How To Use The Antibiotic Safely In Children
Zithromax is an antibiotic used to treat bacterial infections in adults and children. It is commonly prescribed for ear and sinus infections, pneumonia, and strep throat. It is approved for children 6 months or older and is a good option for kids with penicillin allergies.
Commonly referred to as a Z-Pak or a Tri-Pak , azithromycin also comes as a liquid for kids who are unable to swallow pills. It can be taken with or without food.
This article discusses the use of azithromycin for kids. It details what Zithromax treats and pediatric dosing information. It also explains side effects and drug interactions.
Research Into Antibiotics And Sinus Infections
The guidelines were triggered, in part, by studies finding that antibiotics may not make a difference. About 60% to 70% of people with sinus infections recover without antibiotics, according to the American Academy of Allergy, Asthma & Immunology.
In one study of symptom relief, patients given antibiotics generally did no better than patients not given antibiotics.
This study, published in the Journal of the American Medical Association, observed 240 patients with sinusitis. They were given one of four treatments: antibiotics alone, nasal steroid spray alone to reduce tissue swelling, both antibiotics and the spray, or no treatment.
Patients who got no treatment were as likely to get better than those who got the antibiotics. The nasal spray seemed to help people with less severe symptoms at the beginning of their sinus problem, and seemed to make those with more intense congestion worse.
The patients all had sinus symptoms that suggested a bacterial infection. Sinus problems are also caused by viruses, for which antibiotics definitely offer no help.
What Drugs And Food Should I Avoid While Taking Azithromycin
Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, call your doctor before using anti-diarrhea medicine.
Azithromycin could make you sunburn more easily. Avoid sunlight or tanning beds. Wear protective clothing and use sunscreen when you are outdoors.
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How Should This Medicine Be Used
Azithromycin comes as a tablet, an extended-release suspension , and a suspension to take by mouth. The tablets and suspension are usually taken with or without food once a day for 1-5 days. When used for the prevention of disseminated MAC infection, azithromycin tablets are usually taken with or without food once weekly. The extended-release suspension is usually taken on an empty stomach as a one-time dose. To help you remember to take azithromycin, take it around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take azithromycin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Shake the liquid well before each use to mix the medication evenly. Use a dosing spoon, oral syringe, or measuring cup to measure the correct amount of medication. Rinse the measuring device with water after taking the full dose of medication.
If you receive azithromycin powder for suspension in the single-dose, 1-gram packet, you must first mix it with water before you take the medication. Mix the contents of the 1-gram packet with 1/4 cup of water in a glass and consume the entire contents immediately. Add an additional 1/4 cup of water to the same glass, mix, and consume the entire contents to ensure that you receive the entire dose.
Ask your pharmacist or doctor for a copy of the manufacturer’s information for the patient.
Azithromycin Uses For Kids
Though azithromycin is approved for pediatric use, its safety and effectiveness in kids under the age of 6 months haven’t been established. The drug has been approved to treat the following pediatric conditions:
Zithromax is often used off-label for other mild to moderate pediatric infections that are caused by susceptible bacteria, including walking pneumonia and pertussis .
Zithromax is generally not used as first-line treatment unless the first-line antibiotic has failed or the child has an allergy to the preferred drug.
Increasing rates of azithromycin resistance mean that the drug is generally reserved for second-line use. For strep throat, penicillin is the preferred agent. Similarly, the American Academy of Pediatrics recommends amoxicillin as the first-line drug of choice for ear infections.
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Drug Giants Duel Over Kids’ Ear Infections
For nearly a decade, the world’s two largest drug companies have sparred over which firm’s blockbuster antibiotic would be used to treat children’s ear infections. GlaxoSmithKline ‘s popular and powerful Augmentin has maintained a steady lead, but Pfizer is making inroads with its more convenient Zithromax, which was recently approved to kill ear bacteria in one single large dose.
The continuing battle between GlaxoSmithKline and Pfizer , both of which have total sales of about $30 billion, highlights the way that additional clinical trials paid for by drug companies, aggressive marketing campaigns and intellectual property law combine to determine which drugs doctors prescribe–and how much the drug companies make.
The majority of children with ear infections would get better with no antibiotics at all, says Dr. Jerome Klein, a professor of pediatrics at the Boston University School of Medicine. But if a bacterial infection in the ear does not go away, it can spread to the jaw or cause permanent holes to form in the eardrum, leading to hearing loss and other illnesses. “We still see that in Central Africa,” Klein says. “We know that a lot of kids don’t need antibiotics, the problem is we can’t distinguish them from those who do.”
