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Key takeaways
Azithromycin, approved by the FDA for various bacterial infections, is not suitable for everyone due to potential side effects, allergies, or liver problems. Alternative antibiotics include amoxicillin, Augmentin, cefaclor, doxycycline, and levofloxacin.
Alternatives to azithromycin include antibiotics from different classes, such as penicillins, cephalosporins, tetracyclines, sulfonamides, and quinolones. These antibiotics are tailored to treat similar bacterial infections but have varying side effects and drug interactions.
Healthcare providers generally do not recommend natural alternatives for bacterial infections. Antibiotics are effective except in cases where the infection is viral or self-resolving.
Switching from azithromycin to an alternative requires consultation with a healthcare provider, especially if experiencing adverse effects or in cases of drug unavailability, ensuring a seamless transition without compromising treatment efficacy.
Azithromycin, generic for the brand name prescription-only Zithromax and Zithromax Z-Pak, is a member of the macrolide class of antibiotics. The U.S. Food and Drug Administration (FDA) has approved its use for the treatment of a number of bacterial infections including middle ear infections (otitis media), strep throat, community-acquired bacterial pneumonia, upper respiratory infections such as sinusitis and tonsillitis, eye infections, skin infections, genital chancroid ulcers in men, and chlamydia infections in men and women. Azithromycin is available in several dosage forms–film-coated tablets, capsules, oral suspension, intravenous injection, granules for suspension, and as an ophthalmic solution.
Azithromycin is approved for use in adults and children as young as two months old. The antibiotic should not be used if there is a known allergy to azithromycin, erythromycin, or any other macrolide antibiotics (such as clarithromycin), or in those with a history of liver problems associated with previous use of azithromycin. There are no adequate clinical studies in pregnant women, therefore azithromycin should be used during pregnancy only if clearly needed. It is not known whether azithromycin is excreted in human milk so caution should be exercised when azithromycin is administered to nursing women
Although azithromycin is considered safe and effective, there are side effects associated with the use of this antibiotic. are primarily of the gastrointestinal (GI) tract and include diarrhea, nausea, vomiting, indigestion, gastritis, and abdominal pain. Although rare, include liver problems, jaundice, swollen pancreas, Clostridium difficile-associated diarrhea, heart rhythm problems, and life-threatening allergic reactions.
While azithromycin is an effective treatment for many, it may not be the best option for everyone. For various reasons, such as cost, side effect profile, or hypersensitivity to the active or inactive ingredients, an alternative antimicrobial may be necessary. Continue reading to learn more about azithromycin alternatives, their possible side effects, and other important information.
What can I take in place of azithromycin?
Azithromycin belongs to the macrolide class of antibiotics. Other class members include clarithromycin (generic for the brand name Biaxin) and erythromycin (available in many brand names). These other class members might be considered if azithromycin is unavailable. Macrolide antibiotics typically target bacteria that infect the lungs, skin, or soft tissues, but fortunately there are other classes of antibacterials that work well against the same bacteria that cause these infections. These optional classes include penicillins, cephalosporins, tetracyclines, sulfonamides, and quinolones. The chart below highlights alternatives to azithromycin based on the common bacterial infections each is approved to treat.
Compare Zithromax (azithromycin) alternatives |
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|---|---|---|---|
| Drug name | Uses | Oral Dosage | Savings options |
| Zithromax (azithromycin) |
|
Adults: for most bacterial infections 500 mg once on day 1, then 250 mg every 24 hours for 4 days; for chlamydial and chancroid infections 1000 mg as a single dose
Children: dosing is weight based |
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| Azithromycin | See Zithromax Uses | See Zithromax Oral Dosage | Azithromycin coupons |
| Clarithromycin |
|
Adults: for most bacterial infections 250 to 500 mg every 12 hours for 7 to 14 days
Children: dosing is weight based |
Clarithromycin coupons |
| Erythromycin base |
|
Adults: for most bacterial infections 1000 mg per day in divided doses every 6 to 12 hours
Children: dosing is weight based |
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| Amoxicillin |
|
Adults: for most bacterial infections 250 to 500 mg every 8 hours for 10 days
Children: dosing is weight based |
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| Augmentin (amoxicillin and clavulanate) |
|
Adults: for most bacterial infections 500 mg/125 mg to 875 mg/125 mg every 12 hours
Children: dosing is weight based |
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| Cefaclor |
|
Adults: for most bacterial infections 250 to 500 mg every 8 hours
Children: dosing is weight based |
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| Cephalexin |
|
Adults: for most bacterial infections 1000 to 4000 mg per day in divided doses every 6 to 12 hours
Children: dosing is weight based |
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| Tetracycline |
|
Adults: for most bacterial infections 1000 to 2000 mg per day in divided dose 2 to 4 times daily
Children over 8 years of age: dosing is weight based |
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| Doxycycline |
|
Adults: for most bacterial infections 100 mg per day; for bacterial pneumonia, sinusitis, and chlamydia 100 mg every 12 hours for at least 5 days
Children over 8 years of age: dosing is weight based |
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| Bactrim
(sulfamethox-azole and trimethoprim) |
|
Adults: for most bacterial infections 800 mg/160 mg twice daily
Children 2 months and older: dosing is weight based |
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| Ciprofloxacin |
|
Adults: for most bacterial infections 250 to 750 mg every 12 hours; for chancroid infections 500 mg every 12 hours for 3 days
Children: dosing is weight based |
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| Levofloxacin |
|
Adults: for most bacterial infections 250 to 750 mg once-daily for 5 to 10 days
Children 1 month and older: dosing is weight based |
Levofloxacin coupons |
| Clindamycin |
|
Adults: for most bacterial infections 150 to 450 mg every 6 to 12 hours
Children: dosing is weight based |
Clindamycin coupons |
Other alternatives to azithromycin
Top 5 azithromycin alternatives
The following are some of the most common alternatives to azithromycin.
