Which should be given orally or intravenously for the treatment of respiratory infections in children with Azithromycin?

Azithromycin is a macrolide antibiotic that can be widely used to treat a variety of respiratory infections in children. There is no strict requirement for the choice of oral or intravenous (IV) dosage form. However, a safety data of oral and IV treatment in children under 16 years old showed that the incidence of adverse reactions with IV injection (14.12%) was significantly higher than that with oral administration (9.28%). Therefore, the oral dosage form of azithromycin is better tolerated than the IV dosage form in children, and pediatricians are advised to use the oral dosage form as a first-line treatment.

Uses

Azithromycin is also used in clinical practice to treat certain bacterial infections such as bronchitis, pneumonia, sexually transmitted diseases (STDs), and infections of the ears, lungs, sinuses, skin, throat, and reproductive organs. It works by killing bacteria or preventing their growth. However, this drug is not effective for colds, flu, or other viral infections.

Dosage

The maximum oral doses for children vary by condition and regimen. For otitis media, the 1-day regimen max is 1500 mg, while the 3-day and 5-day regimens max at 500 mg on day 1 and 250 mg on subsequent days.

For legionella pneumonia, mycoplasma pneumonia, and general pneumonia in children 6 months or older, the max is also 500 mg on day 1 and 250 mg on days 2 through 5.

For tonsillitis/pharyngitis in children 2 years or older, the max is 500 mg per dose for 5 days.

For sinusitis in children 6 months or older, the max is 500 mg per dose for 3 days. Regarding pelvic inflammatory disease in those 16 years or older, the IV max is 500 mg per day for 1 or 2 days, followed by an oral max of 250 mg per day to complete a 7-day course.

For cat scratch disease in children weighing less than 45 kg, the max is 10 mg/kg orally on day 1 and 5 mg/kg orally once a day for 4 additional days; for those weighing at least 45 kg, it's 500 mg orally on day 1 and 250 mg orally once a day for 4 additional days.

For bartonella infections in adolescents with HIV, the max is 500 mg orally once a day for at least 3 months.

For uncomplicated gonococcal infection in adolescents, the max is 2 g orally as a single dose.

For chlamydia infection, infants 1 to 3 months have a max of 20 mg/kg orally once a day for 3 days, children younger than 8 years weighing at least 45 kg and children 8 years or older have a max of 1 g orally as a single dose, and adolescents also have a max of 1 g orally as a single dose.

For mycobacterium avium-intracellulare prophylaxis in HIV-infected children, primary prophylaxis has a first choice max of 1200 mg orally once a week and an alternative max of 250 mg orally once a day, while secondary prophylaxis maxes at 250 mg orally once a day.

References:

[1] XU LI; Xia J. Safety Comparative Study on Azithromycin Oral and IV Dosage Form in Pediatric Respiratory Infection Therapy[J]. The Internet journal of pediatrics and neonatology, 2007, 8 1. DOI:10.5580/157f.

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