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*The professional part involved in this article is only for medical professionals to read for reference.
Come to unlock it! Azithromycin (AZM) is a 15-membered macrolide antibacterial drug.
It has the characteristics of short course of treatment, easy tolerability, few adverse reactions and no obvious contraindications for children.
It is widely used in the treatment of sensitive bacteria, especially atypical pathogens.
Caused by pediatric respiratory diseases.
Although it is widely used, the rational use, safety and effectiveness of AZM for injection in children under the age of 16 have not been determined.
Is AZM for injection safe and effective against community-acquired pneumonia in children with bacterial infections? What is the recommended dose of intravenous azithromycin for children of different ages? How should children with special diseases such as renal insufficiency use it? Are you familiar with off-label medications of AZM for injection for children? A few days ago, Professor Kunling Shen, Professor Zhai Suodi, etc.
published the "Recommendations for Children's Intravenous Azithromycin Off-label Medication" in the International Journal of Clinical Practice.
This article sorts out 18 recommendations for readers.
1.
Indications Question 1: Is AZM for injection safe and effective for the treatment of Mycoplasma pneumoniae pneumonia in children? Recommendation: It is strongly recommended that AZM injection is used to treat children with Mycoplasma pneumoniae pneumonia.
(1B) Question 2: Is AZM for injection safe and effective to treat children with Chlamydia trachomatis infection or Chlamydia pneumonia? Recommendation: AZM for injection can be used for children with Chlamydia pneumoniae or Chlamydia trachomatis pneumonia.
(2C) Question 3: Is AZM for injection safe and effective for the treatment of legionella pneumonia in children? Recommendation: AZM for injection can be used for legionella pneumonia in children.
(2C) Question 4: Is AZM for injection safe and effective for the treatment of community-acquired pneumonia in children caused by bacteria? Recommendation: AZM for injection can be used as one of the treatment options for bacterial community-acquired pneumonia in children.
(2D) Question 5: Can AZM for injection be used to treat bronchitis in children? Recommendations: AZM for injection is not recommended as a conventional treatment for bronchitis in children.
(1B) 2.
Usage and dosage Question 6: For children with non-severe pneumonia, is there any difference between sequential treatment of AZM and continuous oral treatment? Recommendation: For children who are mildly ill and need to be treated with AZM, it is recommended to give priority to oral administration.
(1C) Question 7: For severe pneumonia in children, is there any difference between sequential treatment of AZM and continuous intravenous treatment? Recommendations: For severely ill children who need to be treated with AZM, sequential administration is recommended, that is, intravenous injection first, and after the children's clinical infection signs are improved and basically stable, oral therapy is changed.
Question 8: What is the concentration and speed of AZM infusion for children with community-acquired pneumonia (CAP)? Recommendations: The concentration of AZM infusion is 1~2mg/ml, and the infusion time for children with CAP should not be less than 1h.
(2C) Question 9: What is the course of AZM sequential treatment for children with CAP? Recommendation: It is recommended that each sequential course of treatment for children with CAP generally does not exceed 10 days.
The transition time from intravenous treatment to oral treatment depends on whether the signs of infection in the child are significantly improved and basically stable.
(2D) Question 10: What is the recommended dose of AZM for children of different ages? Recommendation: For neonates to use AZM, oral administration is the first choice.
If oral administration is not appropriate, intravenous administration can be used with caution.
The dose is 10 mg/kg, once a day; for children> 28 days, the recommended dose is 10 mg/kg.
1 time a day.
(2D) 3.
Adverse reactions and nursing care Question 11: How to deal with the adverse reactions of the gastrointestinal tract caused by AZM for injection? Recommendations: For mild gastrointestinal adverse reactions caused by AZM, if they can be tolerated, no intervention will be carried out; if they cannot be tolerated, symptoms can be relieved by reducing the infusion rate or prolonging the infusion time. (1D) Question 12: How to deal with arrhythmia caused by AZM for injection? Recommendation: When children use AZM injection, they need to be alert to the occurrence of arrhythmia, and high-risk groups should try to avoid using it.
If arrhythmia occurs, the drug should be stopped in time, and active treatment should be given if necessary.
(1D) (Children with the following conditions can be judged to be at high risk: having heart disease, prolonged QT interval, hypokalemia or hypomagnesemia, heart rate lower than normal, or using certain drugs to treat abnormal heart rhythm.
) Question 13: How to deal with pain or phlebitis at the infusion site caused by AZM? Recommendation: If pain or phlebitis at the infusion site occurs when using AZM, and the child cannot tolerate it, consider discontinuing the drug.
(2D) Question 14: How to deal with allergic reactions caused by AZM? Recommendation: When children use AZM, they need to be alert to the occurrence of allergic reactions.
If it happens, the drug should be stopped immediately and epinephrine treatment should be given.
At the same time, attention should be paid to the recurrence of the child's allergic reaction.
(1D) IV.
Medication for Special Population Question 15: How to use AZM for injection in children with liver damage? Recommendations: Children with liver damage should use AZM for injection with caution, and closely monitor changes in liver function (such as serum alanine aminotransferase, aspartate aminotransferase, and bilirubin).
(1D) Question 16: How to use AZM for injection in children with renal impairment? Recommendation: Children with mild to moderate renal impairment can use AZM for injection, but children with severe renal impairment should be used with caution.
(1D) Question 17: How to use AZM for injection in children with congenital heart disease? Recommendations: Children with congenital heart disease should use AZM for injection with caution, and it is necessary to closely monitor the changes in the children's ECG.
(2D) Question 18: How to use AZM for injection in obese children? Recommendation: When obese children use AZM for injection, the dose calculated by weight should not exceed the adult dose.
(2D) References: [1] Zhou P, Wang X, Zhang X, Xu B, Tong X, Zhou W, Shen K, Zhai S.
Recommendations on off-label use of intravenous azithromycin in children.
Int J Clin Pract.
2021 Jan 9:e14010.
Come to unlock it! Azithromycin (AZM) is a 15-membered macrolide antibacterial drug.
It has the characteristics of short course of treatment, easy tolerability, few adverse reactions and no obvious contraindications for children.
It is widely used in the treatment of sensitive bacteria, especially atypical pathogens.
Caused by pediatric respiratory diseases.
Although it is widely used, the rational use, safety and effectiveness of AZM for injection in children under the age of 16 have not been determined.
Is AZM for injection safe and effective against community-acquired pneumonia in children with bacterial infections? What is the recommended dose of intravenous azithromycin for children of different ages? How should children with special diseases such as renal insufficiency use it? Are you familiar with off-label medications of AZM for injection for children? A few days ago, Professor Kunling Shen, Professor Zhai Suodi, etc.
published the "Recommendations for Children's Intravenous Azithromycin Off-label Medication" in the International Journal of Clinical Practice.
This article sorts out 18 recommendations for readers.
1.
Indications Question 1: Is AZM for injection safe and effective for the treatment of Mycoplasma pneumoniae pneumonia in children? Recommendation: It is strongly recommended that AZM injection is used to treat children with Mycoplasma pneumoniae pneumonia.
(1B) Question 2: Is AZM for injection safe and effective to treat children with Chlamydia trachomatis infection or Chlamydia pneumonia? Recommendation: AZM for injection can be used for children with Chlamydia pneumoniae or Chlamydia trachomatis pneumonia.
(2C) Question 3: Is AZM for injection safe and effective for the treatment of legionella pneumonia in children? Recommendation: AZM for injection can be used for legionella pneumonia in children.
(2C) Question 4: Is AZM for injection safe and effective for the treatment of community-acquired pneumonia in children caused by bacteria? Recommendation: AZM for injection can be used as one of the treatment options for bacterial community-acquired pneumonia in children.
(2D) Question 5: Can AZM for injection be used to treat bronchitis in children? Recommendations: AZM for injection is not recommended as a conventional treatment for bronchitis in children.
