Don't use azithromycin, be careful to death!

*It is only for medical professionals to read and refer to those things about strokes of azithromycin! Azithromycin is a commonly used antibacterial drug in the respiratory department.
It only needs to be administered once a day.
It does not require a skin test before medication and is effective against Mycoplasma pneumoniae.
It is frequently used in respiratory infections.
Unreasonable use of azithromycin is also common, and tragedies are also common.
It happened! Let’s take a look at those things about azithromycin today! 1.
How to play the antibacterial effect Azithromycin is a 15-membered ring macrolide antibiotic.
Its role is to interfere with the synthesis of its protein by binding to the subunit of the 50S ribosome of sensitive bacteria (does not affect the synthesis of nucleic acid)
.

It has good antibacterial activity against Haemophilus influenzae, Legionella pneumophila and Mycoplasma.
It is also effective against Streptococcus and Pseudomonas aeruginosa infections.
It is also effective against non-tuberculous mycobacteria, especially Mycobacterium intracellulare complex bacteria.
Important therapeutic significance [1]
.

2.
Under what circumstances to choose the drug (1) Mycoplasma pneumonia: Mycoplasma pneumoniae has a resistance rate of 54.
9%-60.
4% to azithromycin.
When mycoplasma pneumonia is suspected, azithromycin is no longer the first choice.
Adults prefer tetracyclines (doxycycline, rice).
Nocycline), fluoroquinolones (levofloxacin, moxifloxacin) [2]
.

Children may consider oral or intravenous azithromycin [3]
.

(2) Haemophilus influenzae: The bacterium is resistant to azithromycin by more than 30%
.

The first choice for the treatment of Haemophilus influenzae is amoxicillin/clavulanic acid, ampicillin/sulbactam.
For ampicillin resistance, cefuroxime or azithromycin can be used [2]
.

(3) Simple chronic obstructive pulmonary disease: patients with simple chronic obstructive pulmonary disease are mainly Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis.
At this time, anti-infection can choose macrolides (azithromycin, clarithromycin) Cephalosporins), the first or second generation cephalosporins (such as cefuroxime) and other treatments [4]
.

(4) Drug management in stable COPD: Studies have shown that long-term use of azithromycin and erythromycin can reduce the frequency of acute exacerbations in some patients with COPD
.

However, long-term use of azithromycin may increase bacterial resistance, so long-term use is not recommended unless it is really necessary
.

During the exacerbation of the disease, the use of antibiotics can be restricted by observing the color of sputum and referring to the levels of C-reactive protein and procalcitonin [5]
.

3.
When is it more appropriate to take azithromycin? When to take azithromycin is really a mystery.
After consulting the drug instructions of different manufacturers and different dosage forms, the conclusions may be different.
Some of them are marked to be taken 1 hour before or 2 hours after meals.
, Some labels can be taken with food
.

In order to find out, through consulting the data [6]: (1) According to the drug instructions: most domestic azithromycin requires taking 1 h before or 2 h after a meal, and imported azithromycin tablets and dry suspensions can be taken with food (2) Whether the bioavailability of azithromycin is affected by food is related to the dosage form of the drug
.

Food will reduce the absorption of capsules and should be taken 1 hour before or 2 hours after a meal; tablets and dry suspensions can be taken with food
.

IV.
Dosing speed need to pay attention to the speed of intravenous infusion.
There are many people questioning why the infusion time is 3 hours when the drug concentration is 1 mg/mL, and the infusion time is 1 when the drug concentration is 2 mg/mL.
h
.

It takes a shorter time when the concentration is high
.

The possible reasons for consulting related literature are as follows [7]: 1.
Both bound drugs and free drugs are in a dynamic balance, and only free drugs can exert pharmacological activity
.

When azithromycin is formulated at a low concentration (1 mg/mL), the binding rate to plasma protein is high.
At this time, the infusion rate is slowed down, so that more azithromycin can be released and distributed in the tissues to exert pharmacological activity
.

2.
For the same dose of azithromycin, 1 mg/mL requires more solvent than 2 mg/mL.
In order to reduce the burden on the heart and the occurrence of acute pulmonary edema, it is necessary to slow down the infusion rate when the amount of solvent is large
.

3.
If the instillation is too fast, the concentration of the drug in the plasma will increase rapidly in a short time, resulting in an increase in the content of motilin in the blood, which can cause nausea, vomiting and abdominal pain
.

For the above reasons, the relatively low concentration (1 mg/mL) requires 3 hours for intravenous infusion
.

Five-dose course of treatment The course of treatment needs to be considered from the following conditions, on the one hand, the pharmacokinetics of the drug and the aftereffect of antibacterial drugs, on the other hand, the patient’s own disease
.

(1) Pharmacokinetics: The terminal elimination half-life of azithromycin in human tissues can reach 68 hours, and azithromycin can still be detected in macrophages and white blood cells on the 12th day after taking the drug
.

And the level of azithromycin in tissues and cells can far exceed 10-100 times of the blood concentration in the same period, and the level of azithromycin in the infected part is 6 times that of the non-infected part, especially in the lung tissue, the level is higher and the action time is long
.

After taking the medicine for 3 days, azithromycin can continue to work in the body for 3-4 days even if it is stopped
.

(2) Post-antibacterial effect: The so-called post-antibacterial effect means that after stopping the antibacterial drug, even if the blood concentration of the drug is lower than the minimum inhibitory concentration (MIC), the bacteria are still in a state of being inhibited for a certain period of time.
Grow
.

