Azithromycin 250 instructions for use. Effective universal antibiotic Azithromycin (instruction for use)

29.10.2020

Azithromycin is a popular antibacterial agent that is used to treat diseases of the upper and lower respiratory tract and bacterial lesions of the genitourinary system, including in children. It has low level toxic effects on the child's body and a long-term effect. Therefore, the drug can be taken only once a day.

The antibiotic Azithromycin is sold in any pharmacy in the form of tablets, capsules and powder for suspension.

There is also a number of its complete analogues: Azitrus, Azivok, Sumametsin, Zitrolid, Zitrotsin, Ecomed, ZI-factor, and so on.

The listed preparations are prepared on the basis of one active substance- 9-Deoxo-9a-aza-9a-methyl-9a-homoerythromycin A, and they all have an identical effect.

Azithromycin is well tolerated by children up to a year.

How does the medicine work?

Azithromycin belongs to a group of drugs called macrolides because of their special structure (if you delve into chemistry, they are based on a 14 or 16-membered lactone ring with attached carbohydrate residues).

The most famous representative of macrolides is Erythromycin, which was treated by fathers and mothers, grandfathers and grandmothers of today's babies.

Azithromycin is a new generation drug, which means it has smaller amount side effects.

It is effective against a whole range of pathological microorganisms resistant to other antibiotics. Among them, many species are the plagues of the twentieth century, as experts call it. In addition, this the only drug that can fight Haemophilus influenzae, taking an active part in the development of pneumonia and meningitis together with staphylococcus aureus.

The drug has the ability to easily penetrate and accumulate in the sputum in the bronchi, as well as in the tissues of the bronchi and lungs, organs of the genitourinary system and skin. This allows the drug to act directly on the focus of inflammation. The mechanism of action of the antibiotic is based on the fact that it prevents microbial cells from synthesizing protein. And without this basic "building material" no cell can exist. Azithromycin reaches its highest concentration in the blood plasma of a child within 2-3 hours after ingestion. From there, it penetrates into the foci of inflammation, accumulates in the tissues of the affected organs and immediately begins its work.

The antibiotic is taken once a day. It would be enough.

In addition to speed, the drug is characterized by slow excretion from the body, which prolongs the therapeutic effect. The antibiotic is usually eliminated from the child's body in 35-55 hours. It is this property of Azithromycin that makes it possible to take it only once a day.

One of the main advantages of the antibiotic is the absence of any interaction with antiallergic drugs. This allows it to be taken by children suffering from allergic diseases and, in particular, bronchial asthma.

In what cases are they prescribed?

Children with Azithromycin are usually treated for diseases of the respiratory system:

bronchitis, pneumonia caused by chlamydia and mycoplasma;
complicated pneumonia with an established pathogen that is sensitive to the drug;
with exacerbations of chronic bronchitis;
in the absence of the effect of treatment with antibiotics related to cephalosporins and penicillins, as well as intolerance to these drugs;
if the child has allergies, bronchial asthma.

If pneumonia is suspected, pediatricians usually prescribe Azithromycin.

In addition to these diseases, Azithromycin is used to treat:

, angina;
scarlet fever;
skin diseases - erysipelas, impetigo, pustular lesions;
inflammation of the urethra;
Lyme disease.

How to navigate in the variety of analogues and forms of releases?

Azithromycin has several forms of release, from which it is possible to choose the most suitable:

Powder for suspension or ready-made suspension 100 mg / 5 ml, equipped with a dosing syringe for children from six months to three years.
Powder for suspension or ready-made suspension 200 mg / 5 ml - from three to 14 years.
Tablets 125 mg.
Tablets with a dosage of 250 mg - they are rarely used to treat children.

Speaking about the dosage, we mean that it is the same for all Azithromycins, which come out under different names, which were discussed above. Some drugs, for example, Sumamed, are presented in all dosage forms - in the form of tablets, powder for suspension and capsules, but Azimed, Azitrus, Azitrox - are intended only for the preparation of a suspension. Ecomed is a ready-to-use mixture.

A more expensive analogue of Azithromycin with the same main active ingredient is Sumamed.

Dosage and regimen

Before you start using the drug, be sure to read the instructions for use (). The dosage of Azithromycin depends on the body weight of the child.

Thus, the total dose required for the course is 30-50 mg per kilogram of body weight.

Example: if Alyosha weighs 14 kg, then he will need 140 mg of Azithromycin per day at one time. A 280 mg tablet can be divided in half or given as a suspension. The boy will need 5 ml of suspension obtained from a 100 mg powder vial (according to the table below). If Alyosha's weight were, for example, 15 kg, it would be impossible to accurately divide the tablet. In this case, it is advisable to use a suspension. Here is a table (from the instructions for use) that will help calculate the required amount of suspension based on the weight of the child:

The drug should not be given simultaneously with food - either one hour before a meal, or two hours after it.

Taking the drug strictly on an empty stomach!

In some cases, during the treatment process, it becomes necessary to adjust the dosage or replace the drug, and only a doctor can do this. Therefore, taking an antibiotic should be carried out only under the supervision of a pediatrician and on his recommendation.

How to prepare a powder suspension

The suspension is prepared immediately before the first use. To a vial with 100 mg of the drug, add 11 ml of boiled chilled water using a dosing syringe and shake well until a homogeneous liquid is obtained. Vials with 200 mg of the drug are diluted with 14.5 ml of water - here the concentration of the drug is higher.

The resulting suspension is given to the child using a double-sided dosing spoon or syringe dispenser. The diluted medicinal product is stored in the refrigerator for no more than 5 days.

The syringe dispenser is a great helper for moms!

It is more convenient for very young children to give a suspension with a dosing syringe. To do this, you need to position the child as for feeding, carefully insert the tip of the syringe into his mouth and slowly squeeze out the medicine so that he has time to swallow.

Contraindications and side effects

After antibiotics, children often experience digestive disorders, stool is disturbed, the child cannot eat those foods that he easily tolerated before. Therefore, it is necessary to rebuild children's immunity. But how to do it right?

Azithromycin is a modern semi-synthetic antibacterial drug of the azalide subclass (macrolide group), which has a wide spectrum of action on pathogenic microflora and has a pronounced bacteriostatic effect.

It is used for inflammatory and infectious lesions, especially in cases where the penicillin series does not suppress the bacterial flora.

Azithromycin is distinguished by its ability to quickly penetrate into all organs and tissues. This is achieved due to the active absorption of the medicinal substance from the intestine into the blood. The active substance is not afraid of acidic environments, and quickly dissolves in fats.

Azithromycin dihydrate is a substance of prolonged action, and a single use of the agent, especially in shock dose,retains its presence in the body for up to 6 days. After taking azithromycin, literally after 2 hours, the maximum concentration of the active substance in the body is observed, which makes it possible to achieve a high therapeutic effect after the first doses of treatment.

Due to this feature, the drug successfully treats serious infections in short courses(from 3 to 5 days), and with a convenient dosage - 1 dose per day. Due to this, azithromycin has gained great popularity in pediatric practice and is used for many infections in the younger generation.

Forms and dosages of azithromycin for children

Due to the fact that azithromycin is a powerful remedy for bacteria, with a mild course of the disease, the drug is not recommended. Only if there are special indications is it “connected” as a percussion tool. For children, azithromycin is prescribed in tablets of 125 and 250 mg, as well as capsules of 250 mg (according to current instruction on the use of the remedy). One blister contains 6 tablets or capsules.

For ease of use, there is another form of azithromycin for children - this is a suspension (syrup), but the packages do not indicate 250 mg, as in tablet form, but the following information is given: 100 mg / 5 ml or 200 mg / 5 ml. For example, to obtain a suspension at a dose of 250 mg, it is necessary to give the child 12.5 ml once (at a dose on the package of 100 mg / 5 ml).

The dosage of the drug and the duration of administration is determined only by the doctor. Any antibacterial agent is not subject to independent use, especially in children.

A dose of azithromycin 125–250 mg is prescribed for a body weight of at least 45 kg, in other cases, a dosage form in the form of a suspension is recommended. For children weighing up to 45 kg, the calculation of the drug is carried out at the rate of 10 mg / kg (reception 1 time per day).

The drug is taken without food (one hour or two hours after a meal). The time of taking the medicine should be fixed, for example, at 11 am. Do not chew the tablet or capsule and drink plenty of water.

Instructions for use of azithromycin for children tells about the method of taking all forms of the drug, but The most convenient capsules are 250 mg.. They are easy to swallow, because. they slip, and there is no unpleasant sensation on the tongue, as from taking pills. Solid forms of azithromycin are already used in children old enough to be able to take them correctly without difficulty.

Important! Azithromycin is not indicated for children under 6 months of age, due to the high likelihood of convulsive reactions and gastrointestinal disorders (up to bleeding).

The price of azithromycin 250 varies between 50–90 rubles and above, depending on the pharmacological company, although you can also find social offers, for example, from Vertex (Russia) - 32 rubles. Azithromycin analogues have a higher price. The cost of sumamed (Teva, Israel), the most famous analogue, is within 350 rubles.

Article in the topic - instructions for use and analogues of sumamed.

For treatment and prevention runny nose, sore throats, SARS and influenza in children, and adults Elena Malysheva recommends effective drug Immunity from Russian scientists. Thanks to its unique, and most importantly 100% natural composition the drug has an extremely high efficiency in the treatment of sore throats, colds and strengthening immunity.

Indications for the use of azithromycin

The drug is prescribed for the following pathological processes:

sinusitis (sinus infections);
tonsillitis (acute and recurrent forms);
tonsillitis;
otitis;
pharyngitis;
bronchitis;
tracheitis;
pleurisy (in the initial stages of the disease);
pneumonia;
erysipelas;
infectious dermatoses;
furunculosis;
scarlet fever;
urinary tract infections;
impetigo;
in complex treatment regimens for the gastrointestinal tract;
Lyme disease (tick-borne borreliosis).

