Azithromycin maintenance therapy in patients with cystic fibrosis: a dose advice based on a review of pharmacokinetics, efficacy, and side effects

Pediatr Pulmonol. 2012 Jul;47(7):658-65. doi: 10.1002/ppul.21620. Epub 2012 Jan 3.


Azithromycin maintenance therapy results in improvement of respiratory function in patients with cystic fibrosis (CF). In azithromycin maintenance therapy, several dosing schemes are applied. In this review, we combine current knowledge about azithromycin pharmacokinetics with the dosing schedules used in clinical trials in order to come to a dosing advise which could be generally applicable. We used data from a recently updated Cochrane meta analysis (2011), the reports of clinical trials and pharmacokinetic studies. Based on these data, it was concluded that a dose level of 22-30 mg/kg/week is the lowest dose level with proven efficacy. Due to the extended half-life in patients with CF, the weekly dose of azithromycin can be divided in one to seven dosing moments, depending on patient preference and gastro-intestinal tolerance. No important side effects or interactions with other CF-related drugs have been documented so far.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / administration & dosage*
  • Anti-Bacterial Agents / adverse effects
  • Anti-Bacterial Agents / pharmacokinetics
  • Azithromycin / administration & dosage*
  • Azithromycin / adverse effects
  • Azithromycin / pharmacokinetics
  • Clinical Trials as Topic
  • Cystic Fibrosis / drug therapy*
  • Humans
  • Meta-Analysis as Topic
  • Pneumonia, Bacterial / drug therapy


  • Anti-Bacterial Agents
  • Azithromycin