1. Amoxicillin
Amoxicillin is in the penicillin class of antibiotics and is approved to treat infections of the ear, nose, throat, skin, and urinary tract, among other infections. Amoxicillin works to kill bacteria by breaking the bonds that hold the bacteria cell wall together. While both amoxicillin and azithromycin are considered broad-spectrum antibiotics, i.e., are effective against a broad range of bacterial infections, azithromycin has a bit greater coverage than amoxicillin. The most common side effects of amoxicillin, very similar to azithromycin, include nausea, vomiting, diarrhea, and skin rash. Amoxicillin is available as a capsule, chewable tablet, and liquid suspension and as a generic or by different brand names such as Amoxil, Moxatag, and Trimox.
2. Augmentin
Augmentin is a brand-name antibiotic that contains amoxicillin with clavulanate. Clavulanate blocks the bacterial enzymes which render amoxicillin less effective. This activity means the combination form has a wider range of activity and may be used for more persistent infections that no longer respond to amoxicillin by itself. The most common side effects of Augmentin, as with amoxicillin, are diarrhea, nausea, vomiting, and rash. Because clavulanate may also contribute to adverse events, it is possible that more patients on Augmentin may experience diarrhea than with amoxicillin alone. Augmentin is available as a tablet, liquid suspension, chewable tablet, and extended-release tablet. It is also available in generic form as amoxicillin/clavulanate.
3. Cefaclor
Cefaclor, also known by the brand name Ceclor, is a second-generation cephalosporin used for a variety of bacterial infections such as respiratory infections, ear infections, skin infections, bone infections, and urinary tract infections. Cephalosporins kill bacteria by preventing them from building cell walls. Azithromycin and cefaclor were compared in a clinical study treating patients with acute otitis media, strep throat, or sinusitis with azithromycin 500 mg once daily for three days versus cefaclor 250 mg given three times daily for ten days and found to be equally effective. The most common of cefaclor, as with azithromycin, are diarrhea, nausea, and vomiting. Cefaclor is available as a capsule, liquid suspension, and extended-release tablet.
4. Doxycycline
Doxycycline, also known by a variety of brand names including Vibramycin and Doryx, is a member of the tetracycline class of antibiotics. This class kills bacteria by preventing them from producing the proteins they need to multiply. Doxycycline is effective against many of the same bacterial infections as azithromycin, and may even be more efficacious in certain infections such as chlamydia. Common of doxycycline similar to azithromycin include diarrhea, nausea, abdominal pain, and vomiting. Side effects of doxycycline that are different from azithromycin include photosensitivity (a condition in which the skin becomes very sensitive to sunlight) and tooth discoloration, particularly in those eight years of age or younger. Doxycycline is available as a capsule, tablet, liquid suspension, and injectable formulation.
5. Levofloxacin
Levofloxacin, also known by the brand name Levaquin, is in the fluoroquinolone (or quinolone) class of antibiotics. Quinolone antibiotics are known to work by interfering with DNA synthesis which decreases the bacteria’s ability to grow. Levofloxacin is used to treat bacterial infections such as pneumonia, bronchitis, sinusitis, chlamydia, and skin infections, particularly when there is a concern that the bacteria might be resistant to other classes of antibiotics. In one clinical trial comparing levofloxacin to azithromycin to treat acute bronchitis, both antibiotics were found to be comparable in effectiveness. Common of levofloxacin that are similar to azithromycin include nausea, vomiting, diarrhea, and abdominal pain. Side effects that are different from azithromycin include insomnia, restlessness, disorientation, and, very rarely, tendonitis (swelling of the fibrous tissue connecting muscle to bone) or tendon rupture. Fluoroquinolones may be more likely to have significant drug-drug interactions than other classes of antibiotics such as azithromycin. Levofloxacin is available as a tablet, oral solution, and injectable formulation.
Natural alternatives to azithromycin
When a person has a serious bacterial infection it is unlikely a healthcare provider will give medical advice suggesting a natural alternative. Although there are naturally occurring compounds that have shown to slow or even kill bacteria responsible for infectious diseases, such as honey, garlic, oregano and thyme essential oils, myrrh extract, echinacea, goldenseal, and turmeric, for most bacterial infections a prescription antibiotic will be necessary.
An important determination your healthcare provider will make is if it is truly a bacterial infection. Many infections, such as community-acquired pneumonia, bronchitis, sinusitis, and middle ear infections, can also be caused by viruses, which do not respond to antibiotics. Also, not all bacterial infections need to be treated with antibiotics because some infections resolve on their own.
How to switch to an azithromycin alternative
Should azithromycin not be available or you take azithromycin and experience untoward side effects, you should talk with your prescribing healthcare provider to determine your next steps. In some situations, it may be continued if the side effects of azithromycin are minor or can be lessened by taking with food.
Azithromycin (or any antibiotic) should not be discontinued before completing the full prescribed number of days or the bacterial infection may return and become even more difficult to treat due to the development of antibiotic resistance. If your healthcare professional does offer an alternative antibiotic, you can discontinue the azithromycin at that time and begin taking the newly prescribed medicine immediately. