Azithromycin Usage In Pediatrics

Question 0

What is Azithromycin often (incorrectly) prescribed for? Why should we avoid using it?

Answer 0

Upper and lower resp tract infections.

Associated with increased rates of pneumococcal resistance.

Question 1

What is Azithromycin?

Answer 1

(Zithromax). Subtype of Macrolides. Inhibits protein synthesis. Similar to erythromycin, but more effective against gram negatives.

Question 2

Azithromycin should be specifically avoided in which infection type? Why?

Answer 2

Bacteremia! It is largely located intracellularly, and has poor systemic distribution in hone blood. Breakthrough infections possible.

Question 3

What is the spectrum of activity of Azithromycin?

Answer 3

Poor gram + coverage in vitro. Better gram negative.

Therefore better for H. Influenza, catarrhalis moraxella then other Macrolides.

Question 4

Resistance to what group of antibiotics is higher in pneumococcus than penicillins?

Answer 4

Macrolides (Azithromycin).

Question 5

Are pneumococcal strains resistant to penicillin usually resistant to Azithromycin?

Answer 5

Yes!

Question 6

When should Azithromycin be used to AoM?

Answer 6

ONLY when child has an absolute contraindications to use of amoxicillin. (Severe allergy)

Question 7

When should Azithromycin be used in cases of CAP?

Answer 7

When suspect an atypical, or in conjunction with third generation cephalosporins for severe pneumonias. Not to be used exclusively for typical (pneumococcal) pneumonias!

Question 8

Should Azithromycin be used as a first line therapy for AoM? Pharyngitis? CAP?

Answer 8

No, no, no.