I agree. Another good reference is Lexi-Comp for medications. It clearly lists drugs that have new found adverse effects and azithromycin is on the top of that list. Zithromax is one of the most successful antibiotics of all time taking on an almost "cult" status and certainly has made Pfizer all the more richer. I think possibly because of Mycoplasma, it became the go to drug for pneumonia, although I prefer Augmentin or a cephalosporin with a proven lobar pneumonia. Zithromax will never go away given its almost universal use for Pertussis especially with the last two epidemics of the last two years (which likely didn't reach Alaska)?
The anecdotal information on Z-pack's inability to treat sinusitis well came from my pharmacist who told me when his customers received Zithromax for sinusitis, he would tell them he would see them in two weeks. Somehow he did this without making the physician look bad. Or maybe he spun the story a bit.
What I find shocking is that a healthcare system, which is supposed to be the best in the world is so slow to learn new but straightforward things such as the fact that when Zithromax is used for the treatment of streptococcal pharyngitis, the dosing is 12 mg/kg/day for five days and not the 10, 5, 5, 5, 5. It must have been at least a year before the pharmacies stopped calling to correct my dosing, and the doctors in the ED still make that error.
On a side note, I hate making the diagnosis of sinusitis given that in pediatrics it is almost always made by history. Parents become quite adamant that their little one with three days of symptoms of cough and the "yellow, green runny nose" is sinusitis or, as they put it, siniitis. Early in the day, I am able to convince them to wait, but late in the day when I am too tired to fight, I will at times give in.
So question for you and UpToDate. If I use the AAP recommendations on the diagnosis of sinusitis, which is the signs and symptoms of an URI that lasts more than ten days, if I wait 10 days to treat the sinus infection of the child that I saw with the same symptoms at three days, did the child suffer with a sinus infection from day one?