Although on the surface the application of azithromycin was stopped after 3 days, in fact, the pathogen was still in a suppressed state after the drug was stopped [8]
.

 Based on the above reasons, it usually takes 3 days to stop for 4 days, and then decide whether to continue using it according to the body temperature, the presence or absence of complications, and the improvement of cough symptoms
.

Six common adverse reactions and countermeasures (1) Gastrointestinal adverse reactions: Generally, there are more adverse reactions in the gastrointestinal tract during intravenous infusion than oral administration.
In order to reduce the vomiting and abdominal pain caused by the drug, the infusion rate can be slowed down or medication Give 3 g of montmorillonite powder in the first 10 minutes and take 50 mL of warm water [7]
.

(2) Abnormal liver function: As the hepatobiliary system is the main way of excretion of azithromycin, it should be used with caution in patients with liver insufficiency, and should not be used in patients with severe liver disease, cholestatic jaundice, and elevated serum aminotransferase
.

If it must be used, liver function needs to be followed up regularly during the medication
.

Seven interactions [9] (1) Azithromycin can increase the blood concentration of digoxin, colchicine, terfenadine, cyclosporine, and phenytoin, closely monitor the adverse reactions; (2) ergotamine or dihydro Ergotamine: Acute ergot poisoning, manifested as severe peripheral vasospasm and hypoesthesia; (3) Nefinavir can increase the serum concentration of azithromycin
.

Although there is no need to adjust the dose of azithromycin when combined with nelfinavir, it is necessary to closely monitor the known adverse effects of azithromycin such as abnormal liver enzymes and hearing damage; (4) When combined with warfarin, attention should be paid to the detection of prothrombin time
.

Eight precautions [9] (1) lactating women: Macrolide drugs are weakly alkaline, which can not only pass through the placental barrier, but are also easy to secrete into breast milk
.

Suspend breastfeeding during the medication period (generally 3 days for infection medication) and within 7 days after stopping the medication
.

(2) Before using azithromycin, you must ask the patient for arrhythmia and the history of QT interval prolongation.
If the diagnosis is missed, the consequences may be fatal
.

It was previously reported that a patient with congenital heart disease lost his life due to misuse of azithromycin leading to a prolonged QT interval
.

(3) For patients with electrolyte disorders, it is recommended to correct the electrolytes and review the ECG before use
.
If there is no abnormality, then consider whether to use the drug .

(4) Patients with myasthenia gravis should be used with caution: patients receiving azithromycin treatment have reported cases of worsening myasthenia gravis and new-onset myasthenia syndrome
.

Reference materials: [1] Tang Xifeng.
Clinical application, drug resistance and adverse reactions of azithromycin[J].
International Journal of Pediatrics,2021,48(2):104-107.
DOI:10.
3760/cma.
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issn.
1673-4408.
2021.
02.
008.
[2]Chinese Medical Association, Chinese Medical Association Journal, Chinese Medical Association General Medicine Branch, etc.
Primary diagnosis and treatment guidelines for community-acquired pneumonia in adults (2018)[J].
Chinese Journal of General Practitioners, 2019,18(2):117-126.
DOI:10.
3760/cma.
j.
issn.
1671-7368.
2019.
02.
005.
[3]National Health Commission of the People's Republic of China, State Administration of Traditional Chinese Medicine.
Guidelines for the diagnosis and treatment of community-acquired pneumonia in children ( (2019 edition)[J].
Chinese Journal of Clinical Infectious Diseases,2019,12(1):6-13.
DOI:10.
3760/cma.
j.
issn.
1674-2397.
2019.
01.
002.
[4]Acute exacerbation of chronic obstructive pulmonary disease Chinese Expert Consensus on Anti-infective Therapy Compilation Group.
Chinese Expert Consensus on Anti-infective Treatment for Acute Exacerbation of Chronic Obstructive Pulmonary Disease[J].
International Journal of Respiration,2019,39(17):1281-1296.
DOI:10.
3760/cma.
j.
issn .
1673-436X.
2019.
17.
001.
[5] Chinese Expert Consensus Compilation Group on Anti-infective Treatment for Acute Exacerbation of Chronic Obstructive Pulmonary Disease.
Chinese Expert Consensus on Anti-infective Treatment for Acute Exacerbation of Chronic Obstructive Pulmonary Disease[J].
International Journal of Respiration,2019 ,39(17):1281-1296.
DOI:10.
3760/cma.
j.
issn.
1673-436X.
2019.
17.
001.
[6] Li Dong, Fang Shiping, Yan Xiaohua, etc.
Biology of domestic and imported azithromycin tablets in the human body, etc.
Efficacy study[J].
China Pharmacy,2006,17(24):1877-1880.
DOI:10.
3969/j.
issn.
1001-0408.
2006.
24.
015.
[7]Li Ping, Gu Jianfang, etc.
Intravenous patients with respiratory infections in the elderly The effect of different initial stages of azithromycin infusion on the main adverse reactions.
Nursing Research, 2017, 31 (13).
[8],.
Research and clinical progress on the antibacterial effects of azithromycin[J].
Basic Medicine and Clinic, 2015,35(8):1126-1129.
[9]Instructions for Azithromycin for Injection (Xishumei).
Update on 2018-10-08.