AZITHROMYCIN - A REVIEW OF ITS USE IN PEDIATRIC

Azithromycin is an azalide antimicrobial agent active in vitro against major pathogens responsible for infections of the respiratory tract, skin and soft tissues in children. Pathogens that are generally suscep tible to azithromycin include Haemophilus influenzae (including ampici llin-resistant strains), Moraxella catarrhalis, Chlamydia pneumoniae, Chlamydia trachomatis, Mycoplasma pneumoniae, Legionella spp., Strepto coccus pyogenes and Streptococcus agalactiae. Azithromycin is also gen erally active against erythromycin- and penicillin-susceptible Strepto coccus pneumoniae and methicillin-susceptible Staphylococcus aureus. A zithromycin is administered once daily, achieves clinically relevant c oncentrations at sites of infection, is slowly eliminated from the bod y and has few drug interactions. In children, azithromycin is usually given as either a 3-day course of 10 mg/kg/day or a 5-day course with 10 mg/kg on the first day, followed by 5 mg/kg/day for a further 4 day s. These standard regimens were as effective as amoxicillin/clavulanic acid: clarithromycin, cefaclor and amoxicillin in the treatment child ren with otitis media. Azithromycin was also as effective as either ph enoxymethylpenicillin (penicillin V), erythromycin, clarithromycin or cefaclor against streptococcal pharyngitis or tonsillitis in children, but appears to result in moire recurrence of infection than phenoxyme thylpenicillin in this indication, necessitating a dosage of 12 mg/kg/ day for 5 days. Community-acquired pneumonia, bronchitis and other res piratory tract infections in children responded as well to azithromyci n as to amoxicillin/clavulanic acid, cefaclor, erythromycin or josamyc in, Azithromycin was similar or superior to ceftibuten in mixed genera l practice populations of patients. However, symptoms of lower respira tory tract infections resolved more rapidly with azithromycin than wit h erythromycin, josamycin or cefaclor. Skin and soft tissue infections responded as well iii azithromycin as to cefaclor, dicloxacillin or f lucloxacillin, and oral azithromycin was as effective as ocular tetrac ycline in treating trachoma. Although not as well tolerated as phenoxy methylpenicillin in the treatment of streptococcal pharyngitis, azithr omycin is at least as well tolerated as most other agents used to trea t respiratory tract and other infections in children and was better to lerated than amoxicillin/clavulanic acid. Adverse events that do occur are mostly gastrointestinal and tend to be mild to moderate in severi ty. Conclusions: Azithromycin is an effective and well tolerated alter native to first-line agents in the treatment of respiratory tract, ski n and soft tissue infections in children, offerring the convenience of a short, once-daily regimen.