▸ Azithromycin. The most common reaction with this drug is gastrointestinal upset. "These are side effects, not allergy. Some people just cannot tolerate macrolides," Dr. Stechenberg noted. Although rash is uncommon with azithromycin, "when it does occur, it lasts for a long time. One of the nice things about this drug is that treatment is only for 5 days because it stays in the body for a long time, but that means when there's rash, it will persist," she said.
▸ Doxycycline. Concerns about tooth staining "have led to a magic cutoff age of 8-9 years old for doxycycline, after the eruption of maxillary central incisors," said Dr. Stechenberg. "In reality, tooth staining results from multiple courses of the drug over long periods."
Photosensitivity dermatitis also is a concern with doxycycline, but this can be prevented with anticipatory guidance regarding the use of broad-spectrum sunscreen and sun avoidance, she said.
▸ Fluoroquinolones. Small studies have shown that fluoroquinolones are reasonably safe in children, "but they should be reserved for patients who have no other reasonable options," she said. "Advise patients to report any joint pain so the medication can be stopped before the possibility of tendon rupture."
▸ Acyclovir. "This is a fairly safe drug to use in children," said Dr. Stechenberg. However, because it is excreted in the kidney almost unchanged, it can cause renal tubular dysfunction, crystalline nephropathy, and interstitial nephritis. She reported having no disclosures related to her presentation.
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