Sumamed Forte: instructions for use of the suspension for children, composition, dosage, antibiotic analogues

"Sumamed Forte" is an antibiotic pharmaceutical product of high therapeutic effectiveness, acting against a large number of pathogenic microorganisms. The medication is different in that it can accumulate in the inflammatory focus, where its concentration is much higher than in plasma and uninfected tissues. Due to its low toxicity, it can be used in pediatrics from six months of age. It rarely causes allergies, almost does not suppress the normal gastrointestinal microflora, and is prescribed with most anti-inflammatory, analgesic and other medicines.

The composition of the suspension for children

The medication is manufactured by the Pliva Pharmaceutical Corporation of Croatia in the form of a granular yellowish powder with a berry-fruit aroma. It is diluted with water, obtaining a pale yellow suspension for internal use, which is often referred to as syrup.

The therapeutic base of the pharmacological product is azithromycin in the form of dihydrate.

In 1 gram of powder, the amount of the treating component is increased by 2 times and is equal to 50.094 mg, and in 5 ml of a correctly diluted suspension there are 200 mg of the therapeutic substance.

There are three formats of pharmaceuticals with a dose of 200 mg / 5 ml.

In a plastic bottle with a volume of 50 or 100 ml with a tight cap, there may be:

• 16.74 grams of powder (indicated on the package - 15 ml);
• 29.295 grams - for 30 ml;
• 35.573 g - for a volume of 37.5 ml.

In fact, the volume of the diluted suspension will be approximately 5 ml more than the nominal.This is provided for more accurate dosing.

In addition to the therapeutic substance, the powder contains aromatic, preservative components, sucrose and emulsifiers.

The bottle is placed in a paper box along with medical instructions, a measuring spoon or a syringe dispenser.

Which group of antibiotics belongs

Azithromycin, which is the medical base of Sumamed, is the first antibiotic substance obtained in the macrolide group of the azalide subclass.

The antimicrobial agent actively stops the division and spread of many microorganisms by inhibiting the production of protein compounds in bacterial cells. With a high concentration in the tissues, the antibiotic not only stops the activity of microbes, but also destroys them completely.

At what age can a child be given

"Sumamed Forte" is allowed to give small patients from six months. But infants weighing up to 10 kg are recommended to be treated using Sumamed powder with a content of 100 mg of the treating component in 5 ml of prepared syrup.

Pharmacological action and indications for taking Sumamed

"Sumamed" is more gentle on the body, unlike penicillin antibiotics, and can be used from infancy.

Benefits of azithromycin:

• rapidly absorbed into the blood showing the largest amount in plasma 2 to 2.5 hours after ingestion;
• does not break down in the stomach, demonstrating 300-fold resistance to acids, in comparison with erythromycin;
• shows fewer gastrointestinal adverse reactions than other macrolides;
• it remains in the body for a long time, supporting the therapeutic effect for about a week after completing the course of administration, which is important in the treatment of severe pathologies;
• low elimination rate allows to reduce the frequency of administration and duration of therapy, reduce the load on the liver;
• due to the ability to penetrate into phagocyte cells moving to the site of inflammation, Sumamed concentrates precisely in the affected tissues, while the accumulation of azithromycin in the area of ​​inflammation is 50 times greater than in the blood;
• It is active, affecting both extracellular organisms and intracellular parasites.

Sumamed is effective against streptococcal and staphylococcal microflora, clostridia, hemophilic bacillus, moraxella, pertussis bacillus, proteobacteria of the neisseria species, Helicobacter pylori, gardnerella, campylobacter euni. It also stops the reproduction of mycoplasma, legionella, mycobacteria, chlamydia, ureaplasma, listeria, borelia, pale treponema.

The main part of the amount of antibiotic received in the body is removed along with bile through the intestines - more than half in unchanged form, the rest - in the form of intermediate substances that do not have therapeutic activity. About 5 - 6% is excreted by the kidneys.

"Sumamed forte" for children is prescribed for the treatment of diagnosed pathologies of an infectious and inflammatory nature caused by aggression of organisms that do not have resistance to the drug:

• bacterial pharyngitis, follicular and lacunar tonsillitis, sinusitis (inflammation of the paranasal sinuses), purulent otitis media of the middle ear;
• pneumonia with an undetected pathogen, acute bronchitis, damage to the upper respiratory tract;
• impetigo, erysipelas, early stage of chronic migratory erythema, furunculosis, Lyme disease, pustular skin pathologies (pyodermatosis), infectious eczema, acne;
• inflammatory lesions of muscles, tendons caused by infection, suppuration of the synovial bag, bacterial bursitis;
• urethritis, inflammation of the cervical canal of the uterus (cervicitis);
• inflammation and ulceration of the gastric mucosa and small intestine against the background of Helicobacter pylori activity.

Only a specialist can decide whether the Sumamed forte suspension is needed for a child with a specific disease, and correlate the features of its course, the severity of symptoms and the patient's age.

Instructions for use and dosage for children

Food that enters the stomach can reduce the absorption of the treating component, so it is advisable to take Sumamed Forte 50-60 minutes before eating, or after waiting 2 hours after eating.

Before giving the medication to the child, the drug mixture of the powder with water is shaken until uniform.

If you missed the medication, give the child the right dose immediately, and the next - after 22 - 24 hours.

The finished suspension can be kept in a room at t no higher than 23 - 25 ° C for no longer than 3 days. In the refrigerator - no longer than 5 days.

In order to obtain the desired dosage, it is necessary to dilute Sumamed Forte correctly so that in 5 ml there are 200 mg of the therapeutic component.

It is important to understand that the actual volume of a correctly diluted mixture should be about 5 ml more than the nominal (indicated on the box), which compensates for the inaccuracy of the set with a syringe or spoon when dosing before use.

The amount of powder in grams	The amount of azithromycin in a bottle in milligrams (in 1 gram - 50.094 mg)	Nominal volume (indicated on the box)	Add water, ml	Actual volume after dilution, ml	The dose of the therapeutic substance in 5 ml of suspension, mg (in actual volume)
16,74	50,094*16,74=839	15 ml	8 – 9,5	20	839/4=209
29,295	50,094*29,295=1468	30 ml	14,5 –16,5	35	1468/7=209
35,573	50,094*35,573=1782	37.5 ml	20	42,5	1782/8,5=209

The dose for the child is measured either with a 5 ml syringe dispenser or with a 2.5 / 5 ml double-sided spoon.

Dilute the powder only with distilled or boiled water at room temperature.

After the child has been given the medicine, it is necessary that he drink some water and completely swallow the remainder of the suspension.

For small patients, an antibiotic for children is given in an amount calculated according to body weight.

For pneumonia, bronchitis, upper respiratory tract infections, skin and tissue diseases, one of two treatment options is used:

• Option 1. For three days, the child is given 10 mg of azithromycin per 1 kg of body weight. Example: a small patient weighing 28 kg can receive azithromycin 280 mg (10 * 28) in 24 hours. In 5 ml is 200 mg, in 1 ml - 40 mg (200/5), which means that the desired 280 mg will be in 7 ml (280/40). A baby weighing 12 kg will need 120 mg (10 * 12) or 3 ml per day (120/40). Moreover, for all the time the child can receive a dose equal to 30 mg per 1 kg. So, a patient weighing 28 kg should not receive more than 30 * 28 = 840 mg of Sumamed, or 840/200 = 4.2 ml of suspension, and a baby weighing 12 kg should not receive more than 30 * 12 = 360 mg, or 9 ml (360/40) suspension.
• Option 2. On day 1, a young patient needs a dose of 10 mg per kilogram of weight, and on the next 4 days - 5 mg / kg. The total amount of medicine for these 5 days should also not exceed 30 mg / kg.

