Azithromycin Pediatric Dosing Guidelines

Standard Dosing Regimens

The American Academy of Pediatrics recommends azithromycin dosing at 10 mg/kg (maximum 500 mg) on day 1, followed by 5 mg/kg (maximum 250 mg) once daily on days 2-5 for most pediatric infections 1, 2
For community-acquired pneumonia (atypical pathogens), the standard dosing regimen is 10 mg/kg (max 500 mg) on day 1, then 5 mg/kg (max 250 mg) daily for days 2-5, as recommended by the Infectious Diseases Society of America 1, 2
The FDA recommends a 5-day regimen of 10 mg/kg day 1, then 5 mg/kg days 2-5 for acute otitis media, with a strength of evidence rated as high 2

For infants <1 month, azithromycin is the preferred macrolide for pertussis treatment and prophylaxis at 10 mg/kg once daily for 5 days, according to the Centers for Disease Control and Prevention 2
For children ≥6 months, the standard 5-day regimen is appropriate, with a dosage of 10 mg/kg (max 500 mg) day 1, then 5 mg/kg (max 250 mg) days 2-5, as recommended by the American Academy of Pediatrics 2

Azithromycin is not first-line for typical bacterial pneumonia caused by S. pneumoniae or H. influenzae, and beta-lactam antibiotics (amoxicillin, amoxicillin-clavulanate) remain first-line for typical pathogens, according to the Infectious Diseases Society of America 1
Limit IV azithromycin to days 1-2 only, then transition to oral therapy when feasible, as recommended by the Society of Hospital Medicine 1, 2

Do not administer azithromycin simultaneously with aluminum- or magnesium-containing antacids, as they reduce absorption, according to the American Society of Health-System Pharmacists 2
Monitor for QT prolongation when used with other QT-prolonging medications, as recommended by the American Heart Association 2
Azithromycin has fewer gastrointestinal side effects than erythromycin, with a strength of evidence rated as moderate 2