In order for the treatment to be effective, a bacterial culture on the microflora with an antibiogram should be carried out. This analysis will determine the causative agent of the disease and help determine whether azithromycin is suitable in a particular case. For example, with angina, a smear is taken from the area of \u200b\u200bthe affected tonsils.

Children very often suffer from herpetic sore throat, we advise you to read the article on how to treat this type of sore throat.

The negative point is that bakposev is prepared for 5-10 days, and the disease is an insidious thing, and will not wait long. Therefore, in most cases, sowing is performed, but the treatment is prescribed blindly. If the antibiotic did not fit, then upon receipt of the results of the smear, it will be possible to accurately apply the sensitive drug to the pathogenic microflora.

You can check out other effective medicines cold here.

Contraindications and side effects

Azithromycin, like all antibacterial agents, has a number of disadvantages and not approved for use under the following conditions:

intolerance to macrolides;
arrhythmias (severe forms);
propensity to allergic reactions;
myasthenia gravis;
severe liver and kidney disease;
age up to 6 months.

Adverse reactions are possible in the form of:

diarrhea
vomiting;
persistent nausea;
dizziness;
pain or cramps in the abdomen;
flatulence;
tachycardia;
refusal to eat;
skin rashes;
irritability;
sleep disorders;
violations of biochemical parameters of blood (more often with an overdose).

The appearance of severe side effects requires immediate discontinuation of the drug.

can be accepted antihistamine(erius, claritin, loratadine). Usually, the doctor prescribes one of these drugs to “cover” antibiotics, warning in advance dangerous symptoms. Even if there is a reaction to the antibiotic, it will pass in the most harmless form.

How to properly store Azithromycin 250?

The medicinal product should be kept away from children and sunlight. The recommended storage temperature is 15-25°C. The shelf life of azithromycin is indicated on the package, and is 2-3 years, depending on the manufacturer.

It should be remembered that azithromycin 250 in tablets and capsules is stored for a long time, because. each pill is protected by a blister, and the syrup (suspension) in the open form quickly deteriorates, it should not be stored for more than 10 days.

Azithromycin analogs

Analogues may match the active substance or the mechanism of action. So, here is a list of analogues that have azithromycin in their composition:

chemomycin;
sumamed;
clubax;
sumamox;
azitrox;
zitrocin;
Azicide;
sumaclid;
zitrolide;
other.

These funds replace azithromycin if the drug itself was not entirely suitable. All these analogues have their price, and it is slightly higher than the price of azithromycin.

The following drugs are suitable for a similar mechanism of action:

clarithromycin;
erythromycin;
lecoclair;
arvicin;
spiramycin;
macrofoams;
rovamycin;
fromelide;
other.

Analogues, reviews, side effects Azithromycin

Feedback on the use of azithromycin 250

Before using azithromycin 250, parents carefully study the instructions for use for children, reviews, and analyze whether the antibiotic will harm the child? Such an approach is undoubtedly justified and deserves respect. Unfortunately, some unfortunate doctors practice the use of azithromycin for other purposes, when lighter antibiotics can also cope with the disease.

Of course, the effect of azithromycin will be lightning fast, but how then to treat complex infections if the body gets used to receiving strong antibiotic with simple forms of disease. This is a rather serious moment in treatment and parents should be aware of this. Trust but check. If in doubt, seek advice from another specialist.

And now let's get acquainted with the reviews of parents, taken from the correspondence of users from well-known forums.

Nastya

My daughter (14 years old) is constantly ill with ARVI, and, unfortunately, very often the disease is complicated by tracheitis or bronchitis, and the complication after the virus comes quickly. Recently got very ill. The pediatrician prescribed Augmentin, ACC, Erespal in syrup. There was practically no result, wheezing went down lower. When my daughter coughed, it was clear to me, not even a doctor, that her breathing was weakened, and the cough seemed to be heard from within.

The antibiotic was replaced with azithromycin 250. After the first tablet, the temperature returned to normal. And after three days the child was healthy. Only three pills and such results. The tool deserves a high rating, and I give it.

Valentine

The doctor canceled amoxiclav and prescribed sumamed (5 tablets in total). I want to warn you, sumamed is an analogue of azithromycin, but much more expensive. The pharmacist suggested this information to me, I really doubted at first, but still took azithromycin. At 15:00 I took the first pill. In the morning I checked my throat, and I was pleased with the result: the raids went down by 50%. Finished all the pills. Then they drank Narine (kefir for dysbacteriosis) for 10 days for prevention. Azithromycin overcame severe sore throat with a bang.

Natalia

My son was 10 years old when he caught a serious cold. Strongly coughed, sweated, the temperature was kept within 37.3 degrees. The doctor, after listening to the child, determined that the breathing was hard, weak and similar to right-sided dry pleurisy. On the first day, it was prescribed: azithromycin 250, and the remaining four days took a smaller dose - 125 mg each. The child recovered quickly.

After a while, the son was given a fluorographic picture, and the radiologist drew attention to the fact that the sinus was “soldered” - this means that once there was pleurisy. So azithromycin helped, and we did without injections at that time. Great antibiotic!

Yanina

Everyone writes only positive things, but my experience is different. I am 24 years old, no longer a child, but the dose of the drug azithromycin was prescribed in a children's dosage - 250 mg. It’s just that my weight is 49 kg, and that’s why they gave me such a dose. Treat tracheobronchitis. She complained of cough, thick sputum, shortness of breath, lethargy and headache.

Bronchitis passed, but a day after taking the last pill (fifth in a row), a terrible rash began all over my body. There were no acne only on the face and hands. They put me on a diet, prescribed Karsil, Holosas and Erius. But, despite all this treatment, the rash went down very slowly. Only after two months the skin was completely cleared.

The reasons for this phenomenon were not found, except for the comment of the immunologist - weak immunity and the liver is poorly cleansed, although the results of blood and ultrasound pathology with the liver were not found. Here is my experience of treatment with azithromycin.

Alexandra

I got sick at the cottage. Runny nose, fever, and then a painful cough began. Moreover, I also infected my daughter, most likely viral infection"worked". I had to go to work on Monday, but the boss made it clear on the phone that I could only be ill for three days or they would find a replacement for me. Saved only sumamed - an analogue of azithromycin.

My daughter developed severe bronchitis, and our district police officer also advised me to drink sumamed only in a children's dosage. Moreover, my daughter had a purulent acne, with which we have been fighting for the second year. Apparently the rash had an infectious origin. They were very satisfied with the drug, I can even say more, I have not seen such an instant effect from antibiotics before.

Azithromycin is a highly effective antibacterial agent with a relatively low price, a long half-life and a low percentage of side effects (no more than 2%). The antibiotic occupies a leading position in the frequency of prescriptions in the treatment of childhood infections and shows excellent results of therapy.

And some secrets...

If you or your child gets sick often and is treated with antibiotics alone, know that you are only treating the effect, not the cause.

So you just “drain” money to pharmacies and pharmaceutical companies and get sick more often.

STOP! stop feeding who you don't know!!! You just need to boost your immunity and you will forget what it is to get sick!

There is a way for this! Confirmed by E. Malysheva, A. Myasnikov and our readers! …

The timely appointment of an antibiotic helps in the fight against infections of the respiratory tract, genitourinary system and other organs. And one of the most popular drugs in this group is Azithromycin. It attracts with low toxicity and long-term effect, due to which the medicine is taken only once a day, and the course of antibiotic therapy with Azithromycin is often short. But is it possible to give this medication to children, at what dose it is used in childhood When should a child not be treated with Azithromycin?

Composition and trade names

The active substance in the drug Azithromycin is represented by a compound with the same name. At the same time, the domestic drug Azithromycin is not the only one with this active ingredient. Azithromycin is the basis of other drugs:

Sumamed
Hemomycin
Azitrox
Azitral
Zitrolide
Ecomed
ZI factor
AzitRus
Azimicin
Suitrox
Sumatrolide solutab
Zitrocin and others.

All these drugs containing azithromycin can replace each other, therefore, we will consider the features of all these drugs at once, calling them Azithromycin.

Auxiliary ingredients, depending on the form of the drug, may be lactose, sucrose, silicon dioxide, magnesium stearate, gelatin, xanthan gum, dyes, flavors and other substances. Therefore, when buying any of the options for Azithromycin, a child with a tendency to allergies should pay attention to additional components.

Watch an interview with a practicing dermatovenereologist, in which he answers questions regarding ezitromycin preparations:

Release form

Azithromycin is available in many forms, which allows you to choose the most suitable medicine for your child. different ages. The medicine is presented with the following options:

Powder. It is presented as white granules or crystals, which may have a creamy yellow tint. The powder is packaged in vials, where you need to add water to make a suspension. In the package, as a rule, there is a dosing syringe, as well as a dosing spoon. The powder form of Azithromycin is represented by two dosages - a medicine, in 5 ml of which, after preparing the suspension, there will be 100 mg of the active substance (Sumamed, Hemomycin, Suitrox, Azitrox, AzitRus, Azithromycin Zintiva, Azithromycin Sandoz) and a drug, 5 ml of the finished solution of which will contain 200 mg azithromycin (AzitRus, Azithromycin Zintiva, Hemomycin, Azithromycin Sandoz, Azitrox, Suitrox). The prepared liquid has a sweet taste and a pleasant smell, so many children drink this syrup without any problems.
Pills. This form of Azithromycin is represented by both dispersible tablets (Sumamed, Sumatrolid solutab) and coated tablets (Sumamed, ZI-factor, Azithromycin, Hemomycin, Azithromycin Forte, Azithromycin Zintiva, Ecomed, AzitRus Forte, Zitnob). The content of the active substance in such tablets is often 125 or 500 mg, but there are also drugs with 250 or 1000 mg of azithromycin. Most drugs are packaged in a blister of 3 or 6 tablets.
Capsules. In this form, Sumamed, Zitrolid, AzitRus, Ecomed, Azithromycin, ZI-factor, Hemomycin, Azitrox, Azitral, Azithromycin-OBL are produced. Each capsule contains 250 mg (rarely 500 mg) of azithromycin, and 1 pack may contain 3, 6, 10, 12 or more capsules.

