Az susp. (Susp) 20ml bot/susp.

Az Suspension 20ml (Azithromycin 200mg/5ml) — Clinical Overview

What Is Az Suspension 20ml?

Az Suspension 20ml is azithromycin 200 mg/5 mL oral suspension by ACI Limited, Bangladesh, supplied in a 20 mL bottle after reconstitution. The smaller 20 mL pack is particularly suited for short treatment courses in lighter children and infants, or for adult single-dose regimens where a small volume is required. It provides exactly 4 doses of 5 mL (200 mg each), making it economical for conditions requiring 1–3 day courses or weight-adjusted doses in young children weighing under 15 kg.

Azithromycin suspension achieves the same spectrum of antibacterial activity as the tablet form — covering typical bacteria (Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus), atypical organisms (Mycoplasma pneumoniae, Chlamydophila pneumoniae, Legionella), and Salmonella typhi — while offering the convenience of liquid oral delivery for patients unable to swallow tablets. The suspension contains 200 mg of azithromycin per 5 mL, meaning each millilitre contains 40 mg of active drug.

Suitable Indications for the 20ml Pack

The 20ml bottle is most appropriate for: acute otitis media (middle ear infection) in young children using the single-dose regimen (30 mg/kg) or 3-day regimen — a 10 kg child requires 10 mL/day loading dose; acute pharyngitis and tonsillitis (penicillin-allergic children) — 5-day course in a 5–8 kg infant; community-acquired pneumonia in infants and toddlers under 15 kg; sinusitis (3-day course in young children); and Chlamydia trachomatis single-dose treatment in patients preferring suspension over tablets (1g = 25 mL, which exceeds the 20ml bottle — tablet form preferred for single-dose adult STI treatment). For typhoid fever courses (7 days) or heavier children, the 35 mL or 50 mL bottle is more appropriate to provide sufficient volume.

Acute Otitis Media (AOM) — A Key Paediatric Indication

Acute otitis media is the most common bacterial infection in children in Bangladesh, typically caused by Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Azithromycin is an important second-line option for AOM, used when: the child cannot take amoxicillin (allergy), amoxicillin treatment has failed, the child cannot swallow tablets, or when compliance with multi-day amoxicillin courses is problematic. Dosing options for AOM: single-dose azithromycin 30 mg/kg (maximum 1.5g) as a one-time treatment; or 10 mg/kg on day 1, then 5 mg/kg on days 2–5 (5-day course); or 10 mg/kg daily for 3 days. For a 10 kg child, the 20ml Az suspension bottle provides exactly the 3-day course (10 mL on day 1, then 5 mL on days 2–3). Clinical response assessment at 48–72 hours is recommended.

Reconstitution and Administration

Reconstitute the 20ml Az Suspension by adding approximately 12 mL of clean water to the powder in two steps, shaking well between additions. The final reconstituted volume will be 20 mL. Shake the bottle well before each use. Measure each dose with the measuring spoon (1 teaspoon = 5 mL = 200 mg) or oral syringe provided. Take on an empty stomach (1 hour before or 2 hours after food) for optimal absorption. Store at room temperature (below 30°C); do not refrigerate. Use within 10 days of reconstitution. Discard any unused suspension after 10 days. The suspension has a strawberry or fruit flavour to improve palatability in children.

Dosing Guide for Common Paediatric Weights

Using Az Suspension 200 mg/5 mL (40 mg/mL): 5 kg infant — day 1: 1.25 mL (50 mg); maintenance: 0.6 mL (25 mg) — use full 5-day course from 20ml bottle easily. 8 kg child — day 1: 2 mL (80 mg); maintenance: 1 mL (40 mg). 10 kg child — day 1: 2.5 mL (100 mg); maintenance: 1.25 mL (50 mg) — 5-day course uses approximately 7.5 mL total (within 20ml bottle). 12 kg child — day 1: 3 mL (120 mg); maintenance: 1.5 mL (60 mg). Note: these are examples; always use the dose prescribed by the physician based on clinical assessment and exact weight. Maximum daily dose: 500 mg (12.5 mL).

Frequently Asked Questions (FAQ)

Q1: Why is the 20ml bottle smaller than other azithromycin suspension packs?
The 20ml pack is designed for shorter treatment courses (3–5 days) in younger, lighter children typically weighing under 12 kg, where smaller volumes per dose mean a 20ml bottle provides a full course. For heavier children, longer courses (such as 7-day typhoid treatment), or where a reserve supply is needed, the 35ml or 50ml bottle provides greater volume. The 20ml pack offers a more economical option when the full course can be completed within its volume.

Q2: Can Az Suspension 20ml be used for adults?
For most adult indications requiring 500mg once daily, a 20ml bottle would provide only 4 doses of 5mL (200mg each) — insufficient for even a 3-day adult course. Adults requiring azithromycin suspension (due to swallowing difficulties, for example) would need the 50ml bottle for a 3-day course (500mg = 12.5mL × 3 days = 37.5 mL total). The 20ml bottle is most practical for paediatric use or for specific single-dose treatments where the required volume falls within 20mL.

Q3: What if my child refuses to take the suspension?
Az suspension has a fruit flavour to improve palatability. If your child refuses to take it, you may mix the measured dose with a small amount of fruit juice or flavoured drink to mask the taste — but do not mix the entire bottle. Administer immediately after mixing. Do not add the dose to a full feed or large drink volume as the child may not finish it and receive an inadequate dose. If the child vomits within 30 minutes of a dose, the full dose may not have been absorbed — consult your physician about whether to repeat the dose.

Q4: Is azithromycin suspension effective for Mycoplasma pneumonia in children?
Yes. Mycoplasma pneumoniae is intrinsically resistant to beta-lactam antibiotics (penicillin, amoxicillin) due to its lack of a cell wall, and azithromycin is the drug of choice for Mycoplasma pneumonia in children. The 5-day azithromycin suspension course (10 mg/kg day 1, then 5 mg/kg days 2–5) effectively eradicates Mycoplasma and resolves the "walking pneumonia" syndrome characterised by persistent cough, low-grade fever, and mild systemic symptoms in school-age children.

Medical Disclaimer: For healthcare professional reference and patient/carer education only. Az Suspension is a prescription antibiotic. All paediatric doses must be prescribed by a qualified physician. Do not self-medicate children with antibiotics.