Azithromycin Dose

[mama2alex]

My son started on 125 mg per day of Azithromycin and is now on 250mg. Is this considered "full strength" (enough to fully knock out an underlying strep infection)? He's 60 pounds.

[bronxmom2]

My son is about the same weight and was giving 300mg... but 250 mg is mentioned here frequently as a treatment dose.

[EAMom]

My son is about the same weight and was giving 300mg... but 250 mg is mentioned here frequently as a treatment dose.

 

The Azith. pills only come in 250mg and 500mg size...so unless you are doing liquid, 300mg is a harder dose to come by. You could do 1.5 of the 250mg's though, and that would be 375mg.

 

My 54 pounder is on 250mg/day.

[peglem]

My daughter (90lbs) was on 250mg/day prophylactically. She was on 5days/off7....Sept 1st, rapid strep test came up +. This was day#7 off, but I think she'd been positive for a few weeks already. The NP who saw her said the 250mg was not a treatment dose and put her on 500mg for 5 days, then resume the 250mg. (that didn't work this time, but that's not relevant to your question)

[bronxmom2]

My son is about the same weight and was giving 300mg... but 250 mg is mentioned here frequently as a treatment dose.

 

The Azith. pills only come in 250mg and 500mg size...so unless you are doing liquid, 300mg is a harder dose to come by. You could do 1.5 of the 250mg's though, and that would be 375mg.

 

My 54 pounder is on 250mg/day.

 

 

we are doing the liquid, which has been a real pain because I have to refill it each 5 days. My pediatrician seemed unaware of the pill option. Thanks!

[colleenrn]

My sister's children also have PANDAS (as well as my children). Her pediatrician is SUPER conservative, but insists (per research that her doctor has read, but I cannot seem to find), that for strep, a treatment dose must be 500mg/day. Her pediatrician says this 500mg/day is needed, even in a child weighing only 60#. I am not sure about lower weights, but for 60# and higher, she says 250 is definitely not enough. If this is true, and I do believe it to be true, many children are getting treatment doses that are far lower than needed. Once the treatment dose is done, bumping down to 250 should be fine.

 

I continue to wonder if this is the reason kids have flareups while on lower prophylacic doses of Zithromax (when it is given every other day or a few times per week). I wonder, if at some point they have an active strep infection that is not detected, that this low dose is ineffective in erradicating the strep.

 

Colleen

[mama2alex]

My sister's children also have PANDAS (as well as my children). Her pediatrician is SUPER conservative, but insists (per research that her doctor has read, but I cannot seem to find), that for strep, a treatment dose must be 500mg/day. Her pediatrician says this 500mg/day is needed, even in a child weighing only 60#. I am not sure about lower weights, but for 60# and higher, she says 250 is definitely not enough. If this is true, and I do believe it to be true, many children are getting treatment doses that are far lower than needed. Once the treatment dose is done, bumping down to 250 should be fine.

 

I continue to wonder if this is the reason kids have flareups while on lower prophylacic doses of Zithromax (when it is given every other day or a few times per week). I wonder, if at some point they have an active strep infection that is not detected, that this low dose is ineffective in erradicating the strep.

 

Colleen

 

This makes a lot of sense to me. I've been wondering how such low doses of antibiotics could completely eradicate an infection that seems to be chronic and stubborn. I've also wondered whether by giving such low doses we are just ridding the body of the weakest organisms and leaving behind the strongest to later multiply - but not sure how much basis in science that particular theory has. Just wondering if we need to really go after it hard in the beginning, completely knock it out, THEN go to a prophylactic dose.

 

How long did you do the "treatment" dose?

[colleenrn]

I think my sister's pediatrician had her 8 and 10 year old on 10 days of Zithromax 500mg.

 

 

Colleen

[Kayanne]

My sister's children also have PANDAS (as well as my children). Her pediatrician is SUPER conservative, but insists (per research that her doctor has read, but I cannot seem to find), that for strep, a treatment dose must be 500mg/day. Her pediatrician says this 500mg/day is needed, even in a child weighing only 60#. I am not sure about lower weights, but for 60# and higher, she says 250 is definitely not enough. If this is true, and I do believe it to be true, many children are getting treatment doses that are far lower than needed. Once the treatment dose is done, bumping down to 250 should be fine.

 

I continue to wonder if this is the reason kids have flareups while on lower prophylacic doses of Zithromax (when it is given every other day or a few times per week). I wonder, if at some point they have an active strep infection that is not detected, that this low dose is ineffective in erradicating the strep.

 

Colleen

 

I have been wondering about this also....