The drug Azitrox is available in different forms, which makes it convenient for both adults and children of all ages.

There is also Azithromycin for injection, for example, Sumamed or Hemomycin lyophilisate. Such a drug in injections is in demand for very severe infections, but is not used in childhood.

Operating principle

Azithromycin belongs to the group of macrolides. Such antibiotics have a fairly wide range of effects on harmful bacteria. After entering the patient's body, they are transferred to the site of inflammation and penetrate both through tissue barriers and through cell walls.

Azithromycin is absorbed quickly enough, as a result of which, after 2-3 hours, its concentration in the bloodstream will be maximum. After discontinuation, the drug circulates in the plasma for another 5-7 days, providing a therapeutic effect.

Azithromycin is prescribed for infectious diseases of the throat

In a moderate dose, Azithromycin is able to suppress the formation of proteins in bacterial cells, which slows down their reproduction. A high concentration of the drug has a bactericidal effect (destroys the pathogen).

Reception of Azithromycin is effective in case of infection:

Staphylococcus aureus.
Epidermal staphylococcus.
Streptococcus group B and other groups.
Pneumococcus.
Pyogenic streptococcus.
Haemophilus stick.
Moraxella.
Pertussis stick.
A stick of parapertussis.
Campylobacter.
Legionella.
Gonococcus.
Gardnerella.
Bacteroids.
Peptostreptococcus.
Clostridia.
Chlamydia.
Mycobacteria.
Ureaplasma.
Mycoplasma.
Pale treponema.
Borrelia.

However, it happens that the drug does not help if the microorganisms have developed resistance to such an antibiotic. This situation requires the replacement of the drug after determining the sensitivity of the pathogen to other antimicrobial agents.

Indications

Angina.
Laryngitis.
Tick-borne borreliosis.
Bronchitis.
Pneumonia.
Sinusitis and other sinusitis.
Streptococcal pharyngitis.
Otitis media.
Whooping cough.
Erysipelas and pustular skin lesions.
Infectious dermatitis.
Urethritis and other infections of the urinary system.
Peptic ulcer of the gastrointestinal tract.

Quite often, the reason for the appointment of Azithromycin is a cold that was not properly treated., as a result of which it was complicated by a more serious bacterial infection. Also, this antibiotic can be prescribed to children when such popular antibacterial agents as penicillins and cephalosporins (for example, Amoxicillin turned out to be ineffective) do not act on the causative agent of the infection.

infectious colds in a complicated form can be treated with Azithromycin. From what age is it allowed to take?

Azithromycin is not used in the treatment of children under 6 months of age.. If the child is already six months old, the doctor may prescribe such a medicine in the form of a suspension. Tablet form or Azithromycin capsules are given to older children who can swallow such drugs. The dosage is calculated based on the body weight of the child. Azithromycin infusions are contraindicated before the age of 16.

Contraindications

Any form of Azithromycin should not be taken in case of hypersensitivity to such an active substance. The medicine is also contraindicated in case of allergy to other macrolide antibiotics. Also, the drug is not given:

With severely impaired liver function.
With severe kidney disease.

Azithromycin should be prescribed with caution if there is a tendency to arrhythmias, water and electrolyte imbalances, problems with the functioning of the kidneys or liver, diabetes(for drugs with sucrose), disorders of carbohydrate metabolism (for suspensions).

Azithromycin should be given to a child only after the appointment of the attending physician Side effects

The children's body sometimes reacts to Azithromycin with the appearance of:

Vertigo.
Excited state.
Rapid fatigue.
Drowsiness.
Feelings of tingling or numbness in the extremities.
Headache.
Anxious mood.
conjunctivitis.
Sleep disorders.
Pain in the chest.
Sensations of strong heartbeats.
Nausea.
Flatulence.
Jaundice.
Liquid stool.
Pain in the stomach.
Vomiting.
Decreased appetite.
Inflammation of the stomach.
Candidal lesions of the mucous membranes.
Skin itching.
Pain in the muscles.
Urticaria.
Eruptions on the skin.

More rare side effects of azithromycin preparations are:

Hearing loss or tinnitus.
Visual impairment.
Constipation.
Liver damage.
Inflammation of the intestine.
Nephritis.
Quincke's edema.
Hypersensitivity to ultraviolet.
Changes in blood tests.
Anaphylactic shock.
Pancreatitis.

Instructions for use

The frequency of taking Azithromycin - 1 time per day, and the duration of treatment is usually 3 days. With tick-borne borreliosis, the drug is prescribed for 5 days.
It should be taken into account that the absorption of the active substance Azithromycin is affected by food intake. For this reason, taking the medicine should not coincide with feeding the baby. The drug is given either after about 2 hours after a meal, or 60 minutes before a meal.
Azithromycin powder is diluted with boiled cool water. To find out how much water is required and how to dilute the medicine, you should clarify such information in the instructions. For example, 12 ml of water should be poured into Sumamed powder.
It is important to shake the suspension bottle before each use., then select the desired dose with a syringe or pour it into a spoon.
If the next dose of Azithromycin is missed, it must be taken immediately, as soon as this fact was discovered. The next dose of the medicine should be 24 hours after the missed dose.
Tablets or capsules should be swallowed without biting and then drink water. What to do if the child chewed this form of Azithromycin? This does not pose any danger, but for a more effective action, the drug shell is not recommended to be broken.

Dosage Suspension

The dose of this form of Azithromycin is calculated according to the weight of the child- for one kilogram of the body weight of a sick baby, 10 mg of the active substance is needed. If a drug with a dosage of 100 mg / 5 ml is used, then 10 mg of azithromycin will be in 0.5 ml of the finished solution. It turns out that a child weighing 5 kg should be given 2.5 ml of the drug (this is 50 mg of the active substance), with a body weight of 6 kg - 3 ml of the drug, with a weight of 7 kg - 3.5 ml and so on.

With a weight of 10-14 kg, for example, at 2 years old, the baby is given 100 mg of azithromycin, which corresponds to 5 ml of suspension. If the child is 3 years old and his weight is already 15 kg, then for treatment he will need 150 mg of azithromycin, so they switch to a more concentrated medicine - 200 mg / 5 ml. A single dose of such a suspension is also determined by weight:

Children with a weight of 15-25 kg (for example, at the age of 6 years or 8 years) are given 5 ml of the drug at a time, which contains 200 mg of the active substance.
A child who weighs 25-35 kg (approximately aged 9-10 years) needs 300 mg of azithromycin, which corresponds to 7.5 ml of the drug.
For children weighing 35-45 kg (at 11-12 years old), the therapeutic dosage of azithromycin is 400 mg, so they are given 10 ml of suspension to drink.
With a weight of over 45 kg (12-13 years), a single dose of the drug is 12.5 ml, which corresponds to 500 mg of the active substance and allows the use of tablets or capsules.

125 mg

This dosage of Azithromycin is presented only in tablets. If they are in the shell, then the medicine is recommended not earlier than 3 years of age, when the child can already swallow it.

Azithromycin with this dosage is prescribed from the age of 12. The child is given 2 capsules or 2 tablets at a time for diseases respiratory system, soft tissues or ENT pathologies. With borreliosis on the first day single dose will be 4 capsules or tablets, and then the dose is reduced to two capsules / tablets per dose.

This dosage of Azithromycin is used in the treatment of children over 12 years of age and adults. The drug is taken 1 tablet or 1 capsule per day.

Overdose

If a child accidentally drinks a very high dose of Azithromycin, it will lead to vomiting, severe nausea, or diarrhea. You may also lose hearing for a while. To help the baby, you should immediately rinse the stomach and consult a doctor for symptomatic treatment.

It is important to choose the correct amount of Azithromycin for the child in order to prevent overdose Interaction with other drugs

If the child is already taking any medications, and he was prescribed Azithromycin, this requires attention from the pediatrician, because many drugs should not be combined with such an antibiotic. For example, if the baby is given antacids, this will impair the absorption of azithromycin and affect the results of treatment.

Other antibacterial agents also affect the activity of the drug, for example, the appointment of tetracycline will enhance the effect of Azithromycin, and lincomycin antibiotics will weaken its therapeutic effect.

Azithromycin also has an effect on treatment with carbamazepine, theophylline, zidovudine, cetirizine, fluconazole, digoxin, phenytoin, warfarin, and many other drugs. That is why the appointment of Azithromycin to children who take other medications should be carefully monitored by a doctor.

Terms of sale

You can buy Azithromycin in a pharmacy only after presenting a prescription received from a doctor. The price of the medicine will depend on many factors, including the form of release, dosage, manufacturing company and others. Domestic drugs are cheaper (their price is from 30 rubles), while foreign ones are more expensive.

Storage conditions and shelf life

You need to keep Azithromycin in a place where you can’t get to Small child. Storage temperature - room temperature (up to +25°С). It is impossible to use a medicine that has expired (it is 2 or 3 years for Azithromycin, depending on the manufacturer and the form of the drug). The suspension prepared from the powder form is not stored for more than five days.

All medicines should be kept out of the reach of children Reviews

There are many positive reviews about the use of Azithromycin in the treatment of children. Moms note that such an antibiotic is very effective for bronchitis and pneumonia. It helps to eliminate cough, reduce body temperature and quickly cope with the disease. It is also often used for otitis and tonsillitis, because these bacterial infections are very common in childhood.

The advantages of Azithromycin are the many dosage forms and the ease of use of the suspension for young children. All mothers like that the medicine is given only once a day, and the duration of treatment is short. Negative reviews about Azithromycin include complaints of treatment failure (if the pathogen turned out to be resistant to the drug) and frequent side effects (allergies, headaches, nausea, and others).

