Due to increased demand, antibiotic oral liquids including azithromycin and clarithromycin may be in short supply.
Carefully consider the need for antibiotic treatment and if prescribing an antibiotic, consider current availability by
consulting your local pharmacy.
An international alternative, azithromycin (Zydus) 200 mg/5 mL powder for oral suspension has been approved
under Section 19A of the Therapeutic Goods Act 1989

Situation
• Azithromycin and clarithromycin oral liquids may be in short supply due to the current rise in Mycoplasma
pneumoniae and Bordetella pertussis infections. The suppliers are working to expedite future shipments.
When to treat
• Antibiotics have limited efficacy in most mild-moderate cases of confirmed or suspected Mycoplasma
pneumoniae infection. As per the Paediatric Improvement Collaborative guidelines, antibiotics may be
prescribed if a child has clinical features suggesting a need for referral to hospital e.g. signs of LRTI with
respiratory distress or hypoxaemia.
• In patients of any age, antibiotic treatment is recommended if the diagnosis of pertussis is made within 3
weeks of cough or other symptom onset. Three weeks after symptoms begin, patients are rarely
infectious and antibiotic therapy is not indicated.
• Please carefully consider the need for antibiotic treatment and if prescribing an antibiotic, consider
current availability by consulting your local pharmacy. Local pharmacies may contact you to amend
current prescriptions to alternative dose formulations or antibiotics.
• An international alternative, azithromycin (Zydus) 200 mg/5 mL powder for oral suspension is available
from Medsurge Healthcare. Please contact your local community pharmacy to determine availability.
Treatment of Mycoplasma pneumoniae
Medication Available
formulations
Adult
patients Paediatric patients
First line Doxycycline*

Tablet** and
capsule
100 mg orally
12-hourly for
7 days.
> 8 years and < 26 kg: 50 mg orally twice a day for 7 days.
> 8 years and 26 – 35 kg: 75 mg orally twice a day for 7 days.
> 8 years and > 35 kg: 100 mg orally twice a day for 7 days.
Second
line
Azithromycin

Tablet** and oral
suspension
500 mg orally
daily for 3
days.
> 6 months: 10 mg/kg up to 500 mg daily for 3 days.

Second
line
Clarithromycin

Tablet and oral
suspension
500 mg orally
12-hourly for
7 days.
1 month – 18 years: 7.5 mg/kg up to 500 mg orally 12 hourly for 7
days.
Alternate
treatment
Erythromycin Capsule and oral
suspension
> 1 month: 40 to 50 mg/kg per day orally in three or four divided
doses (maximum daily dose 2 g) for 7 to 10 days.
Treatment and prevention of pertussis (whooping cough)
Medication Available
formulations Adult patients Paediatric patients
First line

Azithromycin

Tablet** and
oral
suspension
500 mg orally on Day 1,
then 250 mg orally daily
for a further 4 days.
< 6 months: 10 mg/kg orally daily for 5 days.
≥ 6 months: 10 mg/kg up to 500 mg orally on Day 1
then 5 mg/kg up to 250 mg daily for a further 4 days.
First line

Clarithromycin

Tablet and
oral
suspension
500 mg orally 12-hourly
for 7 days.
1 month – 18 years: 7.5 mg/kg up to 500 mg orally
12 hourly for 7 days.
Second
line
Trimethoprim plus
sulfamethoxazole
Tablet and
oral liquid
160+800 mg orally 12-
hourly for 7 days.
> 1 month: 4+20 mg/kg (up to 160+800 mg) orally
12-hourly for 7 days.
*The risk of oesophagitis in children should be considered – counselling should be provided to ensure patients remain upright for at
least an hour after dose administration.
** Both azithromycin and doxycycline can be crushed and mixed with liquid to aid administration in patients who cannot swallow
tablets. Refer to Page 8 - 9 of Antibiotic prescribing in primary care: Therapeutic Guidelines summary table for instructions on crushing
and appropriate liquids to mix with. A tablet cutter should be used when splitting tablets.
Dr Christine Selvey
Director, Communicable Disease Branch