(1B) 2.
Usage and dosage Question 6: For children with non-severe pneumonia, is there any difference between sequential treatment of AZM and continuous oral treatment? Recommendation: For children who are mildly ill and need to be treated with AZM, it is recommended to give priority to oral administration.
(1C) Question 7: For severe pneumonia in children, is there any difference between sequential treatment of AZM and continuous intravenous treatment? Recommendations: For severely ill children who need to be treated with AZM, sequential administration is recommended, that is, intravenous injection first, and after the children's clinical infection signs are improved and basically stable, oral therapy is changed.
Question 8: What is the concentration and speed of AZM infusion for children with community-acquired pneumonia (CAP)? Recommendations: The concentration of AZM infusion is 1~2mg/ml, and the infusion time for children with CAP should not be less than 1h.
(2C) Question 9: What is the course of AZM sequential treatment for children with CAP? Recommendation: It is recommended that each sequential course of treatment for children with CAP generally does not exceed 10 days.
The transition time from intravenous treatment to oral treatment depends on whether the signs of infection in the child are significantly improved and basically stable.
(2D) Question 10: What is the recommended dose of AZM for children of different ages? Recommendation: For neonates to use AZM, oral administration is the first choice.
If oral administration is not appropriate, intravenous administration can be used with caution.
The dose is 10 mg/kg, once a day; for children> 28 days, the recommended dose is 10 mg/kg.
1 time a day.
(2D) 3.
Adverse reactions and nursing care Question 11: How to deal with the adverse reactions of the gastrointestinal tract caused by AZM for injection? Recommendations: For mild gastrointestinal adverse reactions caused by AZM, if they can be tolerated, no intervention will be carried out; if they cannot be tolerated, symptoms can be relieved by reducing the infusion rate or prolonging the infusion time. (1D) Question 12: How to deal with arrhythmia caused by AZM for injection? Recommendation: When children use AZM injection, they need to be alert to the occurrence of arrhythmia, and high-risk groups should try to avoid using it.
If arrhythmia occurs, the drug should be stopped in time, and active treatment should be given if necessary.
(1D) (Children with the following conditions can be judged to be at high risk: having heart disease, prolonged QT interval, hypokalemia or hypomagnesemia, heart rate lower than normal, or using certain drugs to treat abnormal heart rhythm.
) Question 13: How to deal with pain or phlebitis at the infusion site caused by AZM? Recommendation: If pain or phlebitis at the infusion site occurs when using AZM, and the child cannot tolerate it, consider discontinuing the drug.
(2D) Question 14: How to deal with allergic reactions caused by AZM? Recommendation: When children use AZM, they need to be alert to the occurrence of allergic reactions.
If it happens, the drug should be stopped immediately and epinephrine treatment should be given.
At the same time, attention should be paid to the recurrence of the child's allergic reaction.
(1D) IV.
Medication for Special Population Question 15: How to use AZM for injection in children with liver damage? Recommendations: Children with liver damage should use AZM for injection with caution, and closely monitor changes in liver function (such as serum alanine aminotransferase, aspartate aminotransferase, and bilirubin).
(1D) Question 16: How to use AZM for injection in children with renal impairment? Recommendation: Children with mild to moderate renal impairment can use AZM for injection, but children with severe renal impairment should be used with caution.
(1D) Question 17: How to use AZM for injection in children with congenital heart disease? Recommendations: Children with congenital heart disease should use AZM for injection with caution, and it is necessary to closely monitor the changes in the children's ECG.
(2D) Question 18: How to use AZM for injection in obese children? Recommendation: When obese children use AZM for injection, the dose calculated by weight should not exceed the adult dose.
(2D) References: [1] Zhou P, Wang X, Zhang X, Xu B, Tong X, Zhou W, Shen K, Zhai S.
Recommendations on off-label use of intravenous azithromycin in children.
Int J Clin Pract.
2021 Jan 9:e14010.