If it is impossible to use Azithromycin in the treatment of a child, such a drug can be replaced by other antibacterial agents from the macrolide group:

Clarithromycin. This drug is effective against bacterial infections and is approved from 6 months of age.
macrofoam. The active substance of this drug is midecamycin. The drug is produced in granules, from which a suspension is made, as well as in tablets.
Erythromycin. Such an antimicrobial drug was the first macrolide used to treat various infections, so this drug has a lot of side effects.
Roxithromycin. This is an effective macrolide approved for use from 2 months of age. The drug is produced in tablets, which are dissolved before being given to the baby.
Wilprafen. This antibiotic contains the effective macrolide josamycin, so it is prescribed for serious infectious diseases. In childhood, the form of dispersible tablets is used.
Rovamycin. The main component of such a medication is represented by spiramycin. The tablet form of this macrolide is prescribed for children aged 3-4 years and older.

You should not get carried away with antibiotics, because they have a detrimental effect not only on pathogenic bacteria, but also on beneficial microorganisms. However, in some cases, the use of antibacterial agents is justified, since they often help to avoid serious complications. One of the modern antibiotics used in the treatment of children is Azithromycin.

Properties, composition and form of release of the drug Azithromycin

The drug was named after the active substance - azithromycin, which belongs to the semi-synthetic broad-spectrum antibiotics from the class of azalides. The composition also includes auxiliary components: lactose, cellulose, povidone and magnesium stearate.

The antibiotic is active against gram-positive streptococci, gram-negative bacteria, and some anaerobic microorganisms. The drug is effective in the fight against chlamydia, mycoplasma and ureaplasma, but does not affect gram-positive bacteria resistant to Erythromycin.

The product is produced in three dosage forms- in tablets, capsules and suspensions. Small children are not given tablets and capsules because there is a risk that the child will choke. The prepared suspension is more convenient to use for such patients. In addition, it allows you to calculate the dosage exactly according to the weight of the baby.

Indications for use for children

Azithromycin is prescribed for:

bacterial infections of the nasopharynx: sinusitis, sinusitis, otitis media with and without pus, laryngitis, pharyngitis, tonsillitis;
infectious diseases: scarlet fever, whooping cough, Haemophilus influenzae, borreliosis;
diseases respiratory organs: tracheitis, bronchitis, pneumonia;
diseases of the gastrointestinal tract: gastritis, ulcer;
skin lesions: dermatitis, abscesses, erysipelas.

The effectiveness of treatment depends on the pathogen that caused the disease. Before prescribing antibiotic therapy, the doctor must take an analysis - a smear, culture or scraping - and identify the bacterium and its sensitivity to antibiotics.

Often medical worker prescribes medications based on symptoms alone. Many modern drugs have a wide spectrum of action. Most of the time they kill pathogenic flora but are sometimes ineffective. Then the doctor prescribes an antibiotic with an active substance of another pharmacological group.

Instructions for use: dosage by weight and age

According to the instructions, Azithromycin is taken 1 time per day, regardless of the form produced, and preferably at the same time. For better absorption, it is recommended to take the antibiotic between meals - either 1 hour before meals or two hours after. Treatment should last 3 days, according to indications, the course is increased to 5 days.

Suspension

To prepare the suspension, boiled water at room temperature is used. First, the container with dry powder is shaken well and filled with the required amount of water, then the contents of the vial are shaken well. The prepared solution can be stored in the refrigerator for a maximum of 5 days. Before each use, the drug must be shaken. It is recommended to drink the suspension not big amount water.

There are two types of bottles on sale:

Small, containing powder for the preparation of 15 ml of the drug. Dilution requires 7.5 ml of water.
Increased volume, designed to obtain 30 ml of suspension by adding 15 ml of water.

For small children whose body weight has not reached 15 kg, it is necessary to measure the amount of antibiotic very accurately. To do this, it is convenient to use a measuring syringe, which is included in each package. The price of its division is 0.25 ml. Starting from a body weight of 15 kg, you can use the measuring spoon for dosing, which is also included in the kit.

The dose of the drug is calculated not by age, but by body weight. This is due to the fact that both the first year of life and older children can be very different from each other. For one kilogram of body weight of a child, 10 mg of an antibiotic should be given.

Azithromycin powder is produced at a dosage of 100 mg per 5 ml and 200 mg per 5 ml. This means that 0.5 ml of the finished suspension will contain 10 mg or 20 mg, respectively.

For children weighing over 15 kg, it is more convenient to give the drug at a concentration of 200 mg / 5 ml. For children, the liquid form of the drug is preferable, not only because it is easier to swallow. The powder contains flavor additives which turns the suspension into a sweet syrup.

Pills

Children weighing over 45 kg are preferably treated with tablets or capsules. These forms of the drug are available in dosages of 125 mg and 250 mg.

Children from 3 to 12 years of age are prescribed a medicine of 125 mg, after 12 - 250 mg. The dosage may vary depending on the pathology. Tablets and capsules must be swallowed whole and washed down with a small amount of water.

Dosage calculation

According to the instructions Azithromycin for children should be given as follows:

Body weight, kg	Recommended form of the drug
	Suspension, mg		Tablets, capsules, mg
	100 mg / 5 ml	200 mg / 5 ml
5	2,5	-	-
6	3	-	-
7	3,5	-	-
8	4	-	-
9	4,5	-	-
10-14	5	-	-
15-24	-	5	-
25-34	-	7,5	-
35-44	-	10	-
> 45	-	-	12,5

When is the drug contraindicated?

According to the instructions, the antibiotic is not prescribed to infants up to 6 months of age.
The drug is contraindicated in case of allergy or hypersensitivity to azithromycin or auxiliary components of the drug.
If a child suffers from allergies, then it is not recommended to give the drug in the form of a suspension due to the sugar and flavoring additives it contains.
Impaired liver and kidney function of severe degrees, with a creatinine clearance of less than 40 ml / min, are also the reason for refusing to use the drug. Even if liver dysfunction is mild, there is a risk of provoking fulminant hepatitis and severe liver failure. In such cases, drugs containing azithromycin are prescribed under medical supervision.

If symptoms such as yellowing of the skin and eye sclera, hepatic encephalopathy, asthenia, dark urine staining, bleeding appear, treatment should be interrupted until a complete examination of the liver. According to the results, therapy can be continued or replaced with other medicines.

Patients with a severe form of bradycardia, with a tendency to arrhythmias, patients with diabetes mellitus, suffering from heart failure should also be careful when using azithromycin-containing drugs. The use of Azithromycin in conjunction with anticoagulants and cardiac glycosides is possible only after consultation with a specialist.

Possible adverse reactions in a child

As with the use of any medicine, the use of Azithromycin can cause side effects. This does not indicate the imperfection of the drug, but is associated only with the individual characteristics of the organism.

Very rarely, the antibiotic provokes the appearance of side effects, nausea and abdominal pain may occur.

Possible adverse reactions when using Azithromycin in accordance with the WHO classification:

very common - symptoms that occur in 1 in 10 patients: nausea, flatulence, indigestion;
often - effects that occur in at least 1 in 10 patients and not more than 1 in 100 patients: weakness, vomiting, decreased visual acuity and hearing, changes in taste sensations, headache, anorexia, dizziness, pruritus, eosinophilia and lymphocytopenia;
infrequently - occurring with a frequency of at least 1 in 1000, but not more than 1 in 100: insomnia or drowsiness, anxiety, tinnitus, deafness, constipation, neutropenia, leukopenia, hepatitis, urticaria, chest pain, asthenia, edema;
rarely - occurring in at least 1 in 1000 patients, but not more than 1 in 10,000: abnormal liver function;
very rare - refers to cases reported in less than 1 in 10,000 patients: convulsions, syncope, anxiety, aggression, dullness of taste sensations, pancreatitis, decreased blood pressure, arrhythmia, tachycardia, hemolytic anemia thrombocytopenia, liver failure, liver necrosis, anaphylactic shock.

If a child experiences any side effects, it is necessary to consult a doctor about the advisability of continuing to take the medication.

The specialist will either prescribe additional drugs that block negative symptoms, or select another antibiotic.

The cost and analogues of Azithromycin

Azithromycin is a Russian-made drug that is an analogue of Sumamed, which is manufactured by Pliva Hrvatska D.O.O., Croatia. The cost of Azithromycin for children (suspension 200 mg / 5 ml, in a vial 16.5 g) in large cities of Russia averages 250-275 rubles. Sumamed in the same form costs about 350-380 rubles.

Given the effectiveness of azithromycin against many bacteria, many countries of the world are engaged in the production of medicines based on it. Most drugs are in different forms- from tablets to powders for suspension. The composition may vary slightly due to excipients.

The following are preparations based on Azithromycin from various manufacturers:

Azitrox. Domestic antibiotic. Manufactured by Pharmstandard.
Zitromax. Made in Italy by Pfizer.
Zimaks. An antibiotic produced in Turkey. The release is handled by Bilim Pharmaceuticals.
Zitrolide. Another drug of Russian production. Development of OAO Valenta.
Zitrocin. Produced by the Indian company Unique Pharmaceutical Laboratories.
Zetamax Retard. Produced by the American company PFIZER, Puerto Rico.
Sumamox. Development of the Indian pharmaceutical company Oxford Laboratories Pvt. Ltd.
Hemomycin. Issued by Yugoslavia. Manufacturer - Hemofarm Koncern A.D.

Usually, the attending physician prescribes a specific medicine, but if necessary, it is possible to independently choose an analogue in a pharmacy. Which manufacturer to prefer is a personal choice of everyone. However, it is worth remembering that only patented medicines pass the tests, which in this case is Sumamed. For analogues laboratory research are not mandatory.

Azithromycin is an antibiotic from the group of azalide macrolides, which has a bacteriostatic effect and a wide spectrum of action against gram-positive and gram-negative bacteria. The price in online pharmacies and pharmacy chains starts from 90 rubles, depending on the dosage and manufacturer.

Active ingredients

Active ingredient of the drug: azithromycin dihydrate (in terms of azithromycin) 0.500 g and 0.250 g.

pharmachologic effect

Azithromycin is an antibacterial drug from the group of azalide macrolides, with a wide bacteriostatic spectrum of action.

