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INTRODUCTION

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azithromycin (aye-zith-row-my-sin)

Zithromax, Zmax

Classification

Therapeutic: agents for atypical mycobacterium, anti-infectives

Pharmacologic: macrolides

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Indications
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Treatment of the following infections due to susceptible organisms: Upper respiratory tract infections, including streptococcal pharyngitis, acute bacterial exacerbations of chronic bronchitis, and tonsillitis; Lower respiratory tract infections, including bronchitis and pneumonia; Acute otitis media; Skin and skin structure infections; Nongonococcal urethritis, cervicitis, gonorrhea, and chancroid. Prevention of disseminated Mycobacterium avium complex (MAC) infection in patients with advanced HIV infection. Extended-release suspension (Zmax): Acute bacterial sinusitis and community-acquired pneumonia in adults. Unlabeled Use: Prevention of bacterial endocarditis. Treatment of cystic fibrosis lung disease.

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Action
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Inhibits protein synthesis at the level of the 50S bacterial ribosome. Therapeutic Effects: Bacteriostatic action against susceptible bacteria. Spectrum: Active against the following gram-positive aerobic bacteria: Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes (group A strep). Active against these gram-negative aerobic bacteria: Haemophilus influenzae, Moraxella catarrhali, Neisseria gonorrhoeae. Also active against: Mycoplasma, Legionella, Chlamydia pneumoniae, Ureaplasma urealyticum, Borrelia burgdorferi, M. avium. Not active against methicillin-resistant S. aureus.

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Adverse Reactions/Side Effects
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CNS: dizziness, seizures, drowsiness, fatigue, headache. CV: chest pain, hypotension, palpitations, QT prolongation (rare). GI: PSEUDOMEMBRANOUS COLITIS, abdominal pain, diarrhea, nausea, cholestatic jaundice, elevated liver enzymes, dyspepsia, flatulence, melena, oral candidiasis. GU: nephritis, vaginitis. Hemat: anemia, leukopenia, thrombocytopenia. Derm: photosensitivity, Stevens-Johnson syndrome, rashes. EENT: ototoxicity. F and E: hyperkalemia. Misc: ANGIOEDEMA.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Monitor signs of pseudomembranous colitis, including diarrhea, abdominal pain, fever, pus or mucus in stool, and other severe or prolonged GI problems (nausea, vomiting, heartburn). Notify physician or nursing staff immediately of these signs.

  • Monitor patient for signs of angioedema, including rashes, raised patches of red or white skin (welts), burning/itching skin, swelling in the face, and difficulty breathing. Notify physician of these signs immediately.

  • Monitor rashes or other skin reactions such as hives, acne, dermatitis, abnormal sweating, and exfoliation. Notify physician immediately because certain skin reactions may indicate serious hypersensitivity reactions (Stevens-Johnson syndrome).

  • Monitor signs of leukopenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, bleeding gums), or unusual weakness and fatigue that might be due to anemia. Report these signs to the physician.

  • Monitor symptoms of high plasma potassium levels (hyperkalemia), including bradycardia, fatigue, weakness, numbness, and tingling. Notify physician because severe cases can lead to life-threatening arrhythmias and paralysis.

  • Be alert for new seizures or increased seizure activity, especially at the onset of drug treatment. Document the number, duration, and severity of seizures, and report these findings immediately to the physician.

  • Monitor and report signs of nephritis, including blood in urine, decreased urine output, and weight gain from fluid retention.

  • Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, ...

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