Avalon200 mg/5 ml

Avalon is a macrolide antibiotic used to treat a range of bacterial infections caused by susceptible organisms. Indications vary in the strength of supporting evidence:

FDA-Approved / Established Uses

• Acute bacterial exacerbations of chronic bronchitis
• Acute bacterial sinusitis
• Community-acquired pneumonia (mild to moderate, in appropriate outpatients)
• Pharyngitis/tonsillitis (as an alternative in patients unable to take first-line therapy)
• Uncomplicated skin and skin-structure infections
• Acute otitis media (children)
• Urethritis and cervicitis due to Chlamydia trachomatis or non-gonococcal organisms
• Genital ulcer disease (chancroid) in men

Guideline-Supported Uses

• Enteric fever (typhoid) caused by susceptible Salmonella typhi, where locally supported by susceptibility data
• Mycobacterium avium complex (MAC) disease prevention and treatment, used as part of combination antimycobacterial regimens in eligible patients

Off-Label / Adjunct Uses

• Traveler's diarrhea (off-label, in selected patients)
• Cystic fibrosis-related chronic airway inflammation (anti-inflammatory/immunomodulatory adjunct use, off-label)

Avalon should be used only for infections proven or strongly suspected to be caused by susceptible bacteria.

Each tablet/capsule of Azithromycin typically contains Azithromycin Dihydrate equivalent to 250 mg or 500 mg of azithromycin base. Oral powder for suspension, when reconstituted, provides 200 mg/5 mL. Injectable formulations provide Azithromycin for intravenous infusion (e.g., 500 mg per vial). Strengths and available forms may vary by manufacturer.

Avalon is a semi-synthetic macrolide antibiotic belonging to the azalide subclass. It is derived from erythromycin but has an expanded spectrum of activity, improved tissue penetration, a longer half-life allowing shorter treatment courses, and better gastrointestinal tolerability compared with older macrolides. Avalon is available as tablets, oral suspension, and an intravenous formulation for the treatment of susceptible bacterial infections.

Macrolide antibiotic (azalide subclass)

Azithromycin inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit, blocking translocation of peptidyl tRNA and thereby arresting bacterial growth (bacteriostatic; can be bactericidal at higher concentrations against some organisms).

Following oral administration, Azithromycin is rapidly absorbed and widely distributed into tissues, with concentrations in many tissues substantially exceeding plasma levels due to extensive intracellular and tissue uptake. It undergoes limited hepatic metabolism and is primarily eliminated unchanged in bile, with a small proportion excreted renally. Its terminal elimination half-life is long (2–4 days), which permits once-daily dosing and short treatment courses.

Avalon tablets should be swallowed whole with a glass of water. The oral suspension should be shaken well before each use and measured with an accurate dosing device. Avalon may be taken with or without food; taking it with food can reduce stomach upset. Antacids containing aluminum or magnesium should not be taken at the same time as Avalon — separate dosing by at least 2 hours. If a dose is missed, it should be taken as soon as remembered unless it is almost time for the next dose, in which case the missed dose should be skipped; doses should never be doubled.

Avalon has fewer clinically significant CYP3A4-mediated interactions than other macrolides, but the following are well-established and clinically important:

• Ergot derivatives (ergotamine, dihydroergotamine): Theoretical risk of ergotism (acute ergot toxicity); co-administration should be avoided.
• Warfarin and other oral anticoagulants: Avalon may potentiate anticoagulant effect; prothrombin time/INR should be monitored closely if co-administered.
• QT-prolonging drugs (e.g., Class IA and III antiarrhythmics, certain antipsychotics, some antidepressants): Additive risk of QT prolongation and torsades de pointes; avoid combination when possible or monitor closely.
• Nelfinavir: Significantly increases Avalon plasma concentrations; monitor for related adverse effects (e.g., liver enzyme abnormalities, hearing impairment) if co-administered.
• Antacids (aluminum/magnesium-containing): May reduce peak plasma concentration of Avalon if taken simultaneously; separate administration times.
• Digoxin, cyclosporine, and other narrow-therapeutic-index drugs: Macrolides may increase levels of these drugs in some patients; monitoring is advised when co-administered with Avalon.

Always inform the physician or pharmacist of all other medicines being used before starting Avalon.

Most adverse effects associated with Avalon are mild to moderate and gastrointestinal in nature.