 

By the fifth time my dd6 tested positive for strep, the ped had prescribed Clindamycin 300mg 3times a day for 10 days---which is the upper end of an adult dose....she was about 42 lbs at the time.

 

Every culture since has been negative....after the steroid treatment, she is 100% now...

 

In my humble opinion, PANDAS can be managed by:

 

1--clearing the infection

 

2--addressing brain inflammtion (eg. steroids, PEX, IVIG, antibiotics that have properties like azith, motrin, or just letting the brain heal on it's own)

 

3--prophylaxis are necessary

 

The original description of PANDAS was a waxing and waning of symptoms...if there is no waning...I would bet there is still strep somewhere...even with a negative throat culture.

 

Doctors are too squismish about antibiotics---I have so much more to add, but I think I am going to start a new thread

[sf_mom]

Kayanne... I couldn't agree with you more.

 

My sister's children also have PANDAS (as well as my children). Her pediatrician is SUPER conservative, but insists (per research that her doctor has read, but I cannot seem to find), that for strep, a treatment dose must be 500mg/day. Her pediatrician says this 500mg/day is needed, even in a child weighing only 60#. I am not sure about lower weights, but for 60# and higher, she says 250 is definitely not enough. If this is true, and I do believe it to be true, many children are getting treatment doses that are far lower than needed. Once the treatment dose is done, bumping down to 250 should be fine.

 

I continue to wonder if this is the reason kids have flareups while on lower prophylacic doses of Zithromax (when it is given every other day or a few times per week). I wonder, if at some point they have an active strep infection that is not detected, that this low dose is ineffective in erradicating the strep.

 

Colleen

 

I have been wondering about this also....

 

By the fifth time my dd6 tested positive for strep, the ped had prescribed Clindamycin 300mg 3times a day for 10 days---which is the upper end of an adult dose....she was about 42 lbs at the time.

 

Every culture since has been negative....after the steroid treatment, she is 100% now...

 

In my humble opinion, PANDAS can be managed by:

 

1--clearing the infection

 

2--addressing brain inflammtion (eg. steroids, PEX, IVIG, antibiotics that have properties like azith, motrin, or just letting the brain heal on it's own)

 

3--prophylaxis are necessary

 

The original description of PANDAS was a waxing and waning of symptoms...if there is no waning...I would bet there is still strep somewhere...even with a negative throat culture.

 

Doctors are too squismish about antibiotics---I have so much more to add, but I think I am going to start a new thread

[mama2alex]

Thanks to everyone who responded! I contacted our doctor about this issue and she agreed we should up it to 500 mg for 10 days to make sure we completely wipe out the infection.

 

After 10 days on 125mg Zithro, then 2 weeks 250mg Zithro, then 10 days Augmentin (for an ear infection), then 2 more days on Zithro, we are starting him on a ten-day course of 500mg. Will drop back down to 250mg after that.

 

I feel like we're on the right track, and I really appreciate everyone's help figuring this out!

[EAMom]

I think some peds just assume kids can't swallow pills! My dd became a "pro" at pill swallowing at age 7.5 thanks to Mr. PANDAS!

[CZL]

500mg dose Zithro a day ----- so usually 500mg once a day or divide it to 250mg -- twice a day? Any difference?

 

Thanks, Jack

[Kayanne]

My son is about the same weight and was giving 300mg... but 250 mg is mentioned here frequently as a treatment dose.

 

The Azith. pills only come in 250mg and 500mg size...so unless you are doing liquid, 300mg is a harder dose to come by. You could do 1.5 of the 250mg's though, and that would be 375mg.

 

My 54 pounder is on 250mg/day.

 

 

we are doing the liquid, which has been a real pain because I have to refill it each 5 days. My pediatrician seemed unaware of the pill option. Thanks!

 

My daughter took liqud azith 100mg/day. From a powder that when reconsitiuted was 200mg/5ml, our pharmacy would split the powder in half...mix one bottle that was good for 10 days, and give me the second bottle with a separate bottle of the correct amount of distilled water that we could mix for the next 10 days. I was only going back every 20 days. It was red and cherry flavored, so if your son has issues with dye...that may not be an option.

 

Now that she is on the liquid pen vk the pharmacy has assured me that they will contine to help me like that.

 

Also, it is a locally owned pharmacy...not one of the big chains.

 

Karen

[monarchcat]

After sprouting strep symptoms after 11 days on 250mg/day I brought my 8 year old son in and the NP told me that 500mg/day was needed to eradicate any infection and she prescribed 5 days worth at 500mg then we'll go back to the 250mg/day.