Understanding when azithromycin should not be used is essential for your child's safety. Most importantly, avoid this medication if your child has had allergic reactions to macrolide antibiotics or has certain heart rhythm conditions.
Azithromycin contraindications include absolute restrictions (macrolide allergies, severe liver dysfunction, certain cardiac arrhythmias) and relative cautions (QT prolongation risk, myasthenia gravis, hepatic impairment). Drug interactions with cardiac medications and certain other drugs require careful monitoring.
Any history of immediate hypersensitivity to azithromycin, erythromycin, clarithromycin, or other macrolide antibiotics
History of hepatitis, cholestatic jaundice, or severe liver dysfunction specifically related to macrolide antibiotic use
Previous cardiac arrhythmias specifically associated with macrolide antibiotic use
Azithromycin may prolong the QT interval and should be avoided in children with known congenital long QT syndrome or those taking other QT-prolonging drugs. Caution is advised in children with electrolyte disturbances (hypokalemia, hypomagnesemia) or cardiac arrhythmias. An ECG may be considered before use in high-risk patients.
Rarely, azithromycin has been associated with worsening symptoms of myasthenia gravis. Although uncommon in pediatrics, azithromycin should be used cautiously or avoided in children with this neuromuscular condition if diagnosed.
Azithromycin should only be used to treat bacterial infections – not viral illnesses like colds or the flu. Misuse increases the risk of resistance. As with any antibiotic, discontinue if serious adverse effects develop (such as hepatotoxicity, arrhythmias, or allergic reactions), and seek medical evaluation.
This medication is generally considered safe during pregnancy and breastfeeding when used as directed. However, if you're pregnant or breastfeeding and need to give this medication to your child, it's always a good idea to discuss this with your healthcare provider to ensure it's the best choice for your specific situation.
Specific drugs: See description
Effect: Increased bleeding risk, elevated INR
How it happens: Enhanced anticoagulant effect through unknown mechanism
Management: Monitor INR more frequently; warfarin dose may need adjustment
Specific drugs: See description
Effect: Elevated digoxin levels leading to toxicity
How it happens: Increased digoxin absorption through altered gut flora
Management: Monitor digoxin levels closely; dose reduction may be needed
Specific drugs: See description
Effect: Increased risk of torsades de pointes
How it happens: Additive QT prolongation effects
Management: Avoid combination if possible; ECG monitoring if necessary
Specific drugs: See description
Effect: Decreased antibiotic effectiveness
How it happens: Reduced azithromycin absorption through chelation
Management: Space azithromycin 2 hours before or 4 hours after antacids
Specific drugs: See description
Effect: Increased cyclosporine levels and potential toxicity
How it happens: Inhibition of cyclosporine metabolism
Management: Monitor cyclosporine levels; dose adjustment may be needed
No information available
No information available
Frequency
Continuous during first dose, then daily
Frequency
Daily monitoring for symptoms
Frequency
Monitor symptoms, labs if prolonged treatment
Frequency
Continuous monitoring