/050810s000_MedR.pdf Page: Study 004
Herpes zoster	Disc. AE	1 % 2 times / day multiple, ophthalmic Recommended Dose: 1 %, 2 times / day Route: ophthalmic Route: multiple Dose: 1 %, 2 times / day Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2007/050810s000_MedR.pdf Page: Study 004	unhealthy, adult n = 333 Health Status: unhealthy Condition: bacterial conjunctivitis Age Group: adult Sex: M+F Population Size: 333 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2007/050810s000_MedR.pdf Page: Study 004
Iritis	Disc. AE	1 % 2 times / day multiple, ophthalmic Recommended Dose: 1 %, 2 times / day Route: ophthalmic Route: multiple Dose: 1 %, 2 times / day Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2007/050810s000_MedR.pdf Page: Study 004	unhealthy, adult n = 333 Health Status: unhealthy Condition: bacterial conjunctivitis Age Group: adult Sex: M+F Population Size: 333 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2007/050810s000_MedR.pdf Page: Study 004
Irritability	Disc. AE	1 % 2 times / day multiple, ophthalmic Recommended Dose: 1 %, 2 times / day Route: ophthalmic Route: multiple Dose: 1 %, 2 times / day Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2007/050810s000_MedR.pdf Page: Study 004	unhealthy, adult n = 333 Health Status: unhealthy Condition: bacterial conjunctivitis Age Group: adult Sex: M+F Population Size: 333 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2007/050810s000_MedR.pdf Page: Study 004
Anaphylaxis		0.5 g 2 times / day multiple, intravenous Recommended Dose: 0.5 g, 2 times / day Route: intravenous Route: multiple Dose: 0.5 g, 2 times / day Sources: https://www.accessdata.fda.gov/drugsatfda_docs/label/2006/050809lbl.pdf	unknown, adult Health Status: unknown Age Group: adult Sex: M+F Sources: https://www.accessdata.fda.gov/drugsatfda_docs/label/2006/050809lbl.pdf
Angioedema		0.5 g 2 times / day multiple, intravenous Recommended Dose: 0.5 g, 2 times / day Route: intravenous Route: multiple Dose: 0.5 g, 2 times / day Sources: https://www.accessdata.fda.gov/drugsatfda_docs/label/2006/050809lbl.pdf	unknown, adult Health Status: unknown Age Group: adult Sex: M+F Sources: https://www.accessdata.fda.gov/drugsatfda_docs/label/2006/050809lbl.pdf
Stevens Johnson syndrome		0.5 g 2 times / day multiple, intravenous Recommended Dose: 0.5 g, 2 times / day Route: intravenous Route: multiple Dose: 0.5 g, 2 times / day Sources: https://www.accessdata.fda.gov/drugsatfda_docs/label/2006/050809lbl.pdf	unknown, adult Health Status: unknown Age Group: adult Sex: M+F Sources: https://www.accessdata.fda.gov/drugsatfda_docs/label/2006/050809lbl.pdf
Toxic epidermal necrolysis		0.5 g 2 times / day multiple, intravenous Recommended Dose: 0.5 g, 2 times / day Route: intravenous Route: multiple Dose: 0.5 g, 2 times / day Sources: https://www.accessdata.fda.gov/drugsatfda_docs/label/2006/050809lbl.pdf	unknown, adult Health Status: unknown Age Group: adult Sex: M+F Sources: https://www.accessdata.fda.gov/drugsatfda_docs/label/2006/050809lbl.pdf

Overview

CYP3A4	CYP2C9	CYP2D6	hERG
			inhibitor 1612

OverviewOther

Other Inhibitor	Other Substrate	Other Inducer
OAT1 599 OAT2 145 OAT3 642 OAT4 146 OATP1A2 35 OATP1B1 788 OATP1B3 706 OATP2B1 123 OCT1 512 OCT2 647	CYP 270 UGT 192 P-gp 1537 MRP2 205

