What liquid antibiotics without red dye are available for pediatric (peds) patients?

Liquid Antibiotics Without Red Dye for Pediatric Patients

For pediatric patients requiring liquid antibiotics without red dye, amoxicillin, cefdinir, azithromycin, and clarithromycin are the most appropriate options, with selection based on the specific infection being treated and patient factors.

First-Line Liquid Antibiotics Without Red Dye

Amoxicillin

• First-line treatment for presumed bacterial pneumonia in children under 5 years at a dose of 90 mg/kg/day in 2 doses 1, 2
• Available as a liquid suspension without red dye 3, 4
• Most commonly prescribed oral antibiotic for pediatric bacterial infections 2
• For children 5 years and older with presumed bacterial pneumonia, the recommended dose is 90 mg/kg/day in 2 doses (maximum 4 g/day) 1, 2

Azithromycin

• First-line for presumed atypical pneumonia in children at a dose of 10 mg/kg on day 1, followed by 5 mg/kg/day once daily on days 2-5 1, 2
• Available as a liquid suspension without red dye 5, 6
• Shorter treatment duration (5 days) improves compliance compared to other antibiotics 5, 6
• Ranked high in palatability studies, making it more acceptable to children 6

Cefdinir

• Alternative for beta-lactamase-producing organisms at a dose of 14 mg/kg/day 7
• Available as an oral suspension without red dye 7, 6
• Ranked high in palatability studies (second highest among tested antibiotics) 6
• Important consideration: The incidence of diarrhea in cefdinir-treated patients ≤2 years of age was 17% compared with 4% in those >2 years old 7

Clarithromycin

• Alternative for atypical pneumonia at a dose of 15 mg/kg/day in 2 doses 1, 2
• Available as a liquid suspension without red dye 5, 6
• Can be used for children who cannot tolerate azithromycin 1

Selection Based on Infection Type

For Presumed Bacterial Pneumonia/Streptococcal Infections

1. First choice: Amoxicillin liquid suspension (90 mg/kg/day in 2 doses) 1, 2
2. Alternative: Amoxicillin-clavulanate liquid suspension (amoxicillin component, 90 mg/kg/day in 2 doses) for beta-lactamase producing organisms 1

For Presumed Atypical Pneumonia (Mycoplasma, Chlamydophila)

1. First choice: Azithromycin liquid suspension (10 mg/kg on day 1, followed by 5 mg/kg/day once daily on days 2-5) 1, 2
2. Alternative: Clarithromycin liquid suspension (15 mg/kg/day in 2 doses) 1, 2

For Beta-lactamase Producing Organisms

1. First choice: Amoxicillin-clavulanate liquid suspension (amoxicillin component, 90 mg/kg/day in 2 doses) 1
2. Alternatives: Cefdinir, cefixime, cefpodoxime liquid suspensions 1, 7

Compliance Considerations

Palatability Ranking (Best to Worst)

• Based on taste studies, the palatability ranking from highest to lowest: loracarbef, cefdinir, cefixime, azithromycin, clarithromycin, amoxicillin/clavulanate 6
• Cephalosporins generally have better taste than macrolides 5

Dosing Frequency

• Once-daily dosing: Azithromycin (after day 1) 1, 2
• Twice-daily dosing: Amoxicillin, amoxicillin-clavulanate, clarithromycin, cefdinir 1, 2, 7
• Medications requiring fewer daily doses improve compliance 5, 6

Treatment Duration

• Shorter courses (5 days) are preferred for compliance: Azithromycin 5, 6
• Standard courses (7-10 days): Amoxicillin, amoxicillin-clavulanate, clarithromycin, cefdinir 1

Special Considerations

Age-Specific Concerns

• For children ≤2 years of age, be aware of higher incidence of diarrhea (17%) and rash (8%) with cefdinir compared to older children 7
• For children >7 years old with atypical pneumonia, doxycycline is an option, but taste is often problematic 1, 2

Mixing Medications with Food

• When administering antibiotics that may have palatability issues, they can be mixed with small amounts of soft foods or liquids 3
• Avoid mixing with peanut butter as it significantly affects drug solubility 3
• When mixing with foods, ensure thorough mixing (1-2 minutes) to produce homogeneous mixtures 3

Common Pitfalls to Avoid

• Underdosing amoxicillin: Use the higher dose (90 mg/kg/day) rather than standard doses (40-45 mg/kg/day) for pneumonia to overcome resistant pneumococci 2
• Inappropriate use of macrolides as first-line therapy for presumed bacterial pneumonia; reserve for atypical pneumonia or as add-on therapy 2
• Failure to reassess children not improving within 48-72 hours of starting antibiotics 2, 8
• Overlooking compliance factors: Consider taste, dosing frequency, and duration when selecting antibiotics for children 5, 6