Streptococcus spp., Staphylococcus spp., H. influenzae, M. catarrhalis, Bacteroides spp., (Clostridia spp.of variable susceptibility) Prevotella spp., Fusobacterium spp., Veillonella spp., Chlamydia trachomatis
Mechanism of Action:
Binds to the 50S ribosomal subunit of rRNA and inhibits the initiation of peptide chain synthesis
Cmax (900mg IV): 15.1mcg/ml; Half-life: Approximately 3 hours; Figure 2, 3
GI: diarrhea, C. difficile associated diarrhea
Skin: rash, anaphylaxis, Stevens-Johnson syndrome
GU: cervicitis, vaginitis
Capsule: 150 mg, 300 mg
Cream, vaginal, as phosphate: 2% (40 g)
Foam, topical, as phosphate 1%: (50 g, 100 g)
Gel, topical 1%: (30 g, 60 g, or 40ml, 75ml)
Granules for oral solution: 75 mg/5 mL (100 mL)
IV: 300 mg (50 mL), 600 mg (50 mL), 900 mg (50 mL)
Lotion 1%: 60 mL
Pledgets, topical 1%: #60
Solution, topical 1%: (30 mL, 60 mL)
Vaginal Suppository: 100 mg #3
Adults: 300mg PO q 6 hours; IV: 600mg to 1200mg/day divided q 12 – 6 hours (1200 to 2700mg/day divided for serious infections); topical: apply to affected area q 12 hours; Intra-vaginal cream: One applicatorful hs for 3 or 7 days (vaginal suppository for 3 days).
Children > 10kg: 8-25mg/kg/day PO divided q 8 – 6 hours (palmitate salt suspension)
Children < 10kg: 37.5mg PO q 8 hours
Children > 1 month: 20 – 40mg/kg/day IV divided q 8 – 6 hours
Children > 12 years old (topical foam): apply once daily to affected areas
Neonates < 1 month: 15 – 20mg/kg/day IV divided q 8 – 6 hours
Disease state based dosing:
Renal failure: Dosing adjustments not necessary
Hepatic failure: Dosing adjustments not necessary
Dosing during Continuous Renal Replacement Therapy
CVVH (Continuous venovenous hemofiltration): 600-900mg q8h
CVVHD (Continuous venovenous hemodialysis): 600-900mg q8h
CVVHDF (Continuous venovenous hemodiafiltration) 600-900mg q8h
Note: CVVH is mainly for fluid removal alone. Many institutions will employ more CVVHD or CVVHDF which combine dialysis with fluid removal.
Erythromycin (macrolides): In-vitro antagonism – clinical significance unknown
Skeletal muscle relaxants (atracurium, vecuronium, pancuronium, cyclobenzaprine, and others): enhanced neuromuscular blockade.
Category C: Risk unknown. Human studies inadequate.
Therapeutic: Culture and sensitivities, signs and symptoms of infection
Toxic: In severe renal or hepatic failure, serum concentration monitoring is recommended.
Brand names/Manufacturer: Various manufacturers (click here for list)