From the Guidelines
For pediatric respiratory conditions requiring anti-inflammatory effects, azithromycin can be dosed at 10 mg/kg on day 1 (maximum 500 mg), followed by 5 mg/kg (maximum 250 mg) once daily for days 2-5 for acute conditions. This dosing regimen is based on the most recent and highest quality study available, which is the British Thoracic Society guidelines for the management of non-tuberculous mycobacterial pulmonary disease (NTM-PD) published in 2017 1.
Key Considerations
- The dosing regimen may vary depending on the specific condition being treated, such as cystic fibrosis or bronchiectasis, where a common regimen is 10 mg/kg (maximum 500 mg) three times weekly or 5 mg/kg daily for extended periods.
- In severe asthma or recurrent wheezing, 10 mg/kg once weekly for 8-12 weeks may be used.
- Azithromycin has immunomodulatory and anti-inflammatory properties, including reducing neutrophil activation, decreasing pro-inflammatory cytokines, and inhibiting mucus hypersecretion.
- Common side effects include gastrointestinal disturbances, and it should be taken on an empty stomach or with food if GI upset occurs.
Important Safety Considerations
- Caution is needed with prolonged use due to potential for antimicrobial resistance, QT interval prolongation, and hearing impairment.
- Regular monitoring is recommended for extended therapy.
- The British Thoracic Society guidelines provide specific dosing recommendations for children, including:
- Child 6 months–17 years: 10 mg/kg once daily (maximum per dose 500 mg) (oral)
- Child 6 months–17 years (body weight 15–25 kg): 200 mg once daily (oral)
- Child 6 months–17 years (body weight 26–35 kg): 300 mg once daily (oral)
- Child 6 months–17 years (body weight 36–45 kg): 400 mg once daily (oral)
- Child 6 months–17 years (body weight 46 kg and above): 500 mg once daily (oral) 1.
These guidelines prioritize the safety and efficacy of azithromycin use in pediatric patients, and should be consulted for specific dosing recommendations.
From the FDA Drug Label
DOSAGE & ADMINISTRATION SECTION Pediatric Patients Azithromycin for oral suspension can be taken with or without food. Community-Acquired Pneumonia The recommended dose of azithromycin for oral suspension for the treatment of pediatric patients with community-acquired pneumonia is 10 mg/kg as a single dose on the first day followed by 5 mg/kg on Days 2 through 5.
The anti-inflammatory dosing of azithromycin for pediatric respiratory infections is not explicitly stated in the provided drug label. The label only provides dosing recommendations for the treatment of specific infections, such as community-acquired pneumonia, acute otitis media, and pharyngitis/tonsillitis.
- Key points:
- The recommended dose for community-acquired pneumonia is 10 mg/kg as a single dose on the first day followed by 5 mg/kg on Days 2 through 5.
- The recommended dose for acute otitis media is 30 mg/kg given as a single dose or 10 mg/kg once daily for 3 days or 10 mg/kg as a single dose on the first day followed by 5 mg/kg/day on Days 2 through 5.
- The recommended dose for pharyngitis/tonsillitis is 12 mg/kg once daily for 5 days. However, azithromycin is not typically used for its anti-inflammatory properties, but rather for its antibacterial properties. Therefore, the provided dosing recommendations are for the treatment of bacterial infections, not for anti-inflammatory purposes 2.
From the Research
Anti-Inflammatory Dosing of Azithromycin
The anti-inflammatory dosing of azithromycin for pediatric respiratory infections is not explicitly stated in the provided studies. However, some studies provide information on the dosing of azithromycin for respiratory infections in children:
- A study published in 1997 3 found that a 3-day course of azithromycin (10 mg/kg daily) and a 5-day course (10 mg/kg on day 1 and 5 mg/kg on days 2-5) had comparable efficacy and tolerability in children with respiratory infections.
- A review published in 2005 4 discussed the role of azithromycin in lower respiratory tract infections, but did not provide specific dosing information for anti-inflammatory effects.
- A study published in 2004 5 described the use of single-dose azithromycin for respiratory tract infections, including a single dose of 30 mg/kg for treatment of acute otitis media in children.
Pediatric Respiratory Infections
The use of azithromycin in pediatric respiratory infections is discussed in several studies:
- A review published in 2018 6 emphasized the importance of appropriate antibiotic use in children and discussed the current choice of antimicrobial therapy for lower respiratory tract infections.
- A study published in 2020 7 discussed the potential benefits and risks of using azithromycin in pediatric respiratory medicine, but did not provide specific dosing information for anti-inflammatory effects.
Dosing Information
While the provided studies do not explicitly state the anti-inflammatory dosing of azithromycin for pediatric respiratory infections, they suggest that azithromycin may have anti-inflammatory effects at various dosing regimens: