Azithromycin Dosing for Pediatric Streptococcal Infections

Dosing Recommendations

The American Academy of Family Physicians recommends a dose of 12 mg/kg once daily for 5 days (maximum 500 mg per day) for pediatric patients with streptococcal pharyngitis 1
For infants and children aged >6 months with other streptococcal infections, including pneumonia, the recommended dose is 10 mg/kg (maximum: 500 mg) on day 1, followed by 5 mg/kg per day (maximum: 250 mg) on days 2-5 2
For infants aged <6 months with other streptococcal infections, the recommended dose is 10 mg/kg per day for 5 days 3, 4

The Centers for Disease Control and Prevention recommends avoiding simultaneous administration of azithromycin with aluminum or magnesium-containing antacids as they reduce absorption 3
Azithromycin is an alternative for patients with penicillin allergy, and penicillin or amoxicillin remains first-line therapy for Group A streptococcal pharyngitis due to narrow spectrum and low cost 1
Monitor for gastrointestinal side effects, which are generally mild to moderate 3

Use azithromycin with caution in patients with impaired hepatic function 3
Resistance of Group A streptococcus to macrolides varies geographically and should be considered when selecting therapy 1