CrCl > 80: 250-500 mg qd iv or po.
CrCl 80-50: 250-500 mg qd iv or po.
CrCl 50-10: 250-500 mg qd iv or po.
CrCl < 10: 250-500 mg qd iv or po.
Hemodialysis 250-500 mg qd iv or po.
Peritoneal dialysis: 250-500 mg qd iv or po.
Important side effects
Death. In people who are taking it for mostly sinusitis and bronchitis, there is an increased risk of death, especially if there is underlying cardiac disease:
"...estimated 47 additional cardiovascular deaths per 1 million courses; patients in the highest decile of risk for cardiovascular disease had an estimated 245 additional cardiovascular deaths per 1 million courses." compared to amoxicillin (PubMed).
Important drug interactions
Avoid aluminum-and magnesium-containing antacids. Aluminum carbonate, aluminum hydroxide, aluminum phosphate, amiodarone, carbamazepine, cyclosporine, digoxin, dihydroxyaluminum aminoacetate, dihydroxyaluminum sodium carbonate, disopyramide, ergot derivatives, fentanyl, hexobarbital, magnesium carbonate, magnesium hydroxide, magnesium oxide, magnesium trisilicate, nelfinavir, phenytoin, pimozide, rifabutin, theophylline, triazolam, warfarin.
Rants and Screeds
So many drugs have 'max' in the name. I need to trademark maxmaxmax. It has the requisite bunch of 'x's' needed in a modern drug. Too bad Omnimax® is taken.
Treatment of choice
Acute mild to moderate exacerbations of COPD: either 500 mg po per day for 3 days OR 500 mg on day one, 250 mg/day on days 2-5
Acute bacterial sinusitis: 500 mg po daily for 3 days.
Cervicitis due to Chlamydia trachomatis: single 1 gram dose po. Cervicitis due to Neisseria gonorrhoeae: single 2 gram dose po. Cellulitis (uncomplicated): 500 mg po on day one, 250 mg/day on days 2-5.
Chancroid (Haemophilus ducreyi): single 1 gram dose.
Pneumonia, community-acquired: 500 mg IV every day for minimum of 2 days, then 500 mg po qd for 7-10 days.
Don't use for
Last Update: 04/17/19.