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Author: Admin | 2025-04-28
Other medications associated with QTc prolongation. In animal studies, although azithromycin was associated with similar QTc prolongation compared to other macrolides, it seemed to have a negligible proarrhythmic effect.[64] While significant hepatoxicity resulting from azithromycin is relatively rare, macrolides are known to cause mixed hepatocellular/cholestatic drug-induced liver injury. With prompt discontinuation of azithromycin, liver injury is almost always reversible with minimal residual impairment. Often, azithromycin-induced hepatotoxicity has associated immunoallergenic features such as rash, fever, and eosinophilia. Severe reactions, such as anaphylaxis, SJS, and drug reaction with eosinophilia and systemic symptoms (DRESS), are rare.[65] Gastrointestinal toxicity is common but typically mild, and most patients can complete the prescribed course of azithromycin. This toxicity is the result of azithromycin’s activation of pro-motility receptors in the gastrointestinal tract.Management of OverdoseThere is no antidote for azithromycin overdose. General symptomatic and supportive measures should be instituted as necessary. Enhancing Healthcare Team Outcomes Although azithromycin is a well-tolerated and effective antimicrobial agent with many clinical indications, it is often inappropriately prescribed, particularly in the primary care setting. Several large retrospective cohort studies involving high levels of inappropriate antimicrobial prescribing overall singled out azithromycin as the most frequently misused drug.[66][67][68][69] Azithromycin is frequently prescribed when there is no clinical indication for antimicrobials, and in many instances, azithromycin is not first-line therapy (e.g., acute otitis media).[66][70] Azithromycin is frequently prescribed when a narrow-spectrum β-lactam (eg, amoxicillin) is the indicated first-line therapy.[66] Increasing resistance to azithromycin, particularly among S pneumoniae isolates, makes the widespread use of azithromycin for upper respiratory illness particularly concerning.[71][72] Broad-spectrum antimicrobial therapy for upper respiratory infection is also associated with increased rates of adverse effects compared with narrow-spectrum agents.[73][74]One possible association with high rates of azithromycin prescription is patient-reported penicillin allergy.[75] Macrolides, particularly azithromycin, are preferred to β-lactam drugs for many clinical indications. Researchers found 12.8% of patients in an extensive electronic medical records database have a penicillin allergy listed in 1 large cohort.[76] Patients with a reported penicillin allergy are as much as 4 times more likely to be prescribed a macrolide antimicrobial.[75] However, a detailed history of a patient’s adverse reactions to penicillin,
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