From the Research
For pediatric patients with motility disorders, azithromycin is typically prescribed at a dose of 5-10 mg/kg/day given once daily, with a maximum dose of 500 mg per day, as supported by the most recent study 1 which suggests its effectiveness in inducing migrating motor complexes.
Key Considerations
- Treatment duration usually ranges from 2-4 weeks initially, with some patients requiring longer courses or maintenance therapy.
- For children with severe gastroparesis or chronic intestinal pseudo-obstruction, the lower end of the dosing range (5 mg/kg/day) is often used for long-term therapy to minimize side effects.
- Azithromycin works as a prokinetic agent by binding to motilin receptors in the gastrointestinal tract, stimulating gastric emptying and improving intestinal motility.
Safety and Efficacy
- Common side effects include abdominal pain, nausea, diarrhea, and potential QT interval prolongation with long-term use, as noted in studies 2 and 3.
- Liver function and cardiac monitoring may be necessary for extended treatment courses.
- The medication should be taken on an empty stomach, at least 1 hour before or 2 hours after meals, for optimal absorption and efficacy.
Clinical Recommendations
- Response to therapy should be assessed after 2-4 weeks to determine if continued treatment is beneficial.
- Azithromycin has been shown to be a suitable alternative to erythromycin in inducing migrating motor complexes, with a potentially improved safety profile 1.
- However, care should be taken when using high doses, and the clinical safety of azithromycin should be considered in the context of other available antibiotics, as discussed in 3.