Azithromycin Dosing for Upper Respiratory Infection (URI)

Dosing Regimen Options

The European Respiratory Society guidelines recommend oral azithromycin 500 mg daily for 3 days or 500 mg on day 1 followed by 250 mg daily for 5 days for adults with URIs 1, 2

Before initiating therapy, an ECG should be performed to assess QTc interval, especially in patients with cardiac risk factors, according to the British Thoracic Society 3, 4
If QTc is >450 ms for men and >470 ms for women, azithromycin should be avoided, as recommended by the British Thoracic Society 3, 4
Baseline liver function tests should be measured before starting therapy, as suggested by the British Thoracic Society 3, 4

Limiting antibiotic exposure whenever possible is preferred to minimize development of resistance, as recommended by the European Respiratory Society 1, 2
Consider viral etiology of many URIs before prescribing antibiotics, according to the European Respiratory Society 2
Treatment with the shortest effective duration will minimize exposure of both pathogens and normal microbiota to antimicrobials, as suggested by the European Respiratory Society 2
Assess response to therapy at days 5-7 (improvement of symptoms), as recommended by the European Respiratory Society 1, 2