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How Do You Know If An Ear Infection Is Viral Or Bacterial
It can be difficult to tell, at least in the beginning. If you or your child is recovering from a virus , its probably more likely youre dealing with a viral ear infection. If strep throat or pneumonia has been in the house, theres a greater chance that its bacterial. But thats not always the case.
Symptoms are similar with viral and bacterial infections. One difference is you have a higher fever with a bacterial ear infection. However, fevers can also happen with viral infections.
Often, its a bit of a waiting game. If the ear infection goes away on its own within a week or so, you can assume it was caused by a virus. If it isnt improving after a week, it might be a bacterial infection and you should definitely seek medical treatment.
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Before Taking This Medicine
You should not use Zithromax if you are allergic to azithromycin, or if:
you have ever had jaundice or liver problems caused by taking Zithromax or
you are allergic to similar drugs such as clarithromycin, erythromycin, or telithromycin.
To make sure Zithromax is safe for you, tell your doctor if you have ever had:
a heart rhythm disorder or
low levels of potassium in your blood or
long QT syndrome .
Zithromax is not expected to harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.
It is not known whether azithromycin passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.
Do not give Zithromax to a child younger than 6 months old.
What Other Drugs Will Affect Zithromax
Tell your doctor about all your current medicines and any you start or stop using, especially:
a blood thinner – warfarin, Coumadin, Jantoven.
This list is not complete. Other drugs may interact with azithromycin, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.
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What Should I Know About Storage And Disposal Of This Medication
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store azithromycin tablets, suspension, and extended-release suspension at room temperature and away from excess heat and moisture . Do not refrigerate or freeze the extended-release suspension. Discard any azithromycin suspension that is left over after 10 days or no longer needed. Discard any unused extended-release azithromycin suspension after dosing is complete or 12 hours after preparation.
Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website for more information if you do not have access to a take-back program.
It is important to keep all medication out of sight and reach of children as many containers are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location â one that is up and away and out of their sight and reach.
How To Take Azithromycin
Use Azithromycin exactly as directed on the label, or as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended.
Follow all directions on your prescription label and read all medication guides or instruction sheets. Use the medicine exactly as directed.
Azithromycin oral is taken by mouth. Azithromycin injection is given as an infusion into a vein, usually for 2 days before you switch to azithromycin oral. A healthcare provider will give you this injection.
You may take azithromycin oral with or without food.
Shake the oral suspension before you measure a dose. Use the dosing syringe provided, or use a medicine dose-measuring device .
Use this medicine for the full prescribed length of time, even if your symptoms quickly improve. Skipping doses can increase your risk of infection that is resistant to medication. Azithromycin will not treat a viral infection such as the flu or a common cold.
Store at room temperature away from moisture and heat. Throw away any unused liquid medicine after 10 days.
Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.
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Oral Antibiotics Have Risks
- Oral antibiotics are more likely to cause resistant bacteria outside the ear. When that happens, these medicines will not work as well in the future. Illnesses will be harder to cure and more costly to treat.
- Antibiotic eardrops kill the bacteria faster and more completely than oral antibiotics. Drops dont go into the bloodstream, so more medicine reaches the infection.
How Should I Take Zithromax
Take Zithromax exactly as prescribed by your doctor. Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended. The dose and length of treatment may not be the same for every type of infection.
Zithromax can be taken with or without food.
Shake the oral suspension well just before you measure a dose. Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.
Use this medicine for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics. Zithromax will not treat a viral infection such as the flu or a common cold.
Store at room temperature away from moisture and heat. Throw away any unused liquid medicine after 10 days.
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Study Design And Eligibility Criteria
This study design is a systematic review and meta-analysis. The studies included are only randomized clinical trials conducted in children from 6 months to 15 years old with otitis media. Identified studies are included in the review if they met the following inclusion criteria:
A randomized clinical trial study for comparison of azithromycin and amoxicillin/clavulanate for treating any type of otitis media.
For each article, the following were critically appraised independently by two reviewers.
Whether the study design or approach was appropriate to the research question.
Whether outcome measure was valid and appropriate to the research question.
The risk of bias in the study design and results were assessed by the Cochrane risk of bias tool-2 .
How To Administer Antibacterial Ear Drops
Antibiotic ear drops are for the ears only and should never be put into the eyes. Always take the entire prescribed amount even if your symptoms improve as it prevents a recurrence of the infection.