Common

• Diarrhea/loose stools
• Nausea
• Abdominal pain
• Vomiting
• Headache

Less Common / Serious (see Precautions and Warnings for detail)

• QT prolongation and cardiac arrhythmia
• Hepatotoxicity, including cholestatic jaundice
• Clostridioides difficile-associated diarrhea/colitis
• Allergic reactions, including rare severe skin reactions and anaphylaxis
• Reversible hearing impairment with prolonged high-dose use

Pregnancy: Available human data have not shown an increased risk of major birth defects with Avalon use in pregnancy; however, data remain limited. Avalon should be used during pregnancy only if clearly needed and the potential benefit justifies the potential risk to the fetus. A physician should always be consulted before use in pregnancy.

Lactation: Avalon is present in breast milk. It should be used with caution during breastfeeding, and the infant should be monitored for gastrointestinal effects such as diarrhea or rash. Consult a physician before using Avalon while breastfeeding.

QT Prolongation: Avalon can prolong the QT interval and has been associated with a small increased risk of cardiovascular death, particularly torsades de pointes, in some studies. Use with caution in patients with known QT prolongation, uncorrected electrolyte abnormalities (hypokalemia, hypomagnesemia), bradycardia, or concomitant use of other QT-prolonging drugs.

Hepatotoxicity: Rare cases of severe, sometimes fatal, hepatotoxicity have been reported. Discontinue Avalon promptly if signs or symptoms of hepatitis occur.

Clostridioides difficile-Associated Diarrhea: May occur during or up to several weeks after therapy with Avalon; evaluate if persistent or severe diarrhea develops.

Myasthenia Gravis: Rare exacerbation of myasthenia gravis symptoms has been reported with Avalon; use with caution in this population.

Infantile Hypertrophic Pyloric Stenosis: Reported with macrolide use in infants; caution advised with use of Avalon in neonates and young infants.

Antibiotic stewardship: Take Avalon exactly as prescribed by your physician; do not stop, extend, skip doses, or share this medicine with others without medical advice.

Overdose with Avalon may cause exaggerated gastrointestinal symptoms such as severe nausea, vomiting, and diarrhea, and rarely, reversible hearing loss. If an overdose of Avalon is suspected, seek immediate medical attention or contact a poison control center/emergency services. Treatment is general symptomatic and supportive care; there is no specific antidote.

Store Avalon tablets/capsules at room temperature (below 30°C), away from light and moisture. Keep out of reach of children. Reconstituted oral suspension of Avalon should be stored as directed on the label (typically at room temperature, away from excessive heat) and discarded after 10 days if unused.

Renal impairment: No dose adjustment is generally required for mild-to-moderate renal impairment with Avalon; caution and physician guidance are advised in severe renal impairment.

Hepatic impairment: Use Avalon with caution in patients with hepatic impairment; it is contraindicated in those with a prior history of cholestatic jaundice/hepatic dysfunction related to its use (see Contraindications).

Elderly: Older adults may be more susceptible to QT-prolongation-related arrhythmias with Avalon; use with caution, particularly with concomitant cardiac risk factors.

Cardiac disease: Caution advised when using Avalon in patients with pre-existing QT prolongation or significant cardiac disease (see Precautions and Warnings).

Treatment duration with Avalon is typically short, ranging from a single dose (e.g., for chlamydial urethritis/cervicitis or chancroid) to 3–5 days for most respiratory and skin infections, owing to its long tissue half-life. Certain indications, such as enteric fever, may require 7 days or longer, and IV-to-oral regimens for pneumonia may total 7–10 days. The exact duration of Avalon therapy should always follow the prescribing physician's instructions and should not be shortened or extended without medical advice.

Avalon oral suspension powder should be reconstituted by adding the specified amount of water to the bottle as indicated on the label, then shaking well to form a uniform suspension. Once reconstituted, the suspension typically provides 200 mg/5 mL and should be shaken before each dose. Reconstituted Avalon suspension should be stored as directed (usually at room temperature) and any unused portion discarded after 10 days.

Macrolide antibiotics; Azalides

Azithromycin exerts its antibacterial effect by binding to the 23S rRNA of the bacterial 50S ribosomal subunit, inhibiting RNA-dependent protein synthesis by blocking translocation of peptidyl tRNA during translation. This action is primarily bacteriostatic, arresting bacterial growth and replication, though Azithromycin can be bactericidal against certain highly susceptible organisms at achievable concentrations.

B

Avalon is approved for use in children 6 months of age and older for acute otitis media and community-acquired pneumonia, and (in children 2 years and older) pharyngitis/tonsillitis, using weight-based dosing as directed by a physician. Safety and efficacy of Avalon for other indications in infants younger than 6 months have not been established. Caution is advised in neonates given a reported association between macrolide exposure and infantile hypertrophic pyloric stenosis. Pediatric dosing of Avalon must always be calculated by a physician based on the child's weight and the specific infection being treated.