Pediatric Azithromycin Dosage Guidelines
The recommended dosage of azithromycin for pediatric patients varies by indication, with standard regimens including 10 mg/kg (maximum 500 mg) on day 1 followed by 5 mg/kg (maximum 250 mg) daily for days 2-5, or 10 mg/kg once daily for 3 days depending on the condition being treated. 1, 2
Dosing by Age and Indication
Standard Dosing for Most Infections
- For children 6 months to 17 years: 10 mg/kg (maximum 500 mg) on day 1, followed by 5 mg/kg (maximum 250 mg) daily for days 2-5 1, 2
- Alternative 3-day regimen: 10 mg/kg once daily for 3 days 2
Weight-Based Dosing Chart
- Children weighing 15-25 kg: 200 mg once daily 3
- Children weighing 26-35 kg: 300 mg once daily 3
- Children weighing 36-45 kg: 400 mg once daily 3
- Children weighing 46 kg and above: 500 mg once daily 3
Specific Indications
Acute Otitis Media (3 options)
- 5-day regimen: 10 mg/kg on day 1, then 5 mg/kg on days 2-5 2
- 3-day regimen: 10 mg/kg once daily 2
- 1-day regimen: 30 mg/kg as a single dose 2, 4
Acute Bacterial Sinusitis
- 10 mg/kg once daily for 3 days 2
Community-Acquired Pneumonia
Pharyngitis/Tonsillitis
- 12 mg/kg once daily for 5 days (maximum 500 mg/day) 2, 5
- Higher dosage is required for streptococcal pharyngitis compared to other indications to prevent recurrence 5
Mycobacterium avium complex (MAC) prophylaxis in HIV-infected children
- 20 mg/kg body weight (maximum 1,200 mg) orally weekly 1
Administration Guidelines
- Azithromycin oral suspension can be taken with or without food 2
- For children who have difficulty with tablets, the oral suspension formulation is well-tolerated and has good palatability 4
- The safety of re-dosing in children who vomit within 30 minutes of receiving a single 30 mg/kg dose has not been established 2
Safety Considerations
- Gastrointestinal side effects (abdominal pain, nausea, vomiting) are most common but generally mild to moderate 4
- Approximately 9% of pediatric patients experience treatment-related adverse events 4
- Higher dosages (30 mg/kg single dose or 20 mg/kg/day for 3 days) are associated with more adverse effects but remain well-tolerated 4
- Avoid concurrent administration with aluminum- or magnesium-containing antacids as they reduce absorption 1
- Monitor for potential drug interactions, particularly with medications that prolong QT interval 3
Clinical Efficacy
- Azithromycin achieves clinically relevant concentrations at infection sites and has a long tissue half-life, allowing for once-daily dosing 6
- For streptococcal pharyngitis, higher dosages (60 mg/kg total course) show superior efficacy compared to standard regimens 5
- The long half-life results in sustained systemic exposure even after completion of the dosing regimen 7
Azithromycin's convenient dosing schedule (once daily for 3-5 days) and good tolerability profile make it an excellent choice for pediatric infections, particularly when compliance may be an issue with longer treatment courses 6, 4.