Azithromycin Dosing and Treatment Duration

Chronic Maintenance Therapy

For patients with bronchiectasis and ≥3 exacerbations/year, the European Respiratory Society recommends a preferred starting dose of 500 mg three times weekly or 250 mg daily, with a minimum treatment duration of 6-12 months to assess efficacy 2
The American Thoracic Society suggests that patients with cystic fibrosis and chronic Pseudomonas aeruginosa can be treated with 250 mg daily or 250-500 mg three times weekly, and continue long-term if beneficial 3
For patients with severe, uncontrolled asthma, the British Thoracic Society recommends a trial of 500 mg three times weekly or 250 mg daily for 6-12 months, and discontinue if no benefit is observed 2
The Centers for Disease Control and Prevention recommend that patients with disseminated MAC in HIV/AIDS continue full therapeutic doses lifelong as secondary prophylaxis, with a typical dose of 500 mg daily in combination with ethambutol 4

The European Urology Association recommends that patients with non-gonococcal urethritis/cervicitis (Chlamydia) be treated with a single 1 gram dose of azithromycin 1
The European Urology Association also recommends that patients with gonococcal urethritis/cervicitis be treated with a single 2 gram dose of azithromycin, which must be combined with ceftriaxone 1g IM/IV 1

The American Heart Association recommends screening for QTc prolongation before initiating chronic azithromycin therapy, and contraindicates its use if QTc >450 ms (men) or >470 ms (women) 2
The Centers for Disease Control and Prevention recommend that infants <1 month with pertussis be treated with 10 mg/kg daily for 5 days, and monitored for infantile hypertrophic pyloric stenosis 6
The Centers for Disease Control and Prevention also recommend avoiding aluminum/magnesium antacids, as they reduce azithromycin absorption when taken simultaneously 6
The European Urology Association recommends that azithromycin must be combined with ceftriaxone for the treatment of gonococcal infections, and never used as monotherapy due to resistance 1