Antibiotics in Pediatric Practice: Azithromycin

A.N. Gratsianskaya Department of Clinical Pharmacology, Russian National Research Medical University. N.I. Pirogova, Moscow

Azithromycin is one of the most demanded antibiotics among pediatricians, the effectiveness and safety of which has been repeatedly proven in clinical studies and in practice. As with any drug that is well established in the pharmaceutical market, azithromycin has many generics. The article provides data on studies of azithromycin in pediatric practice, and also touches upon the problem of choosing a quality generic.

The most common pathology in the human population in general and up to 90% in the pediatric population are community-acquired respiratory tract infections - bronchitis and pneumonia, which, depending on the nature of the clinical manifestations, it is customary to divide into typical and atypical.

The typical course is characterized by an acute onset with severe fever, intoxication and cough, which is usually due to the presence of pneumococcus (Streptococcus pneumonia), moraxella (Moraxella catarralis) or Haemophilus influenzae.

The atypical course of the disease is usually low-symptom, with normal or low-grade fever, no intoxication, and a characteristic obsessive, dry, unproductive cough. The causative agents of atypical community-acquired respiratory infections are chlamydia (Chlamydia pneumonia) and mycoplasma (Mycoplasma pneumonia). The probability of mycoplasma or chlamydial etiology of bronchitis and pneumonia in children is estimated at 40%, with a peak in the first year of life and after 10 years [1-3]. The indications for the appointment of antibiotics are signs indicating the bacterial nature of the disease - mucopurulent and purulent sputum in combination with severe intoxication and hyperthermia for more than 3 days. A protracted course of the disease, especially if the intracellular nature of the pathogen is suspected, is also an indication for antibacterial therapy - in this case, macrolides are the drugs of choice.


The first of the macrolides, erythromycin, was synthesized in 1952, but it still has not lost its clinical significance. In the 70s and 80s. Of the twentieth century, attention to macrolides increased sharply, which was due to intensive study of the role of intracellular pathogens of diseases. Were developed and introduced into clinical practice new representatives of macrolide antibiotics with improved (compared to erythromycin) microbiological and pharmacokinetic parameters, as well as better tolerance. Macrolides have entered a period of "renaissance" - especially in pediatric practice, where they have won recognition due to their high efficiency, safety and ease of use.

Azithromycin is an attractive representative of the macrolead group in terms of choosing an antibiotic for the treatment of respiratory infections in pediatric practice. Azithromycin is well known to medical practitioners around the world and there is a large body of reliable information about its effectiveness and safety.

Azithromycin has a wide spectrum of antimicrobial activity, including gram-positive and gram-negative microorganisms: Hae-mophilus influenzae (in first place among macrolides), Moraxella catarrhalis, Bordetella pertussis, Bordetella parapertussis, Campylobacter jejuni, Legionella pneumophila, Neisseria gonorrhoeae, Gardnerella vaginalis), anaerobes (Bacteroides bivius, Peptostreptococcus spp., Peptococ-cus, Clostridium perfringens), chlamydia (Chlamydia trachomatis, Chlamydia pneumoniae), mycobacteria (Myco-bacteria avium complex), mycoplasma (Mycoplasma pneumoniae), ureaplasma (Ureaplasma urealyticum), spirochetes (Treponema pallidum, Borrelia burgdorferi).

The effectiveness of azithromycin against intracellular pathogens is due to its extremely high ability to penetrate cells.