It has an effect both on bacteria located inside the cells, and on bacteria located outside them.

The active substance interacts with the 50S subunit of ribosomes, inhibits the activity of the peptide translocase enzyme at the translation stage, as a result of which protein synthesis is inhibited, and the growth and reproduction of bacteria slows down. High concentrations of Azithromycin kill bacteria, that is, they have a bactericidal effect.

Bacterial resistance to the drug may be initial or formed during antibiotic therapy.

Microorganism sensitivity scale to azithromycin (minimum inhibitory concentration (MIC), mg/l):

Are sensitive to Azithromycin:

Aerobic gram-positive microorganisms: Staphylococcus aureus (methylcillin-susceptible), Streptococcus pneumoniae penicillin-susceptible), Streptococcus pyogenes;
Aerobic gram-negative microorganisms: Haemophilus influenzae, Haemophilus parainfluenzae, Legionella pneumophila, Moraxella catarrhalis, Pasteurella multocida, Neisseria gonorrhoeae;
Anaerobic microorganisms: Clostridium perfringens, Fusobacterium spp., Prevotella spp., Porphyromonas spp.;
Other: Chlamydia trachomatis, Chlamydia pneumoniae, Chlamydia psittaci, Mycoplasma pneumoniae, Mycoplasma hominis, Borrelia burgdoferi.

Moderately sensitive or insensitive:

Aerobic gram-positive microorganisms: Streptococcus pneumoniae (moderately sensitive or resistant to penicillin).

Resistant to the action of Azithromycin:

Aerobic gram-positive microorganisms: Enterococcus faecalis, Staphylococci spp. (methicillin-resistant), Staphylococcus aureus (including methicillin-susceptible strains), Staphylococus pneumoniae, Staphylococcus spp. Groups A (beta-hemolytic).
Azithromycin is inactive against strains of Gram-positive bacteria resistant to erythromycin.
Anaerobes: Bacteroides fragilis group.

Azithromycin is well absorbed in the gastrointestinal tract and rapidly distributed throughout the tissues of the body. After a single dose of 0.5 g, bioavailability is 37% (the effect of the "first pass" through the liver). The maximum concentration after oral administration (0.5 g - 0.4 mg / l) is reached after 2-3 hours. The intracellular and tissue concentration of the antibiotic is 10-50 times higher than the serum concentration.

Azithromycin is acid-resistant and lipophilic. Passes freely through histohematic barriers. Easily penetrates into urinary organs and tissues, including the prostate gland, respiratory organs, skin and soft tissues. Part of the drug is also transported to the infectious focus by phagocytes (macrophages and polymorphonuclear leukocytes), where it is released in the presence of bacteria.

Penetrating through cell membranes, creates high intracellular concentrations, due to which it acts against pathogenic bacteria located inside the cells. In places of localization of the infectious process, antibiotic concentrations are 24-34% higher than in healthy tissues, while the more intense the inflammation, the higher the concentrations. After taking the last dose of Azithromycin, its effective concentrations persist for 5-7 days.

In unchanged form, more than half of azithromycin is excreted by the intestines, 6% is excreted by the kidneys.

For pharmacokinetics big influence has a meal, namely, a 31% increase in the maximum concentration.

In elderly men (65-85 years old), pharmacokinetic parameters do not change, in elderly women, the maximum concentration increases by 30-50%.

Indications for use

Infectious and inflammatory diseases caused by microorganisms sensitive to the drug:

infections of the upper respiratory tract and ENT organs: pharyngitis, tonsillitis, sinusitis, otitis media;
lower respiratory infections: acute bronchitis, exacerbation chronic bronchitis, pneumonia, including those caused by atypical pathogens;
skin and soft tissue infections: acne vulgaris medium degree severity, erysipelas, impetigo, secondarily infected dermatoses;
initial stage Lyme disease (borreliosis) - migratory erythema (erythema migrans);
urinary tract infections caused by Chlamydia trachomatis (urethritis, cervicitis).

Contraindications

Increased individual sensitivity to macrolide antibiotics;
Severe liver or kidney failure;
Children under 12 years of age weighing less than 45 kg (for this dosage form);
Breast-feeding;
Simultaneous administration with ergotamine and dihydroergotamine.

Carefully:

With moderate violations of the liver and kidneys;
With arrhythmias or predisposition to arrhythmias and prolongation of the QT interval;
With the combined use of terfenadine, warfarin, digoxin.

Instructions for use and dosage

Azithromycin capsules are taken orally, 500 mg once a day, regardless of food intake. For adults (including the elderly) and children over 12 years of age weighing more than 45 kg, the regimen for taking the drug is as follows:

For treatment infectious diseases ENT organs, respiratory tract, skin and soft tissues are prescribed 500 mg once a day for 3 days (course dose -1.5 g).
For the treatment of moderate acne: 2 capsules 250 mg once a day for 3 days, then 250 mg twice a week for 9 days. Heading dose 6.0 g.
For the treatment of borreliosis (erythema migrans): on the first day, a single dose of 1 gram of the drug (2 capsules of 500 mg), then from the 2nd to the 5th day, 500 mg daily. Heading dose 3.0 g.
For urinary infections caused by Chlamydia trachomatis (urethritis, cervicitis): at the same time 2 capsules of 500 mg.

With moderate renal impairment (creatinine clearance> 40 ml / min), dose adjustment is not required.

If for some reason the next dose of azithromycin was missed, then the missed dose should be taken as soon as possible, and subsequent doses should be taken at intervals of 24 hours.

Side effect

From the side gastrointestinal tract: nausea, vomiting, abdominal pain, diarrhea, flatulence, liquid stool, digestive upset, constipation, anorexia, discoloration of the tongue, pseudomembranous colitis, cholestatic jaundice, hepatitis, changes in laboratory parameters of liver function, liver failure, liver necrosis (possibly fatal).

Allergic reactions: itching, skin rashes, angioedema, urticaria, photosensitivity, anaphylactic shock (in rare cases fatal), erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis.

From the side of cardio-vascular system: palpitations, arrhythmia, ventricular tachycardia, an increase in the QT interval, bidirectional ventricular tachycardia.

From the blood and lymphatic systems: thrombocytopenia, neutropenia, eosinophilia.

From the genitourinary system: interstitial nephritis, acute renal failure.

From the side nervous system: headache, dizziness, drowsiness, insomnia, asthenia, anxiety, hyperactivity, aggressiveness, nervousness, convulsions, paresthesia.

From the senses: tinnitus, reversible hearing loss up to deafness (when taking long-term use high doses of the drug), impaired perception of taste and smell.

From the musculoskeletal system: arthralgia.

Others: vaginitis, candidiasis.

In some patients, after the end of taking azithromycin, hypersensitivity reactions may persist for a long time, and therefore specific treatment under medical supervision may be required.

In addition, given the likelihood of side effects from the central nervous system, care should be taken when administering vehicles and work with mechanisms.

Overdose

Symptoms of an overdose of azithromycin: reversible hearing loss, nausea, vomiting, diarrhea. Treatment of overdose: symptomatic.

Pregnancy and lactation

During pregnancy, Azithromycin should be prescribed only in cases where the expected benefit to the mother outweighs the potential risk to the fetus.

Breastfeeding during treatment with azithromycin should be temporarily discontinued.

Interaction with other drugs

Drugs to reduce the acidity of the contents of the stomach (antacids) do not affect the bioavailability of azithromycin, but reduce its maximum concentration by 30%, so the antibiotic should be taken at least one hour before taking antacids or two hours after taking them and eating.
Parenteral use of azithromycin does not affect the plasma concentration of cimetidine, efavirenz, fluconazole, indinavir, midazolam, triazolam, cotrimoxazole when they are used together, however, it must be borne in mind that the likelihood of such interactions is high when azithromycin is prescribed for oral administration.
If necessary, the simultaneous use of azithromycin and cyclosporine, it is recommended to carry out the content of cyclosporine in the blood.
While taking azithromycin with digoxin, the blood concentration of digoxin should be monitored, since some macrolides increase the absorption efficiency in the intestine of digoxin, thereby increasing its plasma concentration.
Joint administration of azithromycin and warfarin should be accompanied by control of prothrombin time.
With the combined use of terfenadine and macrolides, it often leads to arrhythmias and prolongation of the QT interval, so such complications should be expected when taking azithromycin and terfenadine at the same time.
Since there is a possibility of inhibition of the CYP3A4 isoenzyme by azithromycin in parenteral form when used together with cyclosporine, terfenadine, ergot alkaloids, cisapride, pimozide, quinidine, astemizole and other drugs, the metabolism of which occurs with the participation of this isoenzyme, the possibility of such an interaction should be considered when prescribing azithromycin for taking inside.
Simultaneous administration of azithromycin and zidovudine does not affect the pharmacokinetic characteristics of zidovudine in plasma or the excretion of it and its glucuronidated metabolite by the kidneys. However, this increases the concentration of the active metabolite - phosphorylated zidovudine in mononuclear cells of peripheral vessels. At present, the significance of this fact remains unclear.
With the combined use of macrolides with ergotamines and dihydroergotamine, the likelihood of manifestation of their toxic properties increases.

Azithromycin is the active substance of the following antibacterial drugs:

Sumamed;
Zitrocin;
Ecomed
Hemomycin;
Azimicin.

According to the mechanism of action, analogues of azithromycin are:

Lecoclar;
Clarithromycin;
Oleandomycin;
Fromilid;
Rovamycin Spiramycin-vero;
Macrofoam;
Erythromycin.

Storage and shelf life

Store in a dry, dark place, out of the reach of children, at temperatures up to 25 °C. The shelf life of azithromycin is 3 years, after which the drug can not be used.

