What is the recommended dose of azithromycin (Zithromax) for a 192lb female with acute otitis media?

From the Guidelines

For a 192lb female with acute otitis media, the recommended dose of azithromycin (Zithromax) is 500mg on the first day, but according to the most recent and highest quality evidence available, the dose is actually 12 mg/kg once daily (max = 500 mg) for 5 days 1. To calculate the dose, we need to convert the patient's weight from pounds to kilograms: 192lb is approximately 87kg. Using the recommended dose of 12 mg/kg once daily, the patient's dose would be: 12 mg/kg * 87 kg = 1044 mg, which exceeds the maximum recommended dose of 500 mg. Therefore, the patient should take 500 mg once daily for 5 days. It's essential to note that azithromycin should be taken at least 1 hour before or 2 hours after meals, as food can reduce absorption. The patient can take it with or without food if stomach upset occurs, though effectiveness may be slightly reduced. Azithromycin works by inhibiting bacterial protein synthesis, and its long half-life allows for once-daily dosing and the short 5-day regimen. Most patients begin feeling improvement within 1-3 days, but it's essential to complete the full course to prevent antibiotic resistance. Common side effects include nausea, diarrhea, and abdominal pain. If symptoms worsen or don't improve after 3 days, the patient should contact their healthcare provider for reevaluation. Some key points to consider when prescribing azithromycin include:

• The dose is based on the patient's weight, so accurate weight measurement is crucial.
• The maximum recommended dose is 500 mg per day.
• The treatment course is 5 days long.
• Patients should be advised to complete the full course of treatment, even if symptoms improve before the end of the course.

From the FDA Drug Label

Adults Infection *Recommended Dose/Duration of Therapy *DUE TO THE INDICATED ORGANISMS (See INDICATIONS AND USAGE.) Community-acquired pneumonia (mild severity) Pharyngitis/tonsillitis (second line therapy) Skin/skin structure (uncomplicated) 500 mg as a single dose on Day 1, followed by 250 mg once daily on Days 2 through 5 Acute bacterial exacerbations of chronic obstructive pulmonary disease (mild to moderate) 500 mg QD × 3 days OR 500 mg as a single dose on Day 1, followed by 250 mg once daily on Days 2 through 5 Acute bacterial sinusitis 500 mg QD × 3 days Genital ulcer disease (chancroid) One single 1 gram dose Non-gonoccocal urethritis and cervicitis One single 1 gram dose Gonococcal urethritis and cervicitis One single 2 gram dose

The recommended dose for acute otitis media is not specified for adults in the provided drug label. However, for pediatric patients, the recommended dose of azithromycin for oral suspension for the treatment of pediatric patients with acute otitis media is:

• 30 mg/kg given as a single dose
• 10 mg/kg once daily for 3 days
• 10 mg/kg as a single dose on the first day followed by 5 mg/kg/day on Days 2 through 5

Since the patient is an adult (192lb female), we cannot directly apply the pediatric dosage guidelines.

• Key point: The label does provide dosing information for various infections in adults, but it does not specify the dose for acute otitis media in adults. Given the information provided in the drug label, no dosage adjustment is recommended based on age or gender. However, the label does not provide a recommended dose for acute otitis media in adults. Therefore, we cannot determine the recommended dose of azithromycin for a 192lb female with acute otitis media based on the provided drug label 2.

From the Research

Dosing Information for Azithromycin

The recommended dose of azithromycin for acute otitis media is not explicitly stated for a 192lb female in the provided studies. However, we can look at the dosing information provided in the studies:

• A dose of 30 mg/kg is mentioned in the study 3 for children with otitis media.
• A dose of 10 mg/kg/day for 3 days is mentioned in the study 4 for children with otitis media.
• A dose of 10 mg/kg once weekly is mentioned in the study 5 for prophylaxis of recurrent acute otitis media in children.
• The study 6 discusses the pharmacokinetic and pharmacodynamic properties of azithromycin, but does not provide specific dosing information for a 192lb female.
• The study 7 mentions a dose of 10 mg/kg/day for 3 days for children with acute otitis media.

Calculating the Dose for a 192lb Female

To calculate the dose for a 192lb female, we need to convert the weight from pounds to kilograms. 1 pound is approximately equal to 0.45 kilograms, so: 192 pounds * 0.45 kilograms/pound = approximately 86.4 kilograms

Using the dose of 30 mg/kg mentioned in study 3, the calculated dose would be: 86.4 kilograms * 30 mg/kg = 2592 mg

Using the dose of 10 mg/kg/day mentioned in studies 4 and 7, the calculated dose would be: 86.4 kilograms * 10 mg/kg = 864 mg/day for 3 days

Important Considerations

It is essential to note that these calculations are based on studies involving children, and the dosing information may not be directly applicable to adults. Additionally, the studies do not provide information on the safety and efficacy of azithromycin in adults with acute otitis media. Therefore, it is crucial to consult a healthcare professional for proper diagnosis and treatment.