What is the dose of azithromycin for a 10-year-old child weighing 78 pounds (35.4 kilograms)?

From the Guidelines

For a 10-year-old child weighing 78 pounds (approximately 35.5 kg), the recommended dose of azithromycin is 10 mg/kg (about 355 mg) on the first day, followed by 5 mg/kg (about 178 mg) once daily for days 2-5, as per the guidelines for empiric therapy for pediatric community-acquired pneumonia 1. Given the child's age and weight, the dose falls under the category for children ≥ 5 years old, where the maximum dose on day 1 is 500 mg, followed by 250 mg on days 2-5 1. The practical dosing for this child would be 250-500 mg on day 1, followed by 250 mg daily for days 2-5, considering the availability of azithromycin in 250 mg tablets or suspension forms. Key points to consider include:

• The medication should be taken on an empty stomach, at least 1 hour before or 2 hours after meals, for better absorption.
• Azithromycin works by inhibiting bacterial protein synthesis, allowing for once-daily dosing and shorter treatment courses.
• Common side effects may include stomach upset, diarrhea, or nausea.
• It is crucial to complete the full course of antibiotics even if symptoms improve before finishing the medication, to ensure effective treatment and prevent antibiotic resistance 1.

From the FDA Drug Label

Pediatric Patients Azithromycin for oral suspension can be taken with or without food. Acute Otitis Media The recommended dose of azithromycin for oral suspension for the treatment of pediatric patients with 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. PEDIATRIC DOSAGE GUIDELINES FOR OTITIS MEDIA, ACUTE BACTERIAL SINUSITIS AND COMMUNITY-ACQUIRED PNEUMONIA (Age 6 months and above, see PRECAUTIONS—Pediatric Use.) Based on Body Weight OTITIS MEDIA AND COMMUNITY-ACQUIRED PNEUMONIA: (5-Day Regimen) * Dosing Calculated on 10 mg/kg/day Day 1 and 5 mg/kg/day Days 2 to 5. Weight100 mg/5 mL200 mg/5 mLTotal mL per Treatment CourseTotal mg per Treatment Course KgLbs. Day 1Days 2–5Day 1Days 2–5 *Effectiveness of the 3-day or 1-day regimen in pediatric patients with community-acquired pneumonia has not been established. 408810 mL (2 tsp) 5 mL (1 tsp) 30 mL1200 mg OTITIS MEDIA: (1-Day Regimen) Dosing Calculated on 30 mg/kg as a single dose Weight200 mg/5 mLTotal mL per Treatment CourseTotal mg per Treatment Course KgLbs.Day 1 408830 mL (6 tsp) 30 mL1200 mg

The dose of azithromycin for a 10-year-old that weighs 78lbs is 1200 mg for the 1-day regimen or 30 mL for the 5-day regimen, as the patient weighs more than 40 kg (88 lbs) but the exact weight is closest to the 78 lbs (35.4 kg) which would be 30 mg/kg = 1071 mg but according to the table for a 5-day regimen for a patient that weighs between 40-50 kg (88-110 lbs) the dose is 1200 mg. However, for the 1-day regimen, the dose is 30 mg/kg which would be 30 mg/kg x 35.4 kg = 1062 mg, but according to the table, the closest dose is 1200 mg for a patient that weighs more than 40 kg (88 lbs). 2

From the Research

Azithromycin Dosing for a 10-year-old

To determine the dose of azithromycin for a 10-year-old weighing 78lbs, we need to consider the available evidence.

• The studies provided do not directly address the dosing of azithromycin for a child of this specific age and weight 3, 4, 5, 6, 7.
• However, study 5 discusses the use of age-based and height-based dosing protocols for children, which may be relevant for determining the dose for a 10-year-old.
• According to study 5, for children 1-11 months old, a simplified approach using age or height could increase program efficiency, but it does not provide specific dosing recommendations for a 10-year-old.
• Studies 6 and 7 compare the efficacy and safety of azithromycin and clarithromycin in adults with upper and lower respiratory tract infections, but do not provide information on pediatric dosing.
• Study 4 mentions the use of clarithromycin in children, but does not provide information on azithromycin dosing for a 10-year-old weighing 78lbs.

Available Dosing Information

• Study 5 suggests that for children 1-11 months old, a two-tiered age-based approach could be used, with doses of 80 mg (2 mL) for children 1-2 months old and 160 mg (4 mL) for children 3-11 months old.
• However, this study does not provide dosing recommendations for children older than 11 months.

Limitations

• The available studies do not provide specific dosing recommendations for a 10-year-old weighing 78lbs.
• More information is needed to determine the appropriate dose of azithromycin for a child of this age and weight.