Dosages for the treatment of other diseases:

1. Acute pharyngitis, tonsillitis, impetigo caused by streptococcal flora (e.g. Streptococcus pyogenes), pustular rashes provoked by aggression of Staphylococcus epidermidis and aureus. Treatment takes 3 days. The dose of the drug is calculated based on the norm of 20 mg per 1 kilogram of weight per day (in just 3 days - 60 mg / kg). A child of 13 kg will receive 20 * 13 = 260 mg, or 260/40 = 6.5 ml per day, and in just 3 days - no more than 60 * 13 = 780 mg, or 780/40 = 19.5 ml.
2. The initial stage of tick-borne borreliosis (Lyme disease), migratory erythema. On the first day, the patient is given a suspension of 20 mg / kg, on the next 4 days - 10 mg / kg. The total amount of azithromycin per course of treatment is 60 mg / kg.
3. Gastrointestinal diseases of the stomach in the presence of Helicobacter pylori. For three days, the patient needs a daily dose of 20 mg per kilogram of weight (in combination with drugs that suppress the production of hydrochloric acid, and other medications as indicated).

Table for dosing by weight of young patients

Body weight in kg	The amount of suspension per day
10 – 14	2.5 ml (100 mg azithromycin)
15 – 25	5 ml
26 – 34	7.5 ml
35 – 44	10 ml
45 and more	12.5 ml (500 mg), which corresponds to the daily dose of adults

The table is compiled to simplify the calculation if parents find it difficult to accurately calculate the dosage.

Drug interaction

With parallel treatment with Sumamed Forte and other medications, possible incompatibility and negative reactions for the body should be considered.

Pharmaceuticals	Possible effects in pharmaceutical interactions with Sumamed Forte
Antacids (Almagel, Maalox, Fosfalugel)	significantly reduce the absorption of azithromycin and reduce therapeutic efficacy
"Warfarin", fenindion ("Fenilin"), "Sincumar", "Acenokumarol", "Mrakumar"	increased blood flow and hemorrhage
"Tetracycline", "Chloramphenicol"	increase the effectiveness of azithromycin
heparin	incompatible with azithromycin
Cyclosporin	increased plasma levels of cyclosporine and possible side effects
Ergotamine, Dihydroergotamine	toxic effect (vasospasm, sensitivity distortion)
Lincomycin, Clindamycin	reduce the therapeutic effect of Sumamed
"Digoxin"	the concentration of digoxin in the blood increases

If necessary, the doctor will either cancel one of the drugs, or adjust the dosage correctly to minimize potential harm.

Contraindications, side effects and overdose

A medication is contraindicated if a minor patient has:

• intolerance to any component of the drug;
• special sensitivity to antibiotics of the class of macrolides, ketolides;
• age up to 6 months;
• severe liver disease;
• fructose intolerance, sucrose, malabsorption of glucose-galactose, sucrose-isomaltose.

It is used with caution in case of hepatic-renal pathologies, arrhythmias, and a tendency to lengthen on the electrocardiogram of the QT interval.

Adverse reactions during treatment are much less common than when treated with other antibiotic agents.

Among the side effects in children can be observed:

• nervousness, sleep disturbance, tearfulness, fatigue;
• skin rash (with allergies);
• nausea, loss of appetite, loose stools;
• headache (in the treatment of otitis media);
• jaundice due to stagnation of bile;
• palpitations, chest pains, drowsiness.

Very rarely - allergic conjunctivitis, gastritis, thrush of the oral mucosa and vaginal candidiasis in girls, Quincke's edema (immediate drug withdrawal is required).

Most unwanted effects disappear after treatment is completed. Sometimes an increase in the level of neutrophils and eosinophils in the blood of a child is recorded, which is also a temporary effect.

If parents do not properly dissolve the powder to prepare the suspension, pouring less water than required, or give the medication to the child more often than recommended, then signs of an overdose may appear: vomiting, diarrhea, skin rash, temporary auditory disturbances, lethargy or overexcitation.

First of all, you need to immediately stop giving the child a medication. If the child feels rather well, you can give him an adsorbent (Polysorb) in a child's dose. If the condition is serious, you need an ambulance call and hospitalization for gastric lavage and special detoxification therapy.

Antibiotic Analogs

Among the analogues of Sumamed Forte containing azithromycin, which are used in pediatrics, we can distinguish: Sumamed, Azithromycin, Hemomycin, Azitrox (in powder for suspension).