{"id":1383,"date":"2015-03-02T11:51:18","date_gmt":"2015-03-02T19:51:18","guid":{"rendered":"https:\/\/phcprimarycare.org\/?p=1383"},"modified":"2015-03-02T11:51:18","modified_gmt":"2015-03-02T19:51:18","slug":"azithromycin-spawn-satan-just-evil-incarnate","status":"publish","type":"post","link":"https:\/\/phcprimarycare.org\/?p=1383","title":{"rendered":"Azithromycin: spawn of Satan or just evil incarnate?"},"content":{"rendered":"

All prescribers are certainly aware of (and hopefully accept the reality of) increasing antibiotic resistance. While guidelines continue to be released encouraging less antibiotic use for sinusitis, bronchitis, and otitis media, there also continues to be use or, more correctly, overuse of these powerful but potentially dangerous drugs.<\/p>\n

One of the most overused antibiotics is azithromycin, which I will address from the pediatric perspective in this post. Sure, it\u2019s convenient, easy to dose, and requires a shorter course. But most of the time it\u2019s either too broad-spectrum or, worse, not an adequate choice. A 2011 study In Pediatrics<\/em><\/a> using visit and prescribing data from 2006-8 found:<\/p>\n

\u201cAntibiotics were prescribed during 21% of pediatric ambulatory visits; 50% were broad-spectrum, most commonly macrolides\u2026 Twenty-three percent of the visits in which antibiotics were prescribed were for respiratory conditions for which antibiotics are not clearly indicated.\u201d<\/p>\n

The authors concluded:<\/p>\n

\u201cBroad-spectrum antibiotic prescribing in ambulatory pediatrics is extremely common and frequently inappropriate.\u201d<\/p>\n

In 2011, azithromycin became the most commonly prescribed antibiotic in the US across all ages. For the same year, it was #2 among children. 2014 prescribing data from PHC shows it is the second most prescribed antibiotic, at 12.5% of all antibiotics, compared to amoxicillin at 20.4%.<\/p>\n

Guidelines from the AAP Infectious Disease Committee (Principles of Judicious Antibiotic Prescribing for Bacterial Upper Respiratory Tract Infections in Pediatrics<\/a>) state very clearly:<\/p>\n

\u201cAzithromycin is not a first line antibiotic for any pediatric URI<\/strong> [emphasis added] and is the antibiotic most likely to be used inappropriately (inadequate coverage for the most common pathogens causing AOM and sinusitis).\u201d<\/p>\n

The Canadian Pediatric Society published their own guidelines in 2013<\/a> that classified azithromycin as \u201cDo Not Use<\/span>\u201d for pneumonia, otitis, and pharyngitis. In addition to being ineffective against the two major organisms that cause otitis (see above), its prolonged half-life leads to more rapid development of bacterial resistance.<\/p>\n

Infectious diseases experts in New Zealand<\/a> recommend azithromycin only be used in the following situations:<\/p>\n