Drug as perpetrator

Target	Modality	Activity
OAT2 147	inhibitor 3277 Sources: https://pubmed.ncbi.nlm.nih.gov/29307856/	no
OAT4 146	inhibitor 3277 Sources: https://pubmed.ncbi.nlm.nih.gov/29307856/	no
OATP1A2 35	inhibitor 3277 Sources: https://pubmed.ncbi.nlm.nih.gov/29307856/	no
OATP1B3 715	inhibitor 3277 Sources: https://pubmed.ncbi.nlm.nih.gov/29307856/	no
OCT1 543	inhibitor 3277 Sources: https://pubmed.ncbi.nlm.nih.gov/29307856/	no
OCT2 648	inhibitor 3277 Sources: https://pubmed.ncbi.nlm.nih.gov/29307856/	no
OAT1 603	inhibitor 3277 Sources: https://pubmed.ncbi.nlm.nih.gov/29307856/	yes
OAT3 644	inhibitor 3277 Sources: https://pubmed.ncbi.nlm.nih.gov/29307856/	yes
OATP1B1 803	inhibitor 3277 Sources: https://pubmed.ncbi.nlm.nih.gov/29307856/	yes
OATP2B1 126	inhibitor 3277 Sources: https://pubmed.ncbi.nlm.nih.gov/29307856/	yes

Drug as victim

Target	Modality	Activity
CYP 270	substrate 3367 Sources: https://pubmed.ncbi.nlm.nih.gov/8882383/	no
UGT 192	substrate 3367 Sources: https://pubmed.ncbi.nlm.nih.gov/8882383/	no
MRP2 205	substrate 3367 Sources: https://pubmed.ncbi.nlm.nih.gov/14982769/	yes
P-gp 1537	substrate 3367 Sources: https://pubmed.ncbi.nlm.nih.gov/14982769/	yes

Tox targets

Target	Modality	Activity	Metabolite	Clinical evidence
hERG 1647	inhibitor 1626 Sources: https://pubmed.ncbi.nlm.nih.gov/33345848/

Sourcing

Vendor/Aggregator	ID	URL
1PlusChem LLC	1P0036XM
A2B Chem	AB48154
AK Scientific	2245AH
AK Scientific	G333
AbovChem LLC	HY-17506
AbovChem LLC	HY-17506A
Angene	AGN-PC-0UPTKE
ApexBio Technology	B1398
ApexBio Technology	B1669
AstaTech	44144
AstaTech	N46072
Axon MedChem	2042
BOC Sciences	117772-70-0
BOC Sciences	83905-01-5
Bide Pharmatech	BD22803
BioSynth	A-9940
BioSynth	Q-200666
Bosche Scientific	A3599
Capot Chemical	35619
Cayman Chemical	15004
Chem Scene	CS-2308
Compound Cloud	23725077
Compound Cloud	441190
Compound Cloud	55185
Enamine	EN300-124208
Fluorochem	210715
Fluorochem	41410
Hangzhou APIChem Technology	AC-093
Hangzhou APIChem Technology	AC-16014
Hangzhou Yuhao Chemical Technology	CJ2083
Hangzhou Yuhao Chemical Technology	LT6959
IBScreen	BB_NC-01452
IBScreen	Bio-0676
KeyOrganics	AS-13638
KeyOrganics	AS-75349
KeyOrganics	FS-5409
MedChem Express	HY-17506
MolPort	MolPort-000-703-093
MolPort	MolPort-002-507-426
MolPort	MolPort-006-069-361
MolPort	MolPort-035-395-771
MolPort	MolPort-042-676-353
Molnova	M10602
Molnova	M16114
Pharmeks	PHAR008664
Pharmeks	PHBB_NC-01335
Ryan Scientific	101-94027
Ryan Scientific	107-57803
Ryan Scientific	Oseltamivir_phosphate
Selleck Chemicals	S4147
Sigma Aldrich	PZ0007
Sigma Aldrich	Y0000306
Sigma Aldrich	Y0000637
Sigma Aldrich	Y0000637\|SIAL
Sigma Aldrich	Y0000641
TargetMol	T1419
TargetMol	T6401
Tocris	3771
Toronto Research Chemicals	A927000
W&J PharmaChem	50C547052
ZINC	ZINC000085537026	http://zinc15.docking.org/substances/ZINC000085537026
eMolecules	170737143
eMolecules	261435398
eMolecules	45919070
eMolecules	56748885
eMolecules	6842676
eNovation Chemicals	D625343
mcule	MCULE-4827019524
mcule	MCULE-8817893418

