AZ 50 ml Suspension

AZ 50ml Suspension (Azithromycin 200mg/5ml) — Clinical Overview

What Is AZ 50ml Suspension?

AZ 50ml Suspension is azithromycin oral suspension 200 mg per 5 mL in dry powder form for reconstitution, manufactured by ACI Limited, Bangladesh. This formulation is specifically designed for patients who cannot swallow tablets — primarily children, but also elderly patients or adults with swallowing difficulties. The 50ml bottle provides sufficient volume for full treatment courses in older children and larger paediatric patients, and can accommodate adult single-dose treatment regimens where the liquid form is preferred.

Azithromycin suspension has equivalent bioavailability to the tablet formulation when taken on an empty stomach, with peak plasma concentration reached within 2–3 hours. The suspension should be taken at least 1 hour before or 2 hours after meals, as food reduces peak concentration by approximately 56% with the suspension formulation (unlike the tablets, where food interaction is less significant). The strawberry-flavoured suspension improves palatability and acceptance in children.

Paediatric Dosing with AZ 50ml Suspension

Azithromycin suspension dosing in children is weight-based. Standard paediatric dose: 10 mg/kg on day 1, then 5 mg/kg once daily on days 2–5 (5-day course). Alternative 3-day course: 10 mg/kg once daily for 3 days. Since the suspension contains 200 mg/5 mL (40 mg/mL), volume calculations are: 10 mg/kg dose — divide weight in kg by 4 to get mL (e.g., 20 kg child: 20 ÷ 4 = 5 mL = 200 mg). 5 mg/kg maintenance dose — divide weight in kg by 8 to get mL (e.g., 20 kg child: 20 ÷ 8 = 2.5 mL = 100 mg). Maximum dose: 500 mg per day regardless of weight. The 50ml bottle provides enough suspension for: a 10 kg child for 10 days, a 20 kg child for a full 5-day course (with some remaining), or a 40 kg child for the loading dose only. Use the measuring spoon or syringe provided — do not estimate doses.

Indications in Paediatric Practice

AZ suspension is used in children for: community-acquired pneumonia (mild, outpatient): 10 mg/kg day 1, then 5 mg/kg days 2–5 — covers typical and atypical pneumonia pathogens including Mycoplasma pneumoniae, which is a particularly important cause of "walking pneumonia" in school-age children. Pharyngitis and tonsillitis (penicillin-allergic children): 12 mg/kg once daily for 5 days (maximum 500 mg/day). Acute otitis media: 30 mg/kg single oral dose, or 10 mg/kg once daily for 3 days — effective against Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Acute sinusitis. Skin and soft tissue infections (uncomplicated). Chlamydial infection in children over 8 years (single dose azithromycin preferred over doxycycline). Enteric fever in children: 20 mg/kg/day (maximum 1g) on day 1, then 10 mg/kg/day for 6 more days for uncomplicated typhoid.

Reconstitution Instructions

AZ 50ml Suspension comes as a dry powder that must be reconstituted with water before use. Step 1: tap the bottle to loosen the powder. Step 2: add the volume of water specified on the label (typically 37 mL of clean water to the 50ml bottle) in two portions, shaking well between additions. Step 3: shake vigorously until the powder is completely dissolved and the suspension is uniform. Step 4: check the label for the correct final volume. The reconstituted suspension will appear cloudy/opaque — this is normal. Use the measuring spoon (5 mL = one teaspoon = 200 mg) provided with the product. Storage after reconstitution: keep at room temperature (below 30°C); do not refrigerate. Shake well before each dose. Use within 10 days of reconstitution. Discard any remaining suspension after 10 days even if some volume remains.

Typhoid Fever in Children — AZ Suspension Protocol

Uncomplicated typhoid fever in children is a common and serious illness in Bangladesh. The recommended azithromycin regimen for paediatric typhoid is 20 mg/kg/day on day 1 (maximum 1g), then 10 mg/kg/day for 6 more days — total 7-day course. Using AZ 200mg/5mL suspension: day 1 loading dose volume = weight (kg) × 0.5 mL (e.g., 20 kg child: 10 mL = 400 mg loading dose — NOTE: maximum 1000mg = 25mL); days 2–7 maintenance = weight (kg) × 0.25 mL. This regimen is effective against fluoroquinolone-resistant Salmonella typhi, which is increasingly prevalent in Bangladesh. The 50ml bottle is particularly suitable for the full 7-day typhoid course in children weighing 10–15 kg.

Mycoplasma Pneumoniae — The "Walking Pneumonia" Pathogen

Mycoplasma pneumoniae is an atypical bacterial pathogen that lacks a cell wall, making it intrinsically resistant to beta-lactam antibiotics (penicillins, cephalosporins). It causes "walking pneumonia" — a mild pneumonia where children and adults remain ambulatory and may appear only mildly unwell despite significant chest X-ray abnormalities. AZ suspension is the treatment of choice for Mycoplasma pneumoniae pneumonia in children who cannot swallow tablets, as azithromycin (and other macrolides) are the drugs of choice for this organism. Features suggesting Mycoplasma pneumonia include: insidious onset, persistent dry cough (>1 week), low-grade fever, headache, and bilateral patchy infiltrates on chest X-ray. Standard treatment: azithromycin 10 mg/kg once daily for 5 days — the 50ml suspension bottle provides the full course for most paediatric patients.

Frequently Asked Questions (FAQ)

Q1: How should I measure the correct dose of AZ suspension for my child?
Use only the measuring spoon or oral syringe provided with the product — never a household teaspoon as these vary in volume. The suspension contains 200 mg per 5 mL. Your doctor will prescribe a specific volume based on your child's weight. The general calculation: day 1 loading dose = weight in kg ÷ 4 (in mL); maintenance dose = weight in kg ÷ 8 (in mL). Always confirm the dose prescribed by your physician and use the measuring device to ensure accuracy.

Q2: Should AZ suspension be taken before or after meals?
AZ 50ml Suspension should be taken on an empty stomach — at least 1 hour before or 2 hours after food. Food reduces the peak concentration of the suspension formulation by approximately 56%, potentially reducing effectiveness. This is different from azithromycin tablets, which can be taken with food. If your child cannot tolerate it on an empty stomach and experiences significant nausea, discuss with your physician — in some cases, taking with a small amount of food may be necessary.

Q3: How long can I keep the AZ suspension after mixing it?
Once reconstituted with water, AZ suspension must be used within 10 days and stored at room temperature (below 30°C). Do not refrigerate. Shake well before each use. After 10 days, discard any remaining suspension — bacterial or fungal contamination becomes a risk, and drug potency may decrease. If the full course has been completed in less than 10 days, discard the remainder rather than saving it for future use.

Q4: Can AZ suspension be used in infants under 6 months old?
Azithromycin use in infants under 6 months should be approached with caution. There is an association between early azithromycin exposure and infantile hypertrophic pyloric stenosis (IHPS) — a narrowing of the stomach outlet that causes severe vomiting and requires surgical correction. The risk appears highest in neonates (first 2 weeks) and infants under 6 weeks. For infants under 6 months with a bacterial infection requiring azithromycin, the risk-benefit assessment with a paediatrician is essential. For children aged 6 months and above, no significant IHPS risk has been identified.

Medical Disclaimer: This information is for healthcare professional reference and parent/carer education only. AZ 50ml Suspension is a prescription antibiotic. Paediatric antibiotic dosing must be calculated and prescribed by a qualified physician based on the child's weight and clinical condition. Self-medication of children with antibiotics is unsafe and promotes drug resistance.