Additionally Pharmacological group: Antibiotic - azalide ATX code: J01FA10 Dosage form: Capsules for oral administration Release form: Capsules of 250 mg and 500 mg. 3 capsules (500 mg) in a blister pack. 1 blisters with instructions for use in a cardboard box. 3 capsules (250 mg) in a blister pack. 2 blister packs with instructions for use in a cardboard box Active substances: Azithromycin dihydrate (in terms of azithromycin) 0.500 g and 0.250 g 00375 g Composition of a hard gelatin capsule: Body: titanium dioxide 2.00%, gelatin up to 100% Cap: titanium dioxide 1.74%, sunset yellow FCF-FD&C 0.41%, gelatin up to 100% Indications: Infectious and inflammatory diseases, caused by susceptible microorganisms

Every mother tries to avoid the use of antibiotics during her child's illness. When the pediatrician declares the need for such funds, most parents start to panic. However, not everything is so scary. In some cases antibacterial drugs able to quickly cope with the infection and return to the baby good health. One of the commonly prescribed medications is Azithromycin. Instructions for use (for children, the drug is used quite often) will be presented to your attention below. You can also learn about substitutes for this drug and reviews about it.

What is Azithromycin?

For a child, the choice of drug is very important. This medication is an antibiotic. It represents a group of macrolides. The drug has a bactericidal and bacteriostatic effect on the patient's body. The drug is available in dosages of 100, 125, 250 and 500 milligrams. The main active ingredient is azithromycin. Depending on the form of release, the drug may have additional components. So, the drug is available in the form of capsules in a gelatin shell, solid tablets, suspension and powder for its preparation.

"Azithromycin" for a child is one of the commonly prescribed drugs. It is very easy to use and can give a quick positive effect. Also, this tool is quite safe for the child's body.

When do children need the described antibiotic?

The drug "Azithromycin" for a child should be prescribed exclusively by a pediatrician. Self-administration can lead to negative reactions and unpleasant consequences. The medicine is usually prescribed after the analysis. Also, an antibiotic is indicated when other medicines have not given positive result within five days. The main indications for the use of the drug "Azithromycin" for a child are the following situations:

diseases affecting the upper respiratory tract (tonsillitis, tonsillitis, sinusitis, laryngitis, nasopharyngitis, and so on);
infections affecting the lower respiratory tract (bronchitis, pneumonia, tuberculosis, and others);
scarlet fever;
infections that cause damage to soft tissues and mucous membranes;
urinary tract infections.

Also, this medicine can be prescribed by doctors in other situations. In this case, each case is considered individually.

Contraindications to treatment

In what cases is it worth limiting the use of a medication or completely abandoning treatment with Azithromycin? Instructions for use (for children it is especially important to take into account contraindications) reports the following situations:

the age of the child is less than 12 years (capsules, tablets) or less than 6 months (suspension);
renal failure in an advanced form;
liver diseases, including acquired ones;
hypersensitivity to azithromycin;
some diseases of the stomach and intestines.

Dosage of the drug

Usually doctors prescribe the medicine "Azithromycin 250 mg" for children. However, for children under three years of age, it is preferable to give a suspension. The dosage of the drug depends on the age of the patient and the choice of dosage form.

For children under 16 years of age, the drug is prescribed at the rate of 10 milligrams of azithromycin per kilogram of body weight. Since it is preferable to choose a medicine for up to 12 years in the form of a suspension, the dose is calculated as follows. For example, your child weighs 10 kilograms. In this case, he needs to be given 100 milligrams of azithromycin. The syrup is available in two doses: 100 and 200 mg per 5 milliliters of the drug. So, in the first case, the baby needs to be given 5 ml of medicine, and in the second - 2.5.

Tablets at a dose of 250 mg are recommended for children over 12 years of age. At the same time, you need to drink no more than one capsule or pill per day. It is worth noting that the treatment with this medication is carried out for only three days. Only in particularly difficult situations, this period can be extended to 4-5 days.

Features of the use of the drug

If tablets "Azithromycin 250 mg" for children are prescribed, then they should not be chewed and crushed. The drug should enter the stomach unchanged. When using the suspension, it is necessary to shake it well each time before use. Also, the medicine should be washed down with plenty of water. Especially it concerns

The medication is taken one hour before a meal or two after a meal. It is also worth recalling the simultaneous use of other drugs. Many drugs are able to suppress or enhance the action of each other. That is why doctors recommend taking a break of two hours between various drugs and Azithromycin.

Side effects

What does the instruction say about the drug "Azithromycin"? For children, according to the abstract, antibiotics should be prescribed only by a doctor, because this drug can cause side effects. However, doctors assure that, subject to the indicated dosage, the medication is well tolerated. Among the most common side effects, experts note weakness, malaise or anxiety, abdominal pain, impaired stool or nausea.

The timely appointment of an antibiotic helps in the fight against infections of the respiratory tract, genitourinary system and other organs. And one of the most popular drugs in this group is Azithromycin. It attracts with low toxicity and long-term effect, due to which the medicine is taken only once a day, and the course of antibiotic therapy with Azithromycin is often short. But is it possible to give this medication to children, at what dose is it used in childhood, and when should a child not be treated with Azithromycin?

Composition and trade names

Azitral
Zitrolide
Ecomed
ZI factor
Azimicin
Suitrox
Sumatrolide solutab
Zitrocin and others.

All these drugs containing azithromycin can replace each other, therefore, we will consider the features of all these drugs at once, calling them Azithromycin.

Watch an interview with a practicing dermatovenereologist, in which he answers questions regarding ezitromycin preparations:

Release form

Azithromycin is available in many forms, which allows you to choose the most suitable medicine for a child of different ages. The medicine is presented with the following options:

Powder. It is presented as white granules or crystals, which may have a creamy yellow tint. The powder is packaged in vials, where you need to add water to make a suspension. In the package, as a rule, there is a dosing syringe, as well as a dosing spoon. The powder form of Azithromycin is represented by two dosages - a medicine, in 5 ml of which, after preparing the suspension, there will be 100 mg of the active substance (Sumamed, Hemomycin, Suitrox, Azitrox, AzitRus, Azithromycin Zintiva, Azithromycin Sandoz) and a drug, 5 ml of the finished solution of which will contain 200 mg azithromycin (AzitRus, Azithromycin Zintiva, Hemomycin, Azithromycin Sandoz, Azitrox, Suitrox). The prepared liquid has a sweet taste and a pleasant smell, so many children drink this syrup without any problems.
Pills. This form of Azithromycin is represented by both dispersible tablets (Sumamed, Sumatrolid solutab) and coated tablets (Sumamed, ZI-factor, Azithromycin, Hemomycin, Azithromycin Forte, Azithromycin Zintiva, Ecomed, AzitRus Forte, Zitnob). The content of the active substance in such tablets is often 125 or 500 mg, but there are also drugs with 250 or 1000 mg of azithromycin. Most drugs are packaged in a blister of 3 or 6 tablets.
Capsules. In this form, Sumamed, Zitrolid, AzitRus, Ecomed, Azithromycin, ZI-factor, Hemomycin, Azitrox, Azitral, Azithromycin-OBL are produced. Each capsule contains 250 mg (rarely 500 mg) of azithromycin, and 1 pack may contain 3, 6, 10, 12 or more capsules.

There is also Azithromycin for injection, for example, Sumamed or Hemomycin lyophilisate. Such a drug in injections is in demand for very severe infections, but is not used in childhood.

Operating principle

Azithromycin is absorbed quickly enough, as a result of which, after 2-3 hours, its concentration in the bloodstream will be maximum. After discontinuation, the drug circulates in the plasma for another 5-7 days, providing a therapeutic effect.

Reception of Azithromycin is effective in case of infection:

Epidermal staphylococcus.
Streptococcus group B and other groups.
Pneumococcus.
Pyogenic streptococcus.
Haemophilus stick.
Moraxella.
Pertussis stick.
A stick of parapertussis.
Campylobacter.
Legionella.
Gonococcus.
Gardnerella.
Bacteroids.
Peptostreptococcus.
Clostridia.
Chlamydia.
Mycobacteria.
Ureaplasma.
Mycoplasma.
Pale treponema.
Borrelia.

However, it happens that the drug does not help if the microorganisms have developed resistance to such an antibiotic. This situation requires the replacement of the drug after determining the sensitivity of the pathogen to other antimicrobial agents.

Indications

Angina.
Laryngitis.
Tick-borne borreliosis.
Bronchitis.
Pneumonia.
Sinusitis and other sinusitis.
Streptococcal pharyngitis.
Otitis media.
Whooping cough.
Erysipelas and pustular skin lesions.
Infectious dermatitis.
Urethritis and other infections of the urinary system.
Peptic ulcer of the gastrointestinal tract.

Quite often, the reason for the appointment of Azithromycin is a cold that was not properly treated., as a result of which it was complicated by a more serious bacterial infection. Also, this antibiotic can be prescribed to children when such popular antibacterial agents as penicillins and cephalosporins (for example, Amoxicillin turned out to be ineffective) do not act on the causative agent of the infection.

At what age is it allowed to take?

Contraindications

With severely impaired liver function.
With severe kidney disease.

Azithromycin should be prescribed with caution in case of a tendency to arrhythmias, water and electrolyte imbalances, problems with the functioning of the kidneys or liver, diabetes mellitus (for drugs with sucrose), carbohydrate metabolism disorders (for suspensions).

Side effects

Instructions for use

The frequency of taking Azithromycin - 1 time per day, and the duration of treatment is usually 3 days. With tick-borne borreliosis, the drug is prescribed for 5 days.
It should be taken into account that the absorption of the active substance Azithromycin is affected by food intake. For this reason, taking the medicine should not coincide with feeding the baby. The drug is given either after about 2 hours after a meal, or 60 minutes before a meal.
Azithromycin powder is diluted with boiled cool water. To find out how much water is required and how to dilute the medicine, you should clarify such information in the instructions. For example, 12 ml of water should be poured into Sumamed powder.
It is important to shake the suspension bottle before each use., then select the desired dose with a syringe or pour it into a spoon.
If the next dose of Azithromycin is missed, it must be taken immediately, as soon as this fact was discovered. The next dose of the medicine should be 24 hours after the missed dose.
Tablets or capsules should be swallowed without biting and then drink water. What to do if the child chewed this form of Azithromycin? This does not pose any danger, but for a more effective action, the drug shell is not recommended to be broken.