PubMed

Title	Date	PubMed
Azithromycin-induced hearing loss.	1999 Feb 15	10690220
In vitro anticryptosporidial activity of ranalexin alone and in combination with other peptides and with hydrophobic antibiotics.	1999 Nov	10614961
Irreversible sensorineural hearing loss as a result of azithromycin ototoxicity. A case report.	2000 Apr	10778901
Activity of nitazoxanide alone and in combination with azithromycin and rifabutin against Cryptosporidium parvum in cell culture.	2000 Apr	10747821
Pharyngeal colonization prevalence rates for Streptococcus pyogenes and Streptococcus pneumoniae in a respiratory chemoprophylaxis intervention study using azithromycin.	2000 Jan	11168029
Clinical efficacy of intravenous followed by oral azithromycin monotherapy in hospitalized patients with community-acquired pneumonia. The Azithromycin Intravenous Clinical Trials Group.	2000 Jul	10858333
Comparative in vitro activity of thiamphenicol-glycinate and thiamphenicol-glycinate-acetylcysteinate and other antimicrobials against respiratory pathogens.	2001	11367873
The SAFE strategy for the elimination of trachoma by 2020: will it work?	2001	11285668
[Skin eruptions due to azithromycin (Azadose-Zithromax) and infectious mononucleosis].	2001 Apr	11395665
In vitro effects of azithromycin on Salmonella typhi: early inhibition by concentrations less than the MIC and reduction of MIC by alkaline pH and small inocula.	2001 Apr	11266420
Efficacy, safety and tolerability of 3 day azithromycin versus 10 day co-amoxiclav in the treatment of children with acute lower respiratory tract infections.	2001 Apr	11266417
Treatment alternatives for Mycobacterium kansasii.	2001 Apr	11266413
Can we eliminate trachoma?	2001 Apr	11264123
Six cases of confluent and reticulated papillomatosis alleviated by various antibiotics.	2001 Apr	11260541
Azithromycin and pelvic inflammatory disease in the Northern Territory.	2001 Apr 2	11346115
Comparison of amoxicillin and azithromycin in the prevention of recurrent acute otitis media.	2001 Apr 6	11249979
[Isolation of Vibrio strains in French coastal waters and infection with Vibrio cholerae non-O1/non-O139].	2001 Apr 7	11346901
Azithromycin: a new 15-membered macrolide.	2001 Feb	11296412
Identification of parasitoses in a child burial from Adak Island (Central Aleutian Islands, Alaska).	2001 Feb	11280043
[Subacute infectious endocarditis due to the agent of cat scratch fever: Bartonella henselae].	2001 Feb	11265556
Lack of an effect of azithromycin on the disposition of zidovudine and dideoxyinosine in HIV-infected patients.	2001 Feb	11210404
Treatment of cat-scratch disease.	2001 Feb	11176245
New approaches to the treatment of group A streptococcal pharyngitis.	2001 Feb	11176244
Antibiotic-resistance patterns of Helicobacter pylori in Croatia: cohort study.	2001 Feb	11172654
Rhodococcus equi and cytomegalovirus pneumonia in a renal transplant patient: diagnosis by fine-needle aspiration biopsy.	2001 Feb	11169894
Azithromycin and gentamicin therapy for the treatment of humans with brucellosis.	2001 Feb 1	11170962
Evaluation of iron-phosphate as a source of internal lake phosphorus loadings.	2001 Feb 5	11258838
In vitro activity of ketolides HMR 3004 and HMR 3647 and seven other antimicrobial agents against Corynebacterium diphtheriae.	2001 Jan	11152428
Resolution of cyclosporine-induced gingival hyperplasia resistant to azithromycin by switching to tacrolimus.	2001 Jan	11146586
Activity of moxifloxacin by itself and in combination with ethambutol, rifabutin, and azithromycin in vitro and in vivo against Mycobacterium avium.	2001 Jan	11120969
Chlamydia pneumoniae infection in circulating human monocytes is refractory to antibiotic treatment.	2001 Jan 23	11157684
Donovanosis: an update.	2001 Jul	11394976
Malaria chemoprophylaxis in the age of drug resistance. I. Currently recommended drug regimens.	2001 Jul 15	11418883
The hidden impact of antibacterial resistance in respiratory tract infection. Re-evaluating current antibiotic therapy.	2001 Jun	11419669
A randomized controlled trial comparing amoxicillin and azithromycin for the treatment of Chlamydia trachomatis in pregnancy.	2001 Jun	11408852
The effect of azithromycin and clarithromycin on ex vivo interleukin-8 (IL-8) release from whole blood and IL-8 production by human alveolar macrophages.	2001 Jun	11389120
Azithromycin-containing regimens for treatment of Mycobacterium avium complex lung disease.	2001 Jun 1	11340525
Macrolide therapy of group A streptococcal pharyngitis: 10 days of macrolide therapy (clarithromycin) is more effective in streptococcal eradication than 5 days (azithromycin).	2001 Jun 15	11360224
Comparative serum bactericidal activity of clarithromycin and azithromycin against macrolide-sensitive and resistant strains of Streptococcus pneumoniae.	2001 Mar	11337186
The activity of antibiotics against Legionella pneumophila: in vitro and in vivo studies.	2001 Mar	11222573
Comparative in vitro activity of moxifloxacin by E-test against Streptococcus pyogenes.	2001 Mar 15	11249826
Azithromycin prophylaxis during a hospital outbreak of Mycoplasma pneumoniae pneumonia.	2001 Mar 15	11237807
Antibiotic treatment in acute Otitis Media promotes superinfection with resistant Streptococcus pneumoniae carried before initiation of treatment.	2001 Mar 15	11237804
Dose-escalation, phase I/II study of azithromycin and pyrimethamine for the treatment of toxoplasmic encephalitis in AIDS.	2001 Mar 30	11316995
Treatment outcomes in acute exacerbations of chronic bronchitis: comparison of macrolides and moxifloxacin from the patient perspective.	2001 Mar-Apr	11393351
[Experimental infection in mice by Plasmodium berghei: an evidence of antiparasitic action of azithromycin].	2001 Mar-Apr	11391444
[Pharmacological and pharmacokinetic properties of azithromycin (Zithromac), a novel 15-membered ring macrolide antibacterial agent].	2001 May	11411344
The activity of 14-hydroxy clarithromycin, alone and in combination with clarithromycin, against penicillin- and erythromycin-resistant Streptococcus pneumoniae.	2001 May	11328768

