Azithromycin Dosing for a 2-Year-Old Child Weighing 28 Pounds
For a 2-year-old child weighing 28 pounds (approximately 12.7 kg), the recommended dose of azithromycin for community-acquired pneumonia is 10 mg/kg (127 mg) on day 1, followed by 5 mg/kg (63.5 mg) once daily on days 2-5.
Dosing Calculation
Based on the FDA-approved drug label for azithromycin 1:
- For community-acquired pneumonia in children:
- Day 1: 10 mg/kg = 127 mg
- Days 2-5: 5 mg/kg = 63.5 mg per day
Practical Administration
Since the child weighs 28 pounds (between 22-44 pounds or 10-20 kg range):
- Use the 100 mg/5 mL oral suspension
- Day 1: 6.5 mL (approximately 1¼ teaspoons)
- Days 2-5: 3.25 mL (approximately ⅔ teaspoon)
Treatment Duration
The standard treatment course for community-acquired pneumonia in children is 5 days 2, 1. Clinical improvement should be seen within 48-72 hours of starting therapy 2.
Important Considerations
- Azithromycin can be taken with or without food, though administration with food may improve gastrointestinal tolerability 1
- Shake the suspension well before each use
- Use a calibrated measuring device for accurate dosing
- Complete the full 5-day course even if symptoms improve before completion
Alternative Options
If azithromycin is not appropriate (e.g., due to allergy or resistance concerns):
- Clarithromycin: 15 mg/kg/day divided in 2 doses (maximum 1 g/day) 2
- For typical bacterial pneumonia: Amoxicillin 90 mg/kg/day in 2 doses 3, 2
Monitoring
- Assess for clinical improvement within 48-72 hours of starting therapy 3
- If no improvement or worsening occurs within this timeframe, reevaluation is necessary 3
Common Pitfalls to Avoid
- Underdosing: Ensure accurate weight-based dosing to maximize efficacy
- Premature discontinuation: Complete the full 5-day course even if symptoms improve
- Failure to reassess: If no improvement occurs within 48-72 hours, reevaluation is necessary
- Inappropriate use: Azithromycin is preferred for atypical pneumonia but may not be first-line for all pneumonia types in young children
Remember that azithromycin has excellent tissue penetration and maintains therapeutic levels due to its long half-life, allowing for once-daily dosing and good compliance 4, 5.