Dosage

Suspension

Children with a weight of 15-25 kg (for example, at the age of 6 years or 8 years) are given 5 ml of the drug at a time, which contains 200 mg of the active substance.
A child who weighs 25-35 kg (approximately aged 9-10 years) needs 300 mg of azithromycin, which corresponds to 7.5 ml of the drug.
For children weighing 35-45 kg (at 11-12 years old), the therapeutic dosage of azithromycin is 400 mg, so they are given 10 ml of suspension to drink.
With a weight of over 45 kg (12-13 years), a single dose of the drug is 12.5 ml, which corresponds to 500 mg of the active substance and allows the use of tablets or capsules.

125 mg

This dosage of Azithromycin is presented only in tablets. If they are in the shell, then the medicine is recommended not earlier than 3 years of age, when the child can already swallow it.

250 mg

Azithromycin with this dosage is prescribed from the age of 12. The child is given 2 capsules or 2 tablets at a time for diseases of the respiratory system, soft tissues or ENT pathologies. With borreliosis on the first day, a single dose will be 4 capsules or tablets, and then the dose is reduced to two capsules / tablets per dose.

500 mg

This dosage of Azithromycin is used in the treatment of children over 12 years of age and adults. The drug is taken 1 tablet or 1 capsule per day.

Overdose

Interaction with other drugs

Azithromycin also has an effect on treatment with carbamazepine, theophylline, zidovudine, cetirizine, fluconazole, digoxin, phenytoin, warfarin, and many other drugs. That is why the appointment of Azithromycin to children who take other medications should be carefully monitored by a doctor.

Terms of sale

Storage conditions and shelf life

Keep Azithromycin in a place where a small child cannot reach. Storage temperature - room temperature (up to +25°С). It is impossible to use a medicine that has expired (it is 2 or 3 years for Azithromycin, depending on the manufacturer and the form of the drug). The suspension prepared from the powder form is not stored for more than five days.

Description

Coated tablets blue color, round, with a biconvex surface, with a risk.

Compound

One tablet contains: active substance: azithromycin - 500 mg; Excipients: calcium hydrogen phosphate dihydrate, hypromellose, corn starch, starch 1500, partially pregelatinized corn starch, sodium lauryl sulfate, magnesium stearate, microcrystalline cellulose, opadry II (including polyvinyl alcohol, talc, macrogol 3350, lecithin (soy), titanium dioxide E 171, iron oxide yellow E 172, aluminum varnish based on indigo carmine E 132).

Pharmacotherapeutic group

Antibacterial agents for systemic use. Macrolides.
ATX code– J01FA10.

Pharmacological properties

Pharmacodynamics
Mechanism of action
Azithromycin is a broad-spectrum antibiotic, the first member of a new subgroup macrolide antibiotics called aza-leads. The molecule is constructed by adding an oxygen atom to the lactone ring of erythromycin A. The chemical name of azithromycin is: 9-deoxy-9a-aza-9a-methyl-9a-homoerythromycin A. The molecular weight is 749.0.
The mechanism of action of azithromycin is binding to the 50 S unit of the ribosome, which prevents the synthesis of bactericidal proteins and translocation of peptides.
Mechanism of resistance
Resistance to azithromycin may be natural or acquired. The three main mechanisms of resistance in bacteria are: target-side alteration, alteration to antibiotic transport, and antibiotic modification.
Complete cross-resistance exists between the following microorganisms: Streptococcus pneumoniae, group A beta hemolytic streptococcus, Enterococcus faecalis and Staphylococcus aureus, including methicillin resistant S aureus (MRSA) to erythromycin, azithromycin, other macrolides and lincosamides.
Limit concentrations (Breakpoints)
Limit concentrations of sensitivity to azithromycin for typical pathogens are:
EUCAST (European Committee on Antimicrobial Susceptibility Testing) limit values for minimum inhibitory concentrations (MICs):
Erythromycin can be used to determine the sensitivity of these bacteria to other macrolides (azithromycin, clarithromycin, and roxithromycin).
At intravenous administration macrolides have an effect on Legionella pneumophila < 1 мг/л для штаммов дикого типа).
Macrolides are used in the treatment of infections caused by Campylobacter jejuni(minimum inhibitory concentration of erythromycin< 1 мг/л для штаммов дикого типа). Азитромицин используется для лечения инфекций, вызванных S.typhy(minimum inhibitory concentration ≤ 16 mg/l for wild-type strains) and Shigella spp..
Sensitivity
The incidence of acquired resistance may differ for selected specimens both geographically and temporally, and local information on resistance would be highly desirable, especially in the treatment of severe infections. A specialist should be consulted when the incidence of acquired resistance is such that the very use of the drug in the last few types of infections becomes questionable.
Antimicrobial spectrum of azithromycin:
GENERALLY SENSITIVE MICROORGANISMS
- aerobic gram-positive microorganisms:
- Staphylococcus aureus(methicillin-sensitive);
-Streptococcus pneumoniae(penicillin-sensitive);
-Streptococcus pyogenes;
- aerobic Gram-negative microorganisms:
- haemuphilis influenzae;
- haemophilus parainfluenzae;
- Legionella pneumophila;
- Moraxella calarrhalls;
- Moraxella catarrhalis;
-Pasteurela multocida;
- anaerobic microorganisms:
- Clostridium perfrmgens;
- Fusobacterium spp.;
- Prevotella spp..;
-Porphyriomonas spp.;
- Other microorganisms:
- Chlamydia trachomatis;
MICROORGANISMS WITH ACQUIRED RESISTANCE
- Aerobic gram-positive microorganisms
- Streptococcus pneumoniae(penicillin intermediate resistant, penicillin resistant).
NATURALLY RESISTANT MICROORGANISMS
- Aerobic gram-positive microorganisms:
- Enterococcus faecalis;
- Staphylococcus MRS A, MRSE(Methicillin-resistant staphylococci have acquired resistance to macrolides and are listed here because they are rarely susceptible to azithromycin.)
- Anaerobic microorganisms:
- Bacteriodis fragilis group
Pharmacokinetics
Suction
After oral administration, azithromycin is well absorbed and rapidly distributed in the body. After a single dose of 500 mg, bioavailability is 37% due to the first pass effect through the liver. Cmax in blood plasma is reached after 2-3 hours and is 0.4 mg / l.
Distribution
Protein binding is inversely proportional to plasma concentration and is 7-50%. The apparent Vd is 31.1 l/kg. Penetrates through cell membranes (effective for infections caused by intracellular pathogens). It is transported by phagocytes to the site of infection, where it is released in the presence of bacteria. Easily penetrates through histohematic barriers and enters the tissues. The concentration in tissues and cells is 10-50 times higher than in plasma, and in the focus of infection it is 24-34% higher than in healthy tissues.
Metabolism
Demethylated in the liver, losing activity.
breeding
T1 / 2 is long - 35-50 hours. T1 / 2 from tissues is much larger. The therapeutic concentration of azithromycin is maintained up to 5-7 days after the last dose. Azithromycin is excreted mainly unchanged - 50% through the intestines, 6% by the kidneys.

Indications for use

infections upper divisions respiratory tract (acute and chronic tonsillopharyngitis, acute and chronic recurrent sinusitis, acute otitis media).
Infections of the lower respiratory tract (acute bacterial bronchitis, exacerbation of chronic bronchitis, community-acquired bacterial pneumonia).
Skin and soft tissue infections: uncomplicated forms acne vulgaris, migrating chronic erythema (the initial stage of Lyme disease), erysipelas, impetigo, pyoderma.
Sexually transmitted diseases (urethritis, cervicitis).
Diseases of the stomach and duodenum associated with Helicobacter pylori.

Contraindications

Hypersensitivity to macrolide antibiotics.
Because of the theoretical possibility of ergotism, azithromycin should not be co-administered with ergotamine derivatives.

Dosage and administration

Inside, once a day, 1 hour before a meal or 2 hours after it, with water.
For infections of the upper and lower respiratory tract, skin and soft tissues (with the exception of chronic erythema migrans): 500 mg once a day for 3 days; the total dose is 1500 mg.
For uncomplicated forms acne vulgaris: the course dose is 6 g. The first 3 days are prescribed 1 tablet 500 mg 1 time per day, in the next 9 weeks - 1 tablet 500 mg 1 time per week, and in the second week the tablet is taken 7 days after the previous dose . For chronic erythema migrans: 1 g (2 tablets of 500 mg at the same time) on the first day and 500 mg daily once a day from the second to the fifth day.
For sexually transmitted infections: uncomplicated urethritis / cervicitis - 1 g once.
Diseases of the stomach and duodenum associated with Helicobacter pylori: 1 g (2 tablets of 500 mg) daily, in combination with anti-secretory drugs and others medicines, as directed by a physician.
Azithromycin tablets 500 mg can be administered to children weighing more than 45 kg.
The score on the tablet is not intended to be divided into two equal doses.
Insufficiency of renal function
Patients with creatinine clearance >40 ml/min dose adjustment is not required. Studies of patients with creatinine clearance<40 мл/мин, не проводились. Таким пациентам нужно применять азитромицин с осторожно-стью.
Hepatic insufficiency
Use with caution in patients with severe hepatic impairment.

Side effect

Azithromycin rarely causes adverse reactions.
The table shows side effects by disease and frequency of manifestations. Side effects are classified by frequency as follows: very often (≥ 1/10); often (≥ 1/100 to<1/10); нечасто (≥ 1/1000 до <1/100); редко (≥ 1/10 000 до <1/1 000); очень редко (<1/10 000), неизвестно (невозможно оценить на основании имеющихся данных). Побочные действия в каждой группе в отношении частоты указываются по шкале от более частых к менее частым.