Patents

Sample Use Guides

In Vivo Use Guide

Community-acquired pneumonia (mild severity); Pharyngitis/tonsillitis (second-line therapy); Skin/skin structure (uncomplicated): 500 mg as a single dose on Day 1, followed by 250 mg once daily on Days 2 through 5. Acute bacterial exacerbations of chronic bronchitis (mild to moderate): 500 mg as a single dose on Day 1, followed by 250 mg once daily on Days 2 through 5 or 500 mg once daily for 3 days Acute bacterial sinusitis: 500 mg once daily for 3 days Genital ulcer disease (chancroid) Non-gonococcal urethritis and cervicitis: One single 1 gram dose. Gonococcal urethritis and cervicitis: One single 2 gram dose. Acute otitis media: 30 mg/kg as a single dose or 10 mg/kg once daily for 3 days or 10 mg/kg as a single dose on Day

Route of Administration: Oral

In Vitro Use Guide

Azithromycin can benefit treating allergic airway inflammation and remodeling. Azithromycin significantly reduced the inflammation score, peribronchial smooth muscle layer thickness, epithelial thickening and goblet cell metaplasia, and effectively suppressed apoptotic index (AI) of airway epithelium. Moreover, the increasing mRNA and protein expressions of Caspase-3 and Bax/Bcl-2 ratio in lung tissue were all significantly decreased in azithromycin-treated rats. In vitro, azithromycin significantly suppressed TGF-β1-induced BEAS-2B cells apoptosis and reversed TGF-β1 elevated Caspase-3 mRNA level and Bax/Bcl-2 ratio.

Substance Class	Chemical Created by `admin` on `Fri Dec 15 15:08:52 GMT 2023` Edited by `admin` on `Fri Dec 15 15:08:52 GMT 2023`
Record UNII	JTE4MNN1MD
Record Status	`Validated (UNII)`
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Name

Type

Language

AZITHROMYCIN MONOHYDRATE

Common Name

English

AZITHROMYCIN MONOHYDRATE [EP MONOGRAPH]

Common Name

English

Azithromycin monohydrate [WHO-DD]

Common Name

English

N-METHYL-11-AZA-10-DEOXO-10-DIHYDROERYTHROMYCIN A MONOHYDRATE

Common Name

English

AZITHROMYCIN MONOHYDRATE [USP MONOGRAPH]

Common Name

English

Classification Tree Code System Code

NCI_THESAURUS

C261