Az susp. (Susp) 50ml bot/susp.

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

About Az Suspension 50ml

Az Suspension 50ml contains azithromycin 200 mg per 5 mL as an oral suspension, manufactured by ACI Limited, Bangladesh. The 50 mL bottle is the largest available pack of Az oral suspension and is appropriate for heavier children (20–40 kg weight range), extended treatment courses including 7-day typhoid fever regimens, or households treating multiple children. Each 50 mL bottle after reconstitution provides 10 doses of 5 mL (200 mg each), or proportionally smaller volumes for weight-adjusted paediatric dosing.

Azithromycin's superior tissue penetration and intracellular accumulation distinguish it from older macrolides such as erythromycin. Within phagocytes — the cells that migrate to sites of infection — azithromycin concentrations can be 200–800 times higher than in plasma. When these phagocytes accumulate at infected tissues, they essentially deliver concentrated azithromycin directly to the site of bacterial infection, a property known as "drug targeting." This mechanism contributes to azithromycin's effectiveness even at relatively short dosing intervals and short treatment courses.

Indications and Target Population for 50ml Pack

The 50ml bottle is optimally suited for: children weighing 20–40 kg requiring full 5-day treatment courses; 7-day typhoid fever treatment in children weighing 15–25 kg; community-acquired pneumonia in school-age children (6–12 years); older paediatric patients with pharyngitis/tonsillitis requiring the full 5-day antibiotic course; and households with multiple children where family treatment may be prescribed. It is also appropriate for adults who require suspension rather than tablet form — a 3-day 500mg adult course uses 37.5 mL of the 50ml bottle, which is within the 10-day post-reconstitution window.

Typhoid Fever — The 7-Day Course

Azithromycin suspension is a first-line treatment for uncomplicated typhoid fever in Bangladesh, particularly given the high and rising prevalence of fluoroquinolone-resistant Salmonella typhi. The recommended regimen for paediatric typhoid: 20 mg/kg (maximum 1000 mg) on day 1 as a loading dose, then 10 mg/kg (maximum 500 mg) daily on days 2–7 — a total 7-day course. Volume calculation using Az 200mg/5mL suspension: day 1 loading dose (20 mg/kg) = weight in kg × 0.5 mL; daily maintenance dose = weight in kg × 0.25 mL. Example — 20 kg child: day 1 = 10 mL (400 mg); days 2–7 = 5 mL (200 mg) daily; total volume = 10 + (5×6) = 40 mL — the 50ml bottle provides the complete course with 10mL to spare. The 50ml bottle is the ideal choice for typhoid treatment in children over 15 kg.

Community-Acquired Pneumonia — Dosing in School-Age Children

For school-age children (typically 6–12 years, weight 20–40 kg) with mild community-acquired pneumonia managed in the outpatient setting, the 5-day azithromycin course is appropriate. Standard 5-day regimen: 10 mg/kg on day 1, then 5 mg/kg on days 2–5. For a 25 kg child: day 1 = 6.25 mL (250 mg); days 2–5 = 3.1 mL (125 mg) each day; total = approximately 18.7 mL. For a 30 kg child: day 1 = 7.5 mL (300 mg); days 2–5 = 3.75 mL (150 mg) each day; total = approximately 22.5 mL. Both courses are comfortably within the 50ml bottle. Az 50ml suspension is practical for these age groups where the tablet form may be possible but the suspension is preferred by the patient or carer.

Acute Otitis Media — Single-Dose Option

A single 30 mg/kg dose of azithromycin (maximum 1.5g) has demonstrated non-inferiority to 5-day amoxicillin-clavulanate for acute otitis media in several trials — offering the ultimate convenience of one-dose treatment for AOM. For a 15 kg child: 30 mg/kg = 450 mg = 11.25 mL. For a 20 kg child: 600 mg = 15 mL. For a 25 kg child: 750 mg = 18.75 mL. All of these single doses are within the 50ml bottle, which provides sufficient volume for any paediatric weight with substantial volume remaining. The single-dose option may improve compliance in families where completing multi-day antibiotic courses is challenging, though 5-day courses generally show superior microbiological eradication rates.

Storage, Reconstitution, and Handling

Before reconstitution, store Az 50ml Suspension powder at room temperature (below 30°C) in a dry place. Reconstitution: add approximately 37 mL of clean water to the bottle in two separate additions, shaking vigorously between each addition, until a uniform suspension forms. The bottle label specifies the exact volume of water to add. After reconstitution: store at room temperature (below 30°C); do not refrigerate; shake well before each use to resuspend settled particles; use within 10 days of reconstitution; discard remaining suspension after 10 days regardless of remaining volume. Measure each dose with the measuring spoon or oral syringe provided — accuracy in paediatric dosing is critical.

Frequently Asked Questions (FAQ)

Q1: Can the Az 50ml suspension be stored in the refrigerator?
No. Unlike some antibiotic suspensions that require refrigeration after reconstitution, azithromycin oral suspension should be stored at room temperature (below 30°C) after reconstitution. Refrigeration is not required and may not be recommended. Store in a cool location away from direct sunlight and heat sources. The reconstituted suspension remains stable for 10 days at room temperature. Always check the product label and package insert for specific storage instructions as they take precedence over general guidance.

Q2: What is the maximum dose of Az suspension for any child?
The maximum dose of azithromycin for children is 500 mg (12.5 mL of the 200mg/5mL suspension) per day for most indications, regardless of weight. For the typhoid loading dose on day 1, the maximum is 1000 mg (25 mL). For the acute otitis media single-dose regimen (30 mg/kg), the maximum is 1500 mg (37.5 mL) — but clinical judgement should be applied, and doses exceeding 500 mg should only be given under physician supervision.

Q3: My child's symptoms improved after 2 days — do we need to complete the 5-day course?
Yes, complete the full prescribed course even if symptoms improve early. With azithromycin's unique pharmacokinetics, the drug continues working in tissues for several days after the last dose. Stopping early may leave residual bacteria that were suppressed but not eliminated, potentially leading to relapse or selecting for resistant strains. Early symptom improvement is a good sign, but it does not mean the bacterial infection has been fully eradicated. Always complete the course as prescribed.

Q4: Is Az suspension the same drug as Az tablets — just in liquid form?
Yes. Az 50ml Suspension and Az Tablets both contain azithromycin as the active ingredient, manufactured by ACI Limited. They have the same mechanism of action, spectrum of activity, and clinical indications. The key differences are: the suspension is taken on an empty stomach (food reduces peak absorption significantly), while tablets can be taken with food; the suspension is easier to swallow for children and patients with dysphagia; dosing volumes must be carefully measured with suspension. Clinically, appropriately dosed suspension and tablet formulations produce equivalent treatment outcomes.

Medical Disclaimer: For healthcare professional reference and patient/carer education. Az Suspension 50ml is a prescription antibiotic. All paediatric doses must be prescribed by a qualified physician based on weight and clinical indication. Do not self-medicate children with antibiotics.