Follow these steps to correctly administer ear drops:
- Warm the bottle in your hand for two minutes, inserting cold ear drops can cause dizziness
- Wash your hands
- Have the person with the ear infection lie on their side with the problem ear up
- For children three years and older, gently pull the outer ear outward and upward in the direction toward the top of their head
- For children younger than three years, gently pull the outer eat outward and downward in the direction toward their feet
- Without allowing the dropper to touch the ear, carefully put the drops in the ear
- Remain laying on their side for two minutes or put a cotton plug in the ear
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Azithromycin Side Effects In Kids
Verywell / Brianna Gilmartin
For children taking a five-day course of Zithromax, the most common side effects include:
- Diarrhea and loose stools
When prescribed as a one-time dose, there is a greater risk of vomiting or diarrhea. If the side effects are severe or persistent, call your healthcare provider. On rare occasions, a child may experience a severe and potentially life-threatening allergy known as anaphylaxis.
What Causes Ear Infections
The ear is organized into three structures, the outer, middle, and inner ear. The outer ear contains the outer structure, the auditory canal and the tympanic membrane .
The inner ear is an air-filled space that contains three small bones responsible for transferring vibrations from the eardrum to the inner ear. The inner ear is within the temporal bone and contains membranes and a solution which is responsible for sound transmission.
There are three types of ear infections:
- Acute otitis media: an infection of the middle ear
- Otitis media with effusion: an infection of the middle ear when fluid builds up causing an infection
- Swimmers ear: infection of the outer ear canal
Bacteria or viruses cause ear infections. The most common bacteria for ear infections include streptococcus pneumoniae and haemophilus influenzae. Viruses that cause the common cold can cause ear infections.
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How Does It Work
Azithromycin is an antibiotic of the macrolide group with a bacteriostatic effect . It is active against a wide variety of microbes. The mechanism of action is associated with the suppression of protein production in the cells of the microbe. In high concentrations, it can have a bactericidal effect.
Microorganisms susceptible to this antibiotic: gram-negative aerobes , gram-positive aerobes spp., Clostridium perfringens, Porphyriomonas spp.), others .
Microbes capable of developing resistance to this antibiotic: gram-positive aerobes .
Azithromycin-resistant microorganisms: gram-positive aerobes , Bacteroides fragilis.
What Should I Discuss With My Healthcare Provider Before Using Azithromycin
You should not use azithromycin if you are allergic to it, or if you have ever had:
- jaundice or liver problems caused by taking azithromycin or
- a severe allergic reaction to similar drugs such as clarithromycin, erythromycin, or telithromycin.
Azithromycin oral should not be used to treat pneumonia in people who have:
- cystic fibrosis
- an infection after being in a hospital
- an infection in the blood
- a weak immune system or
- in older adults and those who are ill or debilitated.
Tell your doctor if you have ever had:
- low levels of potassium in your blood
- a heart rhythm disorder or
- long QT syndrome .
It is not known whether this medicine is effective in treating genital ulcers in women.
Tell your doctor if you are pregnant or breastfeeding. Taking azithromycin while breastfeeding may cause diarrhea, vomiting, or rash in the nursing baby.
Azithromycin is not approved for use by anyone younger than 6 months old. Azithromycin should not be used to treat a throat or tonsil infection in a child younger than 2 years old.
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What Other Drugs Will Affect Azithromycin
Tell your doctor about all your other medicines, especially:
This list is not complete. Other drugs may affect azithromycin, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.
Who Cannot Take Z Pack
Who should not take ZITHROMAX? diarrhea from an infection with Clostridium difficile bacteria. low amount of magnesium in the blood. low amount of potassium in the blood. myasthenia gravis, a skeletal muscle disorder. hearing loss. torsades de pointes, a type of abnormal heart rhythm. slow heartbeat.
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Antibiotics That Shouldnt Be A First Choice For Uncomplicated Utis
Other antibiotics appear to be overused, and some physicians may misuse non-recommended antibiotics as first-line treatments. Ciprofloxacin is used in 35% of uncomplicated UTIs, while levofloxacin is used in 2%. These antibiotics can be important treatments in some cases of more complicated UTIs, but can have dangerous side effects.
The U.S. Food and Drug Administration warns that the use of these drugs should be restricted because of their potentially disabling side effects involving tendons, muscles, joints, nerves and the central nervous system. Additionally, in many parts of the country, bacteria commonly causing UTIs are becoming resistant to these antibiotics.
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