iv azithro in kids

[RevEM]

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We had a pretty interesting discussion today on rounds about IV azithro in kids. Nursing was up in arms about it being given to a kid (5yr old, pneumonia) over night in the ED. She "read" it was not approved in kids under 16 and filed a safety report. now there is a big stink. I'm curious if others are using IV azithro in kids or if it is really a no-no. I can't find anything that says it is dangerous and my EMRA antibiotic guide actually has it listed for in pt peds pneumonia. is the nurse crazy or what?

-rev

 

[raynor123456]

Given this

...I can't find anything that says it is dangerous and my EMRA antibiotic guide actually has it listed for in pt peds pneumonia.

I'm going with this.

crazy

But, I suck at pharm.

 

[VA Hopeful Dr]

I've ordered iv zithromax twice this month in young kids. Once, the pharmacist called and asked me to change it (I did). The other time, they didn't so I didn't.

The official answer, to my understanding, is that it isn't supposed to be used in kids but I haven't found a really good answer as to why that is.

 

[Tornadoman84]

My two cents would be that RCTs/any trials on kids (especially around the age of 5) are scarce or are very difficult to do (parents don't want to enroll their kids or for ethical reasons). As a result, a lot of drugs we use are not necessarily "approved" for use in pediatrics but we still use them (ie. As doctors we can "off label use" drugs). The nurse who filed the report should at least had a discussion with the ordering physician to learn more or together with the physician figured out a better solution.

 

[WerdSalid]

IV or PO Azithromycin is included as one of our standard antibiotic selections in the admission order protocol set for pediatric pneumonia.

 

[Stitch]

You CAN use it, but the real question is WHY? I can't even remember the last time I've seen it given IV. It has good absorption orally and you don't gain a lot by making it IV (at least not that I'm aware of). If you're admitting a younger kid for IV zithromax under the assumption that he has an atypical pneumonia, I'd probably try to broaden the differential.

 

[Apollyon]

It has good absorption orally and you don't gain a lot by making it IV (at least not that I'm aware of).

If you go too fast, you gain some nice abdominal pain!

 

[turkeyjerky]

We had a pretty interesting discussion today on rounds about IV azithro in kids. Nursing was up in arms about it being given to a kid (5yr old, pneumonia) over night in the ED. She "read" it was not approved in kids under 16 and filed a safety report. now there is a big stink. I'm curious if others are using IV azithro in kids or if it is really a no-no. I can't find anything that says it is dangerous and my EMRA antibiotic guide actually has it listed for in pt peds pneumonia. is the nurse crazy or what?

-rev

Here's a nice little link to an FAQ on this very issue from UI-C: http://dig.pharm.uic.edu/faq/April10/Azithromycin.aspx

I know we used it IV in kids w/o any issues. I wonder what issues exactly did nursing have? Just because something isn't explicitly approved doesn't mean you can't use it. Did she actually raise an issue about the safety of IV zithromax (and if so, did she have an evidence to back this up?), or was it more of "It's not approved, so I'm not gonna put my license on the line by administering it."

I'm pretty sure my toilet paper isn't FDA approved for wiping up $hit but that's not gonna keep me from doing it.

 

[KidDr]

The hospital I work at (big dedicated stand-alone Children's hospital) uses IV Azithromycin in kids occasionally. I think it is on some of our standard admission order sets for pneumonia. I've seen it used in a child in whom someone suspects atypical pneumonia but who is vomiting or can't take PO for whatever reason. I've seen inpatients with severe pneumonia end up on both IV Azithro + IV 2nd or 3rd generation cephalosporin from time to time.

 

[roja]

gonna agree wtih the why on iv? unless kid couldn't take any po, and nowadays with odt zofran, why would you give it iv?

bioavailibility is the same. just like drugs like cipro, bactrim, doxy, clinda. absolutely no difference in efficacy in po vs IV, just adding several hundred dollars to a hospital bill.

 

[edmadison]

First of all, I hope that the case the OP was discussing was not monotherapy for PNA for a five-year old with azithromycin. This, in my opinion, is malpractice. That's another story, however.

I've used IV azithromycin several times in neonates -- pertussis! In critical care, if we didn't use unapproved interventions in kids, we'd have very few tools. Heck, we even use Zigris occasionally. Let the nurses document it, who cares? Nothing gives them more satisfaction then to catch you making a "mistake". The only question that should bother you is whether the care was appropriate.

Ed

 

[Stitch]

I've used IV azithromycin several times in neonates -- pertussis!

Ed

Good call. What about a very sick sickler with acute chest? I might could see that being a use too.

 

[SurfingDoctor]

The hospital I work at (big dedicated stand-alone Children's hospital) uses IV Azithromycin in kids occasionally. I think it is on some of our standard admission order sets for pneumonia. I've seen it used in a child in whom someone suspects atypical pneumonia but who is vomiting or can't take PO for whatever reason. I've seen inpatients with severe pneumonia end up on both IV Azithro + IV 2nd or 3rd generation cephalosporin from time to time.

Agreed. Vancomycin, Cefotaxime and Azithromycin is part of our admission order sets to the PICU for CAP. Typically, the IV form is used only when they are NPO (eg, newly admitted and don't know which way they will go)