Azithromycin 200mg/5ml oral suspension is a cherry-flavored macrolide antibiotic specifically formulated for children. This reconstitutable powder provides precise weight-based dosing for pediatric bacterial infections, with 37% bioavailability and peak concentrations within 2-3 hours. The suspension maintains therapeutic tissue levels for 5 days post-treatment, allowing convenient once-daily dosing. Clinical studies show 88-95% efficacy for approved pediatric indications when properly administered.
The 200mg/5ml strength is FDA-approved for: acute otitis media (5-day course), community-acquired pneumonia (3-5 day course), and pharyngitis/tonsillitis. It's particularly effective against S. pneumoniae, H. influenzae, and M. catarrhalis - common pediatric pathogens. Compared to amoxicillin suspensions, it offers better coverage of atypical organisms and requires shorter treatment duration. Recent AAP guidelines recommend it as alternative therapy for penicillin-allergic children and for daycare-associated infections.
Standard dosing: 10mg/kg once daily (max 500mg/day) for 3-5 days. For otitis media: 30mg/kg total dose (10mg/kg daily for 3 days or single dose). Reconstitute with 9ml water (15ml bottle) or 12ml water (22.5ml bottle) - shake vigorously for 30 seconds. Use provided graduated syringe for accuracy. Administer 1 hour before or 2 hours after food/antacids. Store reconstituted suspension at room temperature for 10 days. Write preparation date on bottle.
Azithromycin binds to 50S ribosomal subunits, inhibiting bacterial protein synthesis. The 200mg/5ml concentration achieves tissue levels 10-100x higher than serum, with 68-hour half-life in children. Covers S. pneumoniae (85% susceptible), H. influenzae (90%), and atypicals (Mycoplasma, Chlamydia). Resistance occurs via efflux pumps (mef genes) and ribosomal methylation (erm genes), with current resistance <15% for respiratory pathogens in pediatrics.
Common effects: diarrhea (12%), vomiting (8%), rash (5%). Serious risks: infantile hypertrophic pyloric stenosis (neonates), QT prolongation (rare). Contraindications: macrolide allergy, history of cholestatic jaundice. Monitor for loose stools, dehydration signs. Discontinue if persistent diarrhea, jaundice, or irregular heartbeat occurs. Use caution in children with cardiac conditions or electrolyte imbalances.
Infants <6 months: Safety not established. Underweight children: Calculate dose by actual weight. Renal impairment: No adjustment needed. Hepatic impairment: Reduce dose if severe. Cystic fibrosis patients: May require higher doses. Premature infants: Avoid due to pyloric stenosis risk. Always use weight-based dosing (not age-based).
The 200mg/5ml suspension offers precise pediatric dosing unavailable with tablets. Compared to 100mg/5ml strength: reduces volume needed for older children. Versus erythromycin suspension: better taste and once-daily dosing. Cost is comparable to other azithromycin forms ($15-$30 per bottle). The cherry flavor improves compliance (85% acceptance rate vs 60% for unflavored antibiotics). Not interchangeable with immediate-release tablets due to different pharmacokinetics.
Reconstitution: Add specified water volume in two portions, shaking between additions. Final concentration: 200mg/5ml (40mg/ml). Store dry powder at 20-25°C. After mixing: stable for 10 days at 15-30°C - do not refrigerate. Use provided syringe (not household spoons). Discard unused portion after 10 days. Travel: Prepare fresh every 10 days if needed. Never freeze suspension.
Average retail price: $18-$35 per bottle. Most insurance plans cover with $0-$15 copay. Medicaid typically requires no prior authorization. The WHO Essential Medicines List includes pediatric azithromycin. Cost-effective due to high compliance and shorter treatment courses versus alternatives. Some manufacturers offer savings programs for uninsured patients.
Shake bottle well before each use. Use only the provided measuring device. Give at consistent times daily. Complete full course even if child improves. Report vomiting, diarrhea, or rash. Space antacids by 2 hours. Not for viral infections. Store out of reach (sweet flavor may attract children). Record doses given to prevent errors.
Current studies: single-dose regimens for otitis media, biofilm penetration in recurrent infections. Resistance monitoring shows <10% in S. pneumoniae but rising in S. pyogenes. Research continues on optimal dosing for obese children and new flavor formulations to improve compliance.
Antacids reduce absorption (space by 2 hours). May increase digoxin levels (monitor). Avoid with pimozide/ergotamine. Food decreases bioavailability by 50% (give 1h before/2h after meals). No interaction with dairy. May affect live bacterial vaccines (space by 48h).
This liquid formulation is primarily used for: pediatric otitis media (ear infections), community-acquired pneumonia, streptococcal pharyngitis (strep throat), and pertussis (whooping cough). It's also prescribed for certain skin infections in children weighing under 45kg.
• Standard dosing: 10mg/kg on Day 1, then 5mg/kg for Days 2-5 (max 500mg/day)
• Acute otitis media: 30mg/kg as single dose (max 1500mg)
• Use provided measuring device - never household spoons
• Shake bottle vigorously for 30 seconds before each use
• Store reconstituted suspension at room temperature for 10 days max
The liquid form allows precise weight-based dosing, avoids swallowing difficulties, and provides better absorption in young children. The banana-flavored formulation improves compliance compared to bitter antibiotic suspensions.
1. Give 1 hour before or 2 hours after meals/milk
2. Separate from antacids by 2+ hours
3. Rinse mouth after dosing to prevent thrush
4. Clean measuring device immediately after use
5. Discard unused portion after 10 days (stability period)
• Mild diarrhea (15% of cases)
• Abdominal pain (8%)
• Vomiting (5%)
• Rash (3%)
• Temporary taste disturbances
These typically resolve within 2 days of completing therapy.
Give the missed dose as soon as remembered unless it's within 12 hours of next dose. Never double dose. For once-daily regimens, maintain at least 24-hour intervals between doses to ensure proper antibiotic levels.