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Therapeutic actionIndicationsForms and strengthsDose and durationContra-indications, adverse effects, precautions
1 May 2026Oral drugsSource update: June 2025

Azithromycin Oral: Uses, Dosing, and Precautions

Azithromycin guidance for selected bacterial and chlamydial infections, with indication-based dosing and QT-related safety precautions.

Also searched as

Azithromycin
Prescription under medical supervision

Source reviewed

June 2025

Guide category

Oral drugs

Safety boundary

Prescription medicine information for clinician-guided use.

Kenza Health Hub presents this medicine page as structured health education. Check dose, route, interactions, pregnancy or breast-feeding considerations, and local protocol with a qualified clinician or pharmacist. Read our medical editorial policy.

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 combines source-derived medicine reference sections with Kenza editorial context, while leaving out the Storage and Remarks sections from the source batch.

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