Zithromax (Azithromycin) for Kids: Dosing and Safe Use

Zithromax (azithromycin) is an antibiotic that can be used to treat ear and sinus infections, pneumonia, strep throat, and other bacterial infections in children. It is approved for children 6 months or older and is a good option for kids with penicillin allergies.

Guidelines for pediatric dosing of azithromycin are based on the condition being treated and the weight of the child. The drug is available in pill or liquid form.

This article discusses the use of azithromycin in kids, including how it is taken, possible side effects, and drug interactions.

Benefits of Azithromycin for Children

Zithromax is an oral antibiotic first licensed for use in 1991 for the treatment of certain mild to moderate bacterial infections.

Zithromax is approved by the U.S. Food and Drug Administration (FDA) for the treatment of the following conditions in children:

• Acute otitis media (inner ear infection) in children over 6 months and over
• Acute bacterial sinusitis (sinus infection) in children over 6 months and over
• Community-acquired pneumonia in children over 6 months and over
• Pharyngitis or tonsillitis (including strep throat) in children 2 years and over

Zithromax is often used off-label for other mild to moderate bacterial infections, including those that cause walking pneumonia and pertussis (whooping cough).

Forms of Azithromycin for Kids

Zithromax is a macrolide antibiotic, a class of antibiotics that also includes erythromycin, clarithromycin, fidaxomicin, and telithromycin. Macrolide antibiotics are regarded as broad-spectrum antibiotics because they act against a wide range of bacteria.

Zithromax has long been considered attractive to kids because it is well-tolerated, inexpensive, can be taken with or without food, and often requires only a single dose to clear an infection. (However, overuse of the drug has led to widespread resistance in which bacteria once susceptible to the drug are no longer affected.)

Zithromax is available in several formulations and dosed in milligrams (mg):

• Zithromax tablets (250 mg and 500 mg)
• Zithromax powder (mixed with water for an oral solution)
  
• Zithromax Tri-Pak, 500-mg tablets (use for a three-day course)
• Zithromax Z-Pak, 250-mg tablets (used for a five-day course)
• Zmax (extended-release formulation)

Zithromax is a good choice for children who are allergic to penicillin.

Azithromycin Children Dosages

Zithromax is taken once daily with a course of one or several doses. When used in children, the dosage is calculated based on milligrams per kilogram of body weight (mg/kg).

The formula varies by the condition being treated and the number of doses prescribed.

For instance, if a child weighs 10 kilograms and the dose is 10 mg/kg, the child would be prescribed 100 milligrams (10 mg x 10 kg = 100 mg).

Otitis Media

Otitis media, also known as a middle ear infection, is common in young children because the size and shape of their smaller ear canals can easily trap fluids and germs.

The recommended dosage in children 6 months and over varies by whether one, three, or five doses are prescribed:

• Option 1: 30 mg/kg given as a single dose
• Option 2: 10 mg/kg taken once daily over three consecutive days
• Option 3: 10 mg/kg for the first day, followed by 5 mg/kg per day for the next four days
  

Acute Bacterial Sinusitis

Acute bacteria sinusitis, also referred to as a sinus infection, is most often caused by Streptococcus pneumonia and Haemophilus influenza. Sinusitis is a common complication of an upper respiratory viral infection (like the cold or flu) or a respiratory allergy (such as hay fever).

The recommended dosage in children 6 months and over is:

• 10 mg/kg taken once daily over three consecutive days

Community-Acquired Pneumonia

Community-acquired pneumonia (CAP) is pneumonia that is caught and spread outside a hospital or other healthcare or nursing facility. Streptococcus pneumoniae is the most common cause of CAP, accounting for roughly 50% of cases. Influenza virus A is another common cause.

The recommended dosage in children 6 months and over is:

• 10 mg/kg for the first day, followed by 5 mg/kg per day for the next four days

Pharyngitis or Tonsillitis

Pharyngitis is inflammation of the pharynx (throat) and tonsillitis is inflammation of the tonsils. The most common bacterial cause is Streptococcal pyogenes, the bacteria that causes strep throat. Strep throat accounts for roughly 30% of sore throats in kids,

The recommended dosage in children 2 years and over is:

• 12 mg/kg taken once daily over five consecutive days

Azithromycin Side Effects in Kids

For children taking a five-day course of Zithromax, the most common side effects include:

• Diarrhea and loose stools
• Abdominal pain
• Vomiting
• Nausea
• Rash
• Headache

When prescribed as a one-time dose, there is a greater risk of vomiting or diarrhea. If the side effects are severe or persistent, call your healthcare provider.

On rare occasions, a child may experience a severe and potentially life-threatening allergy known as anaphylaxis.

Azithromycin Interactions

If your child is taking Zithromax and an antacid such as Tums, Mylanta, or Maalox, you may need to separate the doses by four hours to avoid a drop in the concentration of Zithromax in the blood.

Antacids can be taken simultaneously if an extended-release Zmax is prescribed.

Always advise your pediatrician about any drugs your child may be taking, whether pharmaceutical, over-the-counter, nutritional, homeopathic, or traditional.

Azithromycin Warnings

The FDA warns that azithromycin can cause changes in the heart's regular electrical activity, leading to an abnormal heart rhythm condition known as QT interval prolongation. This can cause fast or irregular heartbeats, severe dizziness, blurred vision, fainting, and death (rare).

Certain factors can increase a child's risk while taking Zithromax:

• A family history of QT interval prolongation
• Low blood potassium or magnesium
• A family history of arrhythmias (abnormal heart rhythms)
• Use of anti-arrhythmia medications

Call your healthcare provider if your child experiences irregular heartbeats or has a sudden dizziness spell. If there is fainting, take your child to the emergency room, even if it lasts for only a few seconds.

Summary

Zithromax (azithromycin) is an oral antibiotic that can be used in children to treat a middle ear infection, sinus infection, pneumonia, strep throat, and tonsillitis. Depending on the condtion being treated, it may be given over one to five days. The dose is calculated based on the child's weight in kilograms. Common side effects include upset stomach, diarrhea, and nausea.