1 May 2026Oral drugsSource update: June 2025
Azithromycin oral
Azithromycin guidance for selected bacterial and chlamydial infections, with indication-based dosing and QT-related safety precautions.
Prescription under medical supervision
This guide page is for structured reference only and does not replace a clinician, pharmacist, or emergency review. Dose choice, route choice, interactions, and safety decisions still need professional judgment.
Therapeutic action
Macrolide antibacterial.
Indications
- Trachoma and conjunctivitis due to Chlamydia trachomatis.
- Cervicitis and urethritis due to Chlamydia trachomatis in combination with treatment for gonorrhoea, donovanosis, chancroid, and early syphilis.
- Cholera if the strain is susceptible, typhoid fever, yaws, leptospirosis, and louse-borne and tick-borne relapsing fevers.
- Pertussis, diphtheria, and pneumonia due to Mycoplasma pneumoniae and Chlamydophila pneumoniae.
- Second-line treatment of shigellosis.
- Streptococcal tonsillitis and acute otitis media in penicillin-allergic patients only.
Forms and strengths
- 250 mg and 500 mg tablets.
- 200 mg/5 ml powder for oral suspension, to be reconstituted with filtered water.
Dose and duration
Trachoma, cholera, cervicitis and urethritis due to C. trachomatis, chancroid, early syphilis
- Child: 20 mg/kg, maximum 1 g, single dose.
- Adult: 1 g single dose; 2 g single dose in early syphilis.
Yaws
- Child and adult: 30 mg/kg, maximum 2 g, single dose.
Conjunctivitis due to C. trachomatis
- Child: 20 mg/kg, maximum 1 g, once daily for 3 days.
- Adult: 1 g once daily for 3 days.
Typhoid fever
- Child: 10 to 20 mg/kg, maximum 1 g, once daily for 7 days.
- Adult: 500 mg to 1 g once daily for 7 days, or 1 g on D1 then 500 mg once daily from D2 to D7.
Donovanosis (granuloma inguinale)
- Adult: 1 g on D1 then 500 mg once daily until healing of lesions.
Pertussis
- Child under 6 months: 10 mg/kg once daily for 5 days.
- Child 6 months and over: 10 mg/kg, maximum 500 mg, on D1 then 5 mg/kg, maximum 250 mg, once daily from D2 to D5.
- Adult: 500 mg on D1 then 250 mg once daily from D2 to D5.
Pneumonia due to M. pneumoniae and C. pneumoniae
- Child: 10 mg/kg, maximum 500 mg, once daily for 5 days.
- Adult: 500 mg on D1 then 250 mg once daily from D2 to D5.
Leptospirosis
- Child: 10 mg/kg, maximum 500 mg, on D1 then 5 mg/kg, maximum 250 mg, once daily on D2 and D3.
- Adult: 1 g on D1 then 500 mg once daily on D2 and D3.
Shigellosis
- Child: 12 mg/kg, maximum 500 mg, on D1 then 6 mg/kg, maximum 250 mg, once daily from D2 to D5.
- Adult: 500 mg on D1 then 250 mg once daily from D2 to D5.
Diphtheria
- Child: 10 to 12 mg/kg, maximum 500 mg, once daily for 14 days.
- Adult: 500 mg once daily for 14 days.
Relapsing fevers (louse-borne and tick-borne)
- Child: 10 mg/kg, maximum 500 mg, single dose for louse-borne relapsing fever and once daily for 7 to 10 days for tick-borne relapsing fever.
- Adult: 500 mg single dose for louse-borne relapsing fever and once daily for 7 to 10 days for tick-borne relapsing fever.
Streptococcal tonsillitis, only in penicillin-allergic patients
- Child: 20 mg/kg, maximum 500 mg, once daily for 3 days.
- Adult: 500 mg once daily for 3 days.
Acute otitis media, only in penicillin-allergic patients
- Child: 10 mg/kg, maximum 500 mg, once daily for 3 days.
Contra-indications, adverse effects, precautions
- Do not administer to patients with allergy to azithromycin or another macrolide, and to patients with severe hepatic impairment.
- Administer with caution to children under 6 weeks of age because of the risk of hypertrophic pyloric stenosis, and to patients with risk factors for QT prolongation such as electrolyte disturbances, pre-existing cardiac and renal disorders, and older age.
- May cause gastrointestinal disturbances, reversible hearing disorders, electrolyte disturbances, and QT prolongation.
- Rarely, may cause hypersensitivity reactions including severe cutaneous reactions such as Stevens-Johnson, Lyell, and DRESS syndromes, and life-threatening hepatotoxicity. In these cases, stop treatment.
- Signs and symptoms of hypersensitivity reaction or hepatic disorders require immediate medical attention.
- Do not administer simultaneously with antacids such as aluminium or magnesium hydroxide; administer 2 hours apart.
- Avoid combination with drugs that prolong the QT interval, including amiodarone, chloroquine, co-artemether, fluconazole, haloperidol, mefloquine, moxifloxacin, ondansetron, pentamidine, and quinine.
- Administer with caution and monitor use in patients taking digoxin because digoxin toxicity plasma levels may increase.
- Pregnancy and breast-feeding: no contra-indication.
Source
MSF Essential drugs practical guidelines (January 2026)
This page reproduces the structured reference information for this batch while leaving out the Storage and Remarks sections.
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