Azithromycin

PROVENANCE: the bundled eMC source is the SPC for Azithromycin 200mg/5ml Powder for Oral Suspension, and its adult table is headed 'Adults and adolescents weighing at least 45 kg and unable to swallow solid pharmaceutical forms' — for patients who can swallow solids, confirm against the corresponding tablet/capsule SPC. This bundle contains no intravenous posology; for IV therapy refer to the SPC of the azithromycin IV formulations. No absolute adult maximum dose is stated: the paediatric tables reference the adult ceiling with the footnote '# not to exceed the adult daily dose of 500 mg', but the licensed single 1000 mg dose for chlamydial urethritis and cervicitis exceeds that figure, so no maxDose has been recorded. Community-acquired pneumonia: in adults, oral treatment may also follow intravenous treatment if clinically indicated, to complete a 7- to 10-day total course. Acute exacerbations of chronic bronchitis is an adults-only indication. Consideration should be given to the treatment regimens, doses and duration of treatment recommended in updated treatment guidelines for each indication, and treatment should only be initiated after careful assessment of benefit and risk given the local prevalence of resistance and where preferred regimens are not indicated. Missed dose: if 12 hours or less have passed, take it as soon as possible and take the next dose at the regularly scheduled time; if more than 12 hours have passed, wait until the next scheduled dose. Elderly: no dose adjustment required, but particular caution is recommended because of the risk of cardiac arrhythmia and torsade de pointes. Hepatic impairment: no dose adjustment in mild (Child-Pugh A) or moderate (Child-Pugh B) impairment; no data in severe impairment (Child-Pugh C), so administer with caution. §4.5 was not included in this bundle and §4.8 is marked truncated at the source-fetch limit.

Paediatric patients aged 6 months and older weighing less than 45 kg, by indication (multiple per-kg regimens are stated, so no single per-kg figure is recorded here). Acute bacterial sinusitis, community-acquired pneumonia, acute bacterial skin and skin structure infections: 10 mg/kg/day for 3 days, or 10 mg/kg on day 1 followed by 5 mg/kg/day on days 2-5. Acute bacterial otitis media: a single dose of 30 mg/kg, or 10 mg/kg/day for 3 days, or 10 mg/kg on day 1 followed by 5 mg/kg/day on days 2-5. Acute streptococcal tonsillitis and pharyngitis: 20 mg/kg/day for 3 days, or 12 mg/kg/day for 5 days. Safety and efficacy have not been established in children under 6 months of age for any indication, and there is no relevant use for acute exacerbations of chronic bronchitis in paediatric patients. The SPC carries weight-banded maximum daily dose and volume tables for the 20 mg/mL and 40 mg/mL suspensions. Verify against a children's formulary.