zithromax/azithromycin dosing

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Standard dosing for zithromax/azithromycin is usually 3-5 days decreasing from 500mg to 250mg/day. Why would a doctor prescribe 10days of 500mg zithromax for URI/strep. Client returned to doctor 2 days later complaining of tinnitus/hearing loss. Doc told her to keep taking it for the full course. Aren't macrolides ototxic? Can that be permanent? Isn't 10 days too long @ 500mg? Client is allergic to PCN so Amoxicillin isn't an option. Just concerned for client's hearing. Anyone with experience with this?

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Specializes in Emergency & Trauma/Adult ICU.

500mg po daily for 7-10 days is appropriate dosing for community-acquired pneumonia.

Nothing about ototoxicity in my drug guide, so I pulled out my pharm book:

"Transient hearing loss occurs rarely with high-dose therapy."

Lehne: Pharmacology for Nursing Care, 5th ed. 2004

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Specializes in Vents, Telemetry, Home Care, Home infusion.

medlineplus drug information: azithromycin

dosage guidelines:

http://www.rxlist.com/cgi/generic/zithromaxsusp_ids.htm

[color=#0000cc]ototoxic medications

macrolides and other antibiotics that are only slightly ototoxic...

nevertheless, there are occasional reports of ototoxicity, when there have been prolonged and high levels. the high levels generally require intravenous dosing.

i would discuss your concern with this doctor.

"doctor can you tell me what's different about this patient's diagnosis that they needed higher dose and longer # days on med so i'll understand for future patient needs...."

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Thanks, I checked those websites and really not much on ototoxicity or dosing beyond 5 days there or on any other website I've seen. I'm going to call the pharmacist next.

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Specializes in Med-Surg.

Might want to also consider, if the patient has a URI/strep they could develop an ear infection. I have been known to have a case or two of otitis media after a bad case of strep, and has tinnitus and hearing loss. And lots of pain.

May not be common with other people though, I'm an odd one.

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No,but I am aware that z-pac can cause immediate liver damage,just after 1 dose.Has anyone ever heard this.It is such a widespread med,I didnt know just how potent it can be for some.And to think this is so widely given in nursing homes.Oh well,just a note.

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Specializes in LTC, CPR instructor, First aid instructor..

I like your avatar, Karen.

Fran

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