From the Guidelines
The recommended dose of azithromycin for treating pharyngitis is 12 mg/kg once daily (maximum 500 mg per day) for 5 days, as stated in the 2012 update by the Infectious Diseases Society of America 1, 2, 3.
Key Considerations
- Azithromycin is a suitable alternative for patients with penicillin allergy who cannot take first-line treatments like amoxicillin.
- The medication works by binding to the 50S ribosomal subunit of susceptible bacteria, inhibiting protein synthesis.
- It is essential to confirm that the pharyngitis is likely bacterial in origin before starting treatment, as most cases are viral and do not require antibiotics.
Administration and Duration
- Azithromycin should be taken at least 1 hour before or 2 hours after meals for optimal absorption.
- Patients should complete the full 5-day course even if symptoms improve before finishing the medication to prevent antibiotic resistance and ensure complete eradication of the infection.
Evidence Summary
The Infectious Diseases Society of America recommends azithromycin as a treatment option for GAS pharyngitis in penicillin-allergic individuals, with a dosage of 12 mg/kg once daily (maximum 500 mg per day) for 5 days 1, 2, 3. This recommendation is based on the efficacy, safety, and cost-effectiveness of azithromycin compared to other antibiotic options.
From the FDA Drug Label
Pharyngitis/Tonsillitis The recommended dose of azithromycin for children with pharyngitis/tonsillitis is 12 mg/kg once daily for 5 days. PEDIATRIC DOSAGE GUIDELINES FOR PHARYNGITIS/TONSILLITIS (Age 2 years and above, see PRECAUTIONS—Pediatric Use.) Based on Body Weight PHARYNGITIS/TONSILLITIS: (5-Day Regimen) Dosing Calculated on 12 mg/kg/day for 5 days.
The recommended dose of azithromycin for pharyngitis is 12 mg/kg once daily for 5 days for children aged 2 years and above 4.
- Key points:
- Dose: 12 mg/kg
- Frequency: once daily
- Duration: 5 days
- Age: 2 years and above Note: The dose for adults is not specified in the provided text for pharyngitis.
From the Research
Azithromycin Dose for Pharyngitis
- The recommended dose of azithromycin for treating pharyngitis is a total dose of 60 mg/kg, given either as 12 mg/kg once daily for 5 days or 20 mg/kg once daily for 3 days 5.
- A study comparing azithromycin and penicillin V for the treatment of streptococcal pharyngitis found that azithromycin 500 mg once on day 1 followed by 250 mg once daily for 4 days was effective in treating the infection 6.
- A meta-analysis of randomized, controlled trials found that azithromycin administered at a dosage of 60 mg/kg in children or administered for 3 days at a dosage of 500 mg/day in adults was more effective than other treatment regimens in producing eradication and clinical cure of group A streptococcal tonsillopharyngitis 7.
- Another study compared 10 days of clarithromycin therapy with 5 days of azithromycin therapy and found that the 10-day clarithromycin regimen was more effective in eradicating the organism 8.
- A systematic review of different antibiotic treatments for group A streptococcal pharyngitis found that there was no difference in symptom resolution between cephalosporins and penicillin, and that macrolides were not more effective than penicillin 9.
Dosage Regimens
- A 3-day regimen of azithromycin 500 mg/day may be effective in adults 7.
- A 5-day regimen of azithromycin 12 mg/kg once daily may be effective in children 5.
- A 10-day regimen of clarithromycin 250 mg twice daily may be more effective than a 5-day regimen of azithromycin 8.