Zithromax and Azithromycin for Children

Understanding the Basics of Antibiotics for Your Little Ones

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Zithromax has to be one of the most convenient antibiotics that you can take and you may have taken a 5-day Z-PAK yourself a time or two. The fact that you can also take just a three or one day course of Zithromax makes it particularly popular with parents of children who don't like to take medicine.

In children, Zithromax can be used to treat

  • Acute otitis media (ear infections)

Keep in mind that Zithromax is not usually considered to be a first-line antibiotic, though. For example, penicillin should usually be used for strep throat, and Zithromax is used only if a child is allergic to penicillin. And the AAP recommends Amoxil as the first line drug for ear infections.

Zithromax is often used off-label for many other mild to moderate pediatric infections that are caused by susceptible bacteria, including sinus infections (sinusitis), Cat Scratch Disease, chronic bronchitis with a secondary bacterial infection, walking pneumonia, and pertussis.

Zithromax Facts

Other facts about Zithromax include that:

  • The trade name for Zithromax is azithromycin.
  • It is a type of macrolide antibiotic.
  • It is a good choice for children who are allergic to penicillin.
  • It can be taken either with or without food.

    Zithromax has also been popular because it has always been a little less expensive than many other brand name antibiotics, even before it became available as a generic.

    It is available as:

    • Zithromax for oral suspension, which when treating ear infections, can be given as a large one-time dose (30mg/kg), once a day for 3 days (10mg/kg/day), or once a day for 5 days.
    • Zithromax Z-Pak 250mg tablets (5-day course).
    • Zithromax Tri-Pak 500mg tablets (3-day course).

    A one-time dose can also be used as a treatment for chlamydia. This is often combined with another antibiotic to treat gonorrhea, as these two infections are sometimes found together.

    Warnings and Side Effects

    For children taking a 5-day course of Zithromax, the most common side effects include diarrhea and loose stools, abdominal pain, vomiting, nausea, and rash. When children take the larger one-time dose, side effects were the same, but the incidence of vomiting and diarrhea were higher. Like other antibiotics, Zithromax can also rarely cause allergic reactions. See the full prescribing information sheet for a list of all known side effects.

    Children with a known hypersensitivity or allergy to Zithromax, erythromycin, or any other macrolide antibiotic should not take it.

    There is also an FDA warning "that azithromycin (Zithromax or Zmax) can cause abnormal changes in the electrical activity of the heart that may lead to a potentially fatal irregular heart rhythm." Those who are at risk while taking Zithromax might include "those with known risk factors such as existing QT interval prolongation, low blood levels of potassium or magnesium, a slower than normal heart rate, or use of certain drugs used to treat abnormal heart rhythms or arrhythmias."

    What You Need To Know About Zithromax

    Although approved for use in children, the "safety, and effectiveness in the treatment of pediatric patients...under 6 months of age have not been established" for Zithromax.

    Other important information about Zithromax include that:

    • Talk to your pediatrician and pharmacist about possible drug interactions if your child is taking other medications.
    • Although very convenient if your child can take it, the very big downside of the one-time dose of Zithromax is that if your child vomits right away, you will likely need to get a new prescription.
    • Multiple generic versions of azithromycin 250mg, 500mg, and 600mg tablets have been approved by the FDA.

      And remember that even though you might only take Zithromax for 5 days, it continues to work for up to 10 days.


      American Academy of Pediatrics Clinical Practice Guideline Diagnosis and Management of Acute Otitis Media. PEDIATRICS Vol. 113 No. 5 May 2004, pp. 1451-1465.

      FDA Drug Safety Communication: Azithromycin (Zithromax or Zmax) and the Risk of Potentially Fatal Heart Rhythms. https://www.fda.gov/Drugs/DrugSafety/ucm341822.htm.

      Zithromax Prescribing Information Sheet. Pfizer. http://labeling.pfizer.com/ShowLabeling.aspx?id=511.