Azithromycin is a macrolide semisynthetic antimicrobial drug indicated for patients with community-acquired pneumonia (CAP) caused by pathogens such as Chlamydia pneumoniae, Haemophilus influenzae, Legionella pneumophila, C. catarrhalis, Mycoplasma pneumoniae, Staphylococcus aureus, or Streptococcus pneumoniae, and whose initiation of therapy requires intravenous administration.

Azithromycin requiring intravenous infusion is mainly azithromycin for injection, which is supplied in the market, including the imported Zithromax produced by Pfizer manufacturers, Amicillin produced by Dalian Meiluo, and Qixian produced by Northeast Pharmaceuticals. As shown in the picture:

(Hishoumi on the left, Kisen in the center, and Amiki on the right)

There are slight differences in the content of the instructions in the same drug produced by each manufacturer, but checking the instructions of azithromycin from several manufacturers, which all mention the same titration requirements: give azithromycin 500mg, formulated as a 2mg/ml, 250 ml solution to be finished within 1 hour or formulated as a 1mg/ml, 500 ml solution to be finished within 3 hours. (The above solutions are 0.9% sodium chloride injection or 5% dextrose injection.)

The instructions state that "all volunteers who received azithromycin at a concentration greater than 2.0 mg/ml had a local reaction to the injection, so the concentration of the drug at the time of sedation should not be too high". In the author's opinion, too fast a drip can also lead to local reactions during injection.

The article "Analysis of Adverse Reactions to Azithromycin by Intravenous Infusion Rate" also states that "Azithromycin administered by intravenous drip often causes gastrointestinal reactions such as nausea, vomiting, and abdominal pain, which are mainly due to the fact that the drug, when administered by sedation, leads to an increase in the level of gastrokinetic hormone in the bloodstream, which binds to receptors located on the gastrointestinal smooth muscle and produces the above gastrointestinal reactions. The above gastrointestinal reactions are caused by the binding of gastrin to receptors located on the smooth muscle of the gastrointestinal tract. Slowing the drip rate can minimize the production of gastrin in the blood and thus reduce the frequency of adverse reactions", "A rapid intravenous infusion of azithromycin also produces venous pain, which is mainly due to the chemical stimulation of vascular endothelial cells by macrolides, prompting basophils and platelets to release substances such as histamine, which cause venous pain". The release of histamine and other substances leads to venous pain. When the infusion rate is accelerated, the chemical stimulation effect is obvious, and the concentration of histamine in the blood rises in a short time, aggravating the venous pain at the infusion site".

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First we need to understand what azithromycin what drug is in that class, so we can analyze why and how to control the speed!

Azithromycin is a macrolide antibiotic, in the macrolide class Azithromycin belongs to the second generation of drugs, the first generation of drugs is erythromycin. In the second generation there are also the drugs Roxithromycin and Clarithromycin. There is also a third class of macrolides, telithromycin.

The mechanism of action of macrolide antibiotics is to block the synthesis of bacterial proteins. Antimicrobials are gram-positive, gram-negative, and some gram-negative bacilli (Haemophilus influenzae, whooping cough bacilli), atypical lethal pathogens (Mycoplasma pneumoniae, Chlamydia), and anaerobic digestive coccobacilli. The main conditions treated are community-acquired pneumonia, and pelvic inflammatory disease!

Then look at the adverse reactions. The most significant adverse reactions are gastrointestinal reactions, including vomiting, abdominal pain, diarrhea, etc., and in severe cases, brain recognition! Gastrointestinal reactions are a bit different from person to person. Therefore, sometimes azithromycin injections will be added to cimetidine to ease the gastrointestinal reaction. In addition, macrolide antibiotics also have hepatotoxicity, cardiotoxicity (arrhythmia, electrocardiogram abnormalities) ototoxicity, local pain, generalized weakness, respiratory depression and other adverse reactions.

Therefore, speed control is needed when injecting azithromycin to prevent aggravation of gastrointestinal reactions from becoming intolerable. Reduce the occurrence of adverse reactions.

Azithromycin injections should be configured so that the concentration of azithromycin does not exceed 2 mg per milliliter. A 3-hour drip is required for a concentration of 1 mg per milliliter and a 1-hour drip is required for a concentration of 2 mg per milliliter.

Azithromycin's chemical structure belongs to the group of 15-membered ring macrolides, and other macrolide antibiotics include erythromycin, madithromycin, and clarithromycin.

Azithromycin is strong against Gram-negative bacteria and weak against Gram-positive bacteria compared to erythromycin. Azithromycin has the strongest action against Mycoplasma pneumoniae of the macrolides.

Azithromycin is still a very unique medicine. It has a half-life of 35-48 hours, so its dosage is also different from other antibacterial drugs. Routinely, azithromycin is used for three days in a week, then stopped for four days, and if the condition requires it, it continues to continue to be used in this way in the next cycle.

So why is it important to control the drip rate with azithromycin?

This is because the most common and predominant adverse reactions to azithromycin are gastrointestinal symptoms, including nausea, vomiting, abdominal pain, and diarrhea, and its incidence is significantly related to the size of the drug dose. Therefore, the rate of titration is controlled so that the concentration of the drug does not reach a high level quickly and cause gastrointestinal reactions. The instructions for azithromycin require that the concentration of the drug after dispensing should not exceed 2 mg / ml, and the duration of intravenous drip should not be less than 1 hour.

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Azithromycin belongs tosecond generationmacrolide antibiotic

Azithromycin intravenous drip should be slow, a drip time should not be less than 60 minutes, the configuration of the azithromycin drip should not be higher than 2mg/ml, the drip at the same time to monitor the electrocardiography

Intravenous macrolides may cause cardiotoxicity, mainly in the form of electrocardiographic repolarization abnormalities, arrhythmias, Q-T interval prolongation, and tip-twist ventricular tachycardia, and even syncope or sudden death.

Therefore, intravenous azithromycin should be administered slowly and at a controlled rate, and once an abnormality is detected, the drug should be stopped immediately and timely measures should be taken.