Azithromycin (Zithromax), a widely prescribed antibiotic, is used to treat a myriad of infections.  Most often, it is prescribed for upper respiratory infection, community acquired pneumonia, otitis media, pertusis and bacterial sinusitis.  In general terms, azithromycin will combat most respiratory tract or soft tissue infections. Azithromycin solution is loved by many parents because it is well received by children, has a small dosing quantity and short length of therapy

Azithromycin belongs to a group of antibiotics called macrolides.  Other macrolides include erythromycin (Ery-Tab), clindamycin (Cleocin), clarithromycin (Klaricid) and telithromycin (Ketek).  Macrolides work by preventing bacteria from multiplying and producing proteins that are essential for their growth. The bacteria eventually die or are killed by the immune system.  Macrolides are bacteriostatic.

Just a note here about antibiotics and the difference between bacteriostatic versus bactericidal antibiotics.  Bacteriostatic antibiotics work by stopping the growth of the bacteria and helping to rid the body’s immune system of the bacteria.  Bactericidal antibiotics actually kill the bacteria.

Azithromycin is available in tablets, suspension, IV and ophthalmic solution.  The solution is approved for kids over six months. Pediatric doses range from 5-20mg/kg.  Usually, azithromycin is started with a loading dose, so a common script will read as 10mg/kg on day one, 5mg/kg on days two thru five. That is right, typically treatment is for only five days!

In addition to the short duration of therapy, most kids really like the cherry/banana flavouring.  For those kids who are not fans of cherry/banana, azithromycin is easily flavoured at the pharmacy.  Azithromycin liquid is a suspension, which means always shake well.  It can be given with or without food, but with a meal may reduce and belly upset for the child. However, azithromycin should not be given with antacids that contain aluminum or magnesium because the antacid will bind the antibiotic and prevent absorption.

Once azithromycin is reconstituted at the pharmacy, it can be stored at room temperature or in the fridge for 10 days.  The most common side effects are belly related –nausea, vomiting, diarrhea and belly ache.  Kids may also complain of headache, dizziness and agitation.  Rare side effects include kidney, liver and heart issues.  This may sound quite scary but the side effects are very rare and more likely when used in the IV formulation (which isn’t approved for children).

Oftentimes, I am asked why one antibiotic is chosen over another.  When deciding what antibiotic is best to use, we often consider the severity of the infection, where the infection is, what kind of bacteria is most likely causing the infection, patient specific information –like allergies and age, and price.

Azithromycin is commonly a good choice for treatment in kids.  Available in generic, it is reasonably priced.  It is well received by both kids and parents and it is effective against many common childhood bacterial infections.