Azithromycin Oral Suspension

Precautions While Taking Azithromycin Oral Suspension

Hypersensitivity
As with erythromycin and other macrolides, serious allergic reactions, including angioneurotic oedema and anaphylaxis (rarely fatal) and drug reaction with eosinophilia and systemic symptoms (DRESS), have been reported. Some of these reactions with azithromycin have resulted in recurrent symptoms and required a longer period of observation and treatment.

Hepatotoxicity
Since the liver is the principal route of elimination for azithromycin, the use of azithromycin should be undertaken with caution in patients with significant hepatic disease. Cases of fulminant hepatitis potentially leading to life-threatening liver failure have been reported with azithromycin. Some patients may have had pre-existing hepatic disease or may have been taking other hepatotoxic medicinal products.

In case of signs and symptoms of liver dysfunction, such as rapidly developing asthenia associated with jaundice, dark urine, bleeding tendency, or hepatic encephalopathy, liver function tests/investigations should be performed immediately. Azithromycin administration should be stopped if liver dysfunction has emerged.

Ergot derivatives
In patients receiving ergot derivatives, ergotism has been precipitated by co-administration of some macrolide antibiotics. There are no data concerning the possibility of an interaction between ergot and azithromycin. However, because of the theoretical possibility of ergotism, azithromycin and ergot derivatives should not be co-administered.

Prolongation of the QT interval
Prolonged cardiac repolarization and QT interval, imparting a risk of developing cardiac arrhythmia and torsades de pointes, have been seen in treatment with other macrolides.

A similar effect with Azithromycin Oral Suspension cannot be completely ruled out in patients at increased risk for prolonged cardiac repolarization; therefore, caution is required when treating patients:
• With congenital or documented QT prolongation
• Currently receiving treatment with other active substance known to prolong QT interval, such as antiarrhythmics of Classes Ia and III, cisapride and terfenadine
• With electrolyte disturbance, particularly in case of hypokalaemia and hypomagnesemia
• With clinically relevant bradycardia, cardiac arrhythmia, or severe cardiac insufficiency.

Superinfection
As with any antibiotic preparation, observation for signs of superinfection with non-susceptible organisms, including fungi, is recommended.
Clostridium difficile-associated diarrhoea
Clostridium difficile associated diarrhoea (CDAD) has been reported with the use of nearly all antibacterial agents, including azithromycin, and may range in severity from mild diarrhoea to fatal colitis.

Strains of C. difficile producing hypertoxin A and B contribute to the development of CDAD. Hypertoxin-producing strains of C. difficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy.

Therefore, CDAD must be considered in patients who present with diarrhea during or subsequent to the administration of any antibiotics. Careful medical history is necessary since CDAD has been reported to occur over 2 months after the administration of antibacterial agents.

Discontinuation of therapy with Azithromycin Oral Suspension and the administration of specific treatment for C. difficile should be considered.
Streptococcal infections
Penicillin is usually the first choice for treatment of pharyngitis/tonsillitis due to Streptococcus pyogenes and also for prophylaxis of acute rheumatic fever. Azithromycin Oral Suspension is in general effective against streptococcus in the oropharynx, but no data are available that demonstrate the efficacy of azithromycin in preventing acute rheumatic fever.

Renal impairment
In patients with severe renal impairment (GFR <10 ml/min), a 33% increase in systemic exposure to azithromycin was observed.
Myasthenia gravis
Exacerbations of the symptoms of myasthenia gravis and new onset of myasthenic syndrome have been reported in patients receiving azithromycin therapy.

Diabetes
Caution in diabetic patients: 5 ml of reconstituted suspension contains 3.0 g of sucrose.
Patients with rare hereditary problems of fructose intolerance, glucose-galactose malabsorption, or sucrase-isomaltase insufficiency should not take this medicine.