Recommended Azithromycin Dosage for Children
The recommended dosage of azithromycin for children varies by indication, with standard regimens including 10 mg/kg on day 1 followed by 5 mg/kg/day for days 2-5 for most respiratory infections, or 10 mg/kg daily for 3 days for certain conditions. 1
Dosage by Indication
Respiratory Infections
- Community-Acquired Pneumonia: 10 mg/kg (maximum 500 mg) on day 1, followed by 5 mg/kg (maximum 250 mg) daily for days 2-5 2, 1
- Atypical Pneumonia (Mycoplasma, Chlamydia): Same 5-day regimen as above 2
- Acute Bacterial Sinusitis: 10 mg/kg once daily for 3 days 1
Ear Infections
- Acute Otitis Media: Three options available 1:
- 5-day regimen: 10 mg/kg on day 1, followed by 5 mg/kg daily for days 2-5
- 3-day regimen: 10 mg/kg once daily for 3 days
- 1-day regimen: 30 mg/kg as a single dose
Throat Infections
- Pharyngitis/Tonsillitis: 12 mg/kg once daily for 5 days (maximum 500 mg/day) 1
- Note: Higher dose than other indications due to potential for recurrence with standard dosing 3
Pertussis (Whooping Cough)
- Treatment and Post-exposure Prophylaxis: 2
- Infants <6 months: 10 mg/kg once daily for 5 days
- Children ≥6 months: 10 mg/kg (maximum 500 mg) on day 1, followed by 5 mg/kg (maximum 250 mg) daily for days 2-5
Mycobacterium avium complex (MAC) Prophylaxis
- HIV-infected children: 20 mg/kg body weight (maximum 1,200 mg) by mouth weekly 2
Administration Guidelines
- Azithromycin can be taken with or without food 1
- Available as oral suspension in concentrations of 100 mg/5 mL and 200 mg/5 mL 1
- Administer as a single daily dose 1
Dosing Considerations
Age-Specific Considerations
- Infants <6 months: For pertussis, use 10 mg/kg daily for 5 days 2
- Children ≥6 months: Use standard age-appropriate dosing based on indication 1
Weight-Based Dosing Tables
- FDA-approved labeling provides detailed weight-based dosing tables for each indication 1
- For example, for a 20 kg child with otitis media (5-day regimen):
- Day 1: 5 mL of 200 mg/5 mL suspension (200 mg)
- Days 2-5: 2.5 mL of 200 mg/5 mL suspension (100 mg daily)
Efficacy and Safety
- Clinical studies show comparable efficacy between 3-day and 5-day regimens for respiratory infections (95.7% vs 96.1% cure rates) 4
- Single-dose therapy (30 mg/kg) for otitis media shows 88% clinical success at end of treatment 5
- Side effects are generally mild and include gastrointestinal disturbances (5-7% of children) 4
- Azithromycin has fewer gastrointestinal side effects than erythromycin 3
Important Cautions
- Drug Interactions: Avoid concurrent administration with aluminum- or magnesium-containing antacids as they reduce absorption 2
- Monitoring: When used with drugs metabolized by cytochrome P450 enzyme system, monitoring is advised 2
- Compliance Advantage: Once-daily dosing and shorter treatment courses (3-5 days) improve compliance compared to other antibiotics 3
Alternative Options
- For children allergic to azithromycin, alternatives include:
Remember that azithromycin should be used judiciously to minimize antibiotic resistance. Limiting exposure to antibiotics whenever possible and using the proper dosage to achieve minimal effective concentration at the infection site are important principles in pediatric antibiotic therapy 2.