Azithromycin dosing in pediatrics


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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

solution, inhalation

  • 75mg

powder for injection

  • 1g
  • 2g

more...

Systemic Infections

Moderately severe: 1-2 g IV/IM q8-12hr; not to exceed 8 g/day

Severe or life-threatening: 2 g IV/IM q6-8hr; not to exceed 8 g/day

Pseudomonal Infections

2 g IV/IM q6-8hr; not to exceed 8 g/day

Urinary Tract Infections

0.5-1 g IV/IM q8-12hr; not to exceed 8 g/day

Graft-Versus-Host Disease (Orphan)

Treatment of oral manifestations of graft-versus-host disease (GVHD)

Orphan indication sponsors

  • Oral Solutions, Inc, 787 Seventh Ave, 48th Floor, New York, NY 10019

Dosing Modifications

Renal impairment

  • CrCl 10-30 mL/min: 1-2 g loading dose, then 50% of usual dosage
  • CrCl <10 mL/min: 1-2 g loading dose, then 25% of usual dosage

Dosing Considerations

Susceptible organisms

  • Gram-negative: Citrobacter spp, Enterobacter spp, Escherichia coli, Haemophilus influenzae, Klebsiella oxytoca, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa, Serratia marcescens

Dosage Forms & Strengths

solution, inhalation

  • 75mg

powder for injection

  • 1g
  • 2g

more...

Mild-to-Moderate Infections

<9 month: Safety and efficacy not established

>9 month: 30 mg/kg IV q8hr; not to exceed 120 mg/kg/day 

Moderate-to-Severe Infections

<9 month: Safety and efficacy not established

>9 month: 30 mg/kg IV q6-8hr; not to exceed 120 mg/kg/day 

Cystic Fibrosis

<9 month: Safety and efficacy not established

>9 month: 50 mg/kg IV q6-8hr; not to exceed 200 mg/kg/day; not to exceed 8 g/day 

>7 years: 75 mg via nebulizer three times daily, at least 4 hr apart, for 28days; not to be repeated for another 28 days

Interactions

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Adverse Effects

>10%

Inhalation

  • Cough (54%)
  • Sore throat (12%)
  • Wheezing (16%)
  • Fever (13%)

Injection

  • Pain at injection site (12%; children); (2%; adults)
  • Increase in serum transaminases (4-6%)
  • Neutropenia (3-11%, children); (<1%, adults)

1-10%

Inhalation

  • Chest discomfort (8%)
  • Abdominal pain (7%)
  • Vomiting (6%)
  • Bronchospasm (3%)
  • Skin rash (2%)

Injection

  • Rash (4%)
  • Thrombocytopenia (4%, children); (<1% adults)
  • Diarrhea (1%)
  • Nausea (1%)
  • Vomiting (1%)
  • Fever (<1%)

< 1%

Inhalation

Facial edema

Joint swelling

Tightness in chest and throat

Bronchospasm

Skin rash

Injection

Abnormal taste

Anaphylaxis

Anemia

Angioedema

Aphthous ulcer

Breast tenderness

Bronchospasm

Clostridium difficile-associated diarrhea (CDAD)

Confusion

Diplopia

Dizziness

Dsypnea

Electrocardiographic changes (transient)

Erythema multiforme

Eosinophilia

Fever

Flushing

Halitosis

Headache

Hepatitis

Hypotension

Insomnia

Jaundice

Leukocytosis

Neutropenia

Pancytopenia

Seizures

Thrombocytopenia

Tinnitus

Tongue numbness

Toxic epidermal necrolysis

Urticaria

Vaginitis

Vertigo

Weakness

Wheezing

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Warnings

Contraindications

Hypersensitivity

Cautions

CDAD has been reported with use of nearly all antibacterial agents, including aztreonam

Dose reduction required with renal impairment

Coadministration with nephrotoxic drugs increases risk of renal impairment

Prolonged use may result in superinfection

Use caution in toxic epidermal necrolysis and renal impairment

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Pregnancy & Lactation

Pregnancy category: B

Lactation: Drug is excreted in milk in low concentrations; use not recommended (American Academy of Pediatrics committee states that drug is compatible with nursing)

Pregnancy Categories

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Pharmacology

Mechanism of Action

Monobactam; inhibits cell wall synthesis by binding to penicillin binding proteins

Absorption

IM form well absorbed; IM/IV forms yield comparable serum concentrations

Peak plasma time: IM/IV push, ≤60 min; IV infusion, 1.5 hr

Distribution

Distributed widely to most body fluids and tissues; crosses placenta; enters breast milk

Relative diffusion of antimicrobial agents from blood into CSF: Good only with inflammation (exceeds usual MICs); CSF level 1% of blood level with normal meninges, 8-40% with inflamed meninges

Protein bound: 58%

Vd: Neonates, 0.26-0.36 L/kg; children, 0.2-0.29 L/kg; adults, 0.2 L/kg

Metabolism

Metabolized in liver

Elimination

Half-life: Adults with normal renal function, 1.7-2.9 hr; adults with end-stage renal disease, 6-8 hr

Excretion: Urine (60-70% as unchanged drug), feces (13-15%)

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Administration

IV Incompatibilities

Additive: Metronidazole, nafcillin

Y-site: Acyclovir, alatrofloxacin, amphotericin B, amphotericin B cholesteryl sulfate, amsacrine, azithromycin, chlorpromazine, daunorubicin, ganciclovir, lorazepam, metronidazole, mitomycin, mitoxantrone, prochlorperazine, streptozocin, vancomycin(?; may depend on concentration)

IV Compatibilities

Additive (partial list): Ampicillin(?), cefazolin, cefoxitin(?), ciprofloxacin, linezolid, tobramycin, vancomycin (may be incompatible at high concentrations of both drugs)

Syringe: Clindamyin

Y-site (partial list): Allopurinol, amikacin, cephalosporins (most), cimetidine, ciprofloxacin, cisatracurium, diltiazem, diphenhydramine, dopamine, famotidine, fluconazole, furosemide, heparin, hydroxyzine, linezolid, magnesium sulfate, metoclopramide, morphine sulfate, ondansetron, propofol, sodium bicarbonate, trimethoprim-sulfamethoxazole, zidovudine

IV Preparation

Reconstituted solutions are colorless to light straw-yellow; may turn pink upon standing, without affecting potency

Use reconstituted solutions and IV solutions (in NS or D5W) within 48 hours if kept at room temperature or within 7 days if kept in refrigerator

IV/IM Administration

IM: Inject deep into large muscle mass

IV: Preferred for doses >1 g or in patients with severe life-threatening infections; administer drug by IV push over 3-5 minutes or by intermittent infusion over 20-60 minutes at final concentration not to exceed 20 mg/mL

Monitor infusion/injection sites carefully; administer around-the-clock to minimize variations in peak and trough serum levels

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Patient Handout

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Formulary

FormularyPatient Discounts

To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

Create Your List of Plans

Adding plans allows you to:

  • View the formulary and any restrictions for each plan.
  • Manage and view all your plans together – even plans in different states.
  • Compare formulary status to other drugs in the same class.
  • Access your plan list on any device – mobile or desktop.

The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

View explanations for tiers and restrictions

Tier Description
1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
NC NOT COVERED – Drugs that are not covered by the plan.
Code Definition
PA Prior Authorization
Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
QL Quantity Limits
Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
ST Step Therapy
Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
OR Other Restrictions
Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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Дата: 31.08.2017, 06:40 / Просмотров: 55255