Disorders and diseases	Side effects
	candidiasis, oral candidiasis, vaginal infection Pseudomembranous colitis	unknown
Blood and lymphatic system disorders	Leukopenia, neutropenia Thrombocytopenia, hemolytic anemia	Uncommon Unknown
Immune System Disorders	Quincke's edema, hypersensitivity Anaphylactic reactions	unknown
Mental disorders	Anxiety Aggression, anxiety	Infrequently Rarely unknown
Nervous System Disorders	Dizziness, headache, paresthesia, dysgeusia Hypoesthesia, drowsiness, insomnia Syncope, convulsions, psychomotor hyperactivity, anosmia, ageusia, parosomnia, myasthenia gravis	unknown
Violations of the organ of vision	visual impairment
Hearing impairment and labyrinth disorders	Hearing impairment, tinnitus Dizziness
Heart disorders	heartbeat Torsade de pointes (pirouette tachycardia), arrhythmia, including ventricular tachycardia	unknown
Vascular disorders	hypotension	unknown
Gastrointestinal disorders	Diarrhea, abdominal pain, nausea, flatulence Vomiting, dyspepsia Gastritis, constipation Pancreatitis, discolored tongue	Often Uncommon Unknown
Liver and biliary tract disorders	Liver disorders Liver failure, liver necrosis, cholestatic jaundice	unknown
Skin and subcutaneous tissue disorders	Rash, itching Stevens-Johnson syndrome, photosensitivity, urticaria Acute generalized exanthematous pustulosis (AGEP) Toxic epidermal necrolysis, erythema multiforme	unknown
Musculoskeletal and connective tissue disorders	Arthralgia
Renal and urinary tract disorders	Acute inflammation of the kidneys, interstitial nephritis	unknown
General disorders and disorders at the injection site	Fatigue Chest pain, swelling, weakness, asthenia
Laboratory and instrumental data	Reduction in the number of lymphocytes, an increase in the number of blood eosinophils, a decrease in the content of bicarbonates in the blood serum An increase in the level of aspartate aminotransferase, alanine aminotransferase, a decrease in the content of bilirubin in the blood serum, an increase in the level of creatinine, urea in the blood serum, changes in the amount of potassium in the blood serum Increased QT interval on ECG	unknown

Interaction with other drugs

Food reduces the absorption of azithromycin.
Antacids: antacids slow down the absorption of azithromycin. The recommended interval between taking the drug and antacids is at least two hours.
cetirizine: simultaneous administration of azithromycin and cetirizine at a dose of 20 mg for 5 days to healthy volunteers did not lead to a change in pharmacokinetics or a significant change in the QT interval.
Didanosine: the simultaneous use of azithromycin at a daily dose of 1200 mg and didanosine in 6 subjects did not affect the pharmacokinetics of didanosine compared with placebo.
Digoxin: since there is evidence of a change in the metabolism of digoxin in patients who take macrolide antibiotics, caution is needed when they are taken simultaneously.
Zidovudine: Azithromycin at a single dose at a dose of 1000 mg and at multiple doses of 1200 mg did not affect the pharmacokinetics, as well as the release of zidovudine and its metabolites.
Ergotamine derivatives: due to the theoretical possibility of ergotism, azithromycin cannot be used together with ergotamine derivatives.
Atorvastatin: with the simultaneous use of atorvastatin (10 mg per day) and azithromycin (500 mg per day), azithromycin did not affect the concentration of atorvastatin in plasma.
Carbamazepine: in pharmacokinetic studies conducted on healthy volunteers, azithromycin had no significant effect on plasma levels of carbamazepine or its active metabolite.
Cimetidine: when taking cimetidine two hours before taking azithromycin, no changes in the pharmacokinetics of azithromycin were observed.
Coumarin oral anticoagulants: in a pharmacokinetic interaction study, azithromycin did not alter the effect of warfarin anticoagulants when taken at a dose of 15 mg in healthy volunteers. After the joint administration of azithromycin and coumarin anticoagulants, the anticoagulant effect increased. Although a causal relationship has not been established, the frequency of prothrombin time checks should be considered when azithromycin is taken by patients taking coumarin anticoagulants.
Cyclosporine: some macrolide antibiotics interfere with the metabolism of ciclosporin. While taking azithromycin and cyclosporine, it is necessary to control the concentration of cyclosporine.
Efavirenz: co-administration of a single dose of azithromycin 500 mg and efavirenz 400 mg daily for 7 days did not result in a clinically significant pharmacokinetic interaction.
Fluconazole: the simultaneous use of a single dose of 1200 mg of azithromycin does not change the pharmacokinetics of a single dose of 800 mg of fluconazole. The total concentration and half-life of azithromycin did not change with the simultaneous use of fluconazole. However, there was a clinically significant decrease in Cmax (18%) of azithromycin.
Indinavir: the simultaneous use of a single dose of 1200 mg of azithromycin does not significantly affect the pharmacokinetics of indinavir when taken at a dose of 800 mg three times a day for 5 days.
Methylprednisolone: in a pharmacokinetic study of drug interactions in healthy volunteers, azithromycin had no significant effect on the pharmacokinetics of methylprednisolone.
Midazolam: in healthy volunteers, simultaneous administration of azithromycin 500 mg daily for 3 days does not cause clinically significant changes in the pharmacokinetics and pharmacodynamics of midazolam when taken once 15 mg.
Nelfinavir: the simultaneous use of azithromycin (1200 mg) and nelfinavir (750 mg three times a day) leads to an increase in the concentration of azithromycin. No clinically significant side effects were identified. There is no need to adjust the dose.
Rifabutin: The simultaneous use of azithromycin and rifabutin did not affect the concentration of either of the two drugs in the blood serum. With the simultaneous use of azithromycin and rifabutin, neutropenia was observed in patients. Neutropenia is associated with the use of rifabutin, a causal relationship when taken in combination with azithromycin has not been established.
Sildenafil: there was no evidence of an effect of azithromycin (when taking 500 mg daily for 3 days) on the AUC and Cmax values \u200b\u200bof sildenafil or its main metabolites in the blood.
Terfenadine: interaction of terfenadine and azithromycin was not revealed. In some cases, such an interaction cannot be completely excluded. Yet there is no evidence of such a reaction. As with other macrolides, azithromycin and terfenadine should be used with caution at the same time.
Theophylline: Azithromycin does not affect the pharmacokinetics of theophylline in healthy volunteers. The simultaneous use of theophylline and other macrolide antibiotics sometimes leads to an increase in the concentration of theophylline in the blood serum.
Triazolam: Co-administration of azithromycin 500 mg on day 1 and 250 mg on day 2 and triazolam 0.125 mg on day 2 in 14 healthy volunteers had no significant effect on the pharmacokinetic parameters of triazolam compared with concomitant administration of triazolam and placebo .
Trimethoprim/sulfamethoxazole: Co-administration of trimethoprim/sulfamethoxazole DS (160 mg/800 mg) for 7 days and azithromycin 1200 mg on day 7 did not significantly affect peak concentrations, total exposure, or elimination of trimethoprim and sulfamethoxazole.

Precautionary measures

allergic reactions: In rare cases, severe allergic reactions, anaphylactic edema and anaphylaxis have been reported. Some of these reactions are accompanied by recurrent symptoms and require longer monitoring and treatment.
Hypersensitivity: as with the use of erythromycin and other macrolides, there have been reports of rare serious allergic reactions, including angioedema and anaphylaxis (rarely fatal), skin reactions, including acute generalized exanthematous pustulosis (AGEP), Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reactions with rash, eosinophilia and systemic symptoms (DRESS syndrome). The use of azithromycin leads to a recurrence of the symptoms of some of the above reactions, which requires a longer period of observation and treatment.
If an allergic reaction develops, azithromycin should be discontinued immediately and appropriate treatment instituted. The doctor needs to know that it is possible to re-develop the symptoms of allergic reactions after the cessation of symptomatic treatment.
Hepatic impairment: Azithromycin should be used with caution in patients with severe liver disease. It is necessary to check the liver function if symptoms of dysfunction appear, such as the rapid development of asthenia associated with jaundice, dark urine, bleeding tendency or hepatic encephalopathy.
Ergotamine: in patients taking ergot alkaloid derivatives in parallel with some macrolides, there have been cases of ergot toxicity. It has not been proven that Azithromycin, when taken together with ergot alkaloid derivatives, causes ergotoxicity, however, these drugs should not be prescribed together.
Secondary infection: as with other antibiotics, monitoring for signs of secondary infections with non-susceptible organisms, including fungi, is recommended.
Clostridium Difficile-associated diarrhea: diarrhea associated with organisms Clostridium difficile, has been observed with almost all antibacterial drugs, including azithromycin. The severity can vary from mild diarrhea to acute colitis. Antibacterial therapy alters the normal intestinal microflora and leads to overgrowth of the body C. difficile.
Impaired kidney function: in patients with severe renal insufficiency (GFR<10 мл/мин) системное воздействие азитромицина увеличивается на 33 %.
Prolongation of repolarization and QT interval myocardial infarction, which carries the risk of developing cardiac arrhythmia and torsades de pointes, have been reported in the treatment of other macrolides. A similar effect cannot be completely excluded when using azithromycin in patients who are at increased risk for prolonged myocardial repolarization, so special care is needed when treating patients with:
hereditary or documented prolongation of the QT interval;
concomitant use of other drugs known to prolong the QT interval, such as class IA and III antiarrhythmics, tizapride and terfenadine;
electrolyte imbalance, especially in the case of the development of hypokalemia and hypomagnesemia;
clinically significant bradycardia, cardiac arrhythmias, or severe heart failure.
Exacerbation of symptoms of myasthenia gravis or new myasthenic syndrome has been reported in patients treated with azithromycin.
Streptococcal infections: penicillin is generally the drug of choice in the treatment of pharyngitis/tonsillitis caused by Streptococcus pyogenes, and as a prophylaxis of acute rheumatic fever. Azithromycin is generally effective in the treatment of acute pharyngitis, but there is no evidence of efficacy in the prevention of acute rheumatic fever.

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