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HelpHelp, from those who gave 500mg zith per day

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I have only given my son 13 115lbs a maintenance dose of zithromax 600mg every other day for the last year. He never did get back to baseline and recently had an extreme flare of symptoms. He has only tics. I was always scared to go to full dose 500mg or 600mg a day because my first pediatrician(who I left) put the fear of god in me about liver damage. Now I think I have no choice. He had been declining slowly the past 6 months.

 

I need reassurance on how long others have stayed on this dosage. Thanks, Kathy

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I have only given my son 13 115lbs a maintenance dose of zithromax 600mg every other day for the last year. He never did get back to baseline and recently had an extreme flare of symptoms. He has only tics. I was always scared to go to full dose 500mg or 600mg a day because my first pediatrician(who I left) put the fear of god in me about liver damage. Now I think I have no choice. He had been declining slowly the past 6 months.

 

I need reassurance on how long others have stayed on this dosage. Thanks, Kathy

 

Kathy -

 

I don't think 500mg per day is excessive - especially if you only do it for a short period of time. My son weighs more than your son but he was on 500 mg of azith for 4 months with no liver problems.

 

However, to be safe you can ask the pediatrician to run liver function tests. It is a simple (one tube) blood test. My son is on many meds including diflucan, which is very hard on the liver. Therefore, we do liver function tests every 6 weeks. So far - everything has been OK. I know several of the families online who are on lyme antibiotics also do liver functions regularly.

 

Perhaps your pediatrician could order the tests? Maybe you could do a baseline before you begin the 500 mg and then check every 4-6 weeks to make sure the numbers are not changing significantly?

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For Lyme they prescribe high doses of antibiotics but we never had that high a dose of azithro and we took it a long time (my kids and I). I took 500 mg a day so that seems high for a child to take 600. My kids who weigh a little less than that, 70 to 90, took 250 a day along with other antibiotics. It might be better to take 250 every day rather than a day on and a day off. I'd have him evaluated for other infections like Lyme too because the missing link might be that you need a combo of antibiotics as is usually prescribed with Lyme. With that high a dose , even every other day, my non medical hunch would be that it might not be the right antibiotic or you may need to either change medications or to add a second or third antibiotic. When someone has Lyme an antibiotic that has helped before can become ineffective as you describe so the llmds switch it up often. Lyme and coinfections are just so common in boys that age and especially in kids diagnosed with pandas. You can have just one symptom and have Lyme or bartonella or babesia, etc. It's just another avenue to consider.

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We do run a blood test every 6 weeks or so. Giving him 600mg every other day is really giving like 300 every day and I don't think that dose has been sufficient. I did add augmentin to the mix. Thanks Kim, I think maybe a 4-6 weeks and then taper down to see effect. I know others have given high zith for a while too, I just couldn't find the old posts. Kathy

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I don't think a dose averaging 300mg/day is adequate for a 115 pound person (esp. if it's not getting him back to baseline). I would go to 500mg/day for at least 2 mo. and see if that helps.

 

I haven't heard of going over 500mg/day...but don't know that it couldn't be done.

 

My 65 pounder has been on 500mg/day for a month at a time. Normally we are on 250mg/day (started that dose when she was 42 pounds).

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The optimal dose for zithromax to treat strep is 12mg/kg/day (dose for other infections like ear infections may be lower). SO, for 115# child, that would be 627mg/day. Physicians are really not giving enough zithromax for their patients with strep. The "standard" dose given is a measly Z-pack, which for a child may mean only 250mg/day or less for only 5 days. For adults, the "standard" dose is only 500mg the first day and 250mg for the next 4 days. This is not enough for strep treatment and I do not understand why this is happening. The zithromax insert that comes with the mediciation clearly states 12mg/kg/day for strep.

 

Determining how much zithromax to give as a prpophylactic dose (after you have been giving a treatment dose for a sufficient lenght of time) varies. My kids have been on a little over two years of zithromax 250mg/day. When they have a big flareup, I increase it to 500mg.

I would feel comfortable putting my daughter (she is 14 and weighs about 125) on 500mg of zithromax for at least a month, if not more. You can be extra careful and do liver functions if yo want o rif that wouyld help persuade your physician. Another option is staying at the 600 every other day and adding another antibiotic, but if it were me, I would increase the zith to 500mg/day for a month.

 

Colleen

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I am approximately the same size as your son and was on 500 m.g. Azithro for months and combo with other antibiotics with no issues.

 

Good luck with the higher dose and combo antibiotics. My feeling if works, stick with it.... Remember if there is a chronic infection you might see a temporary flair of symptoms due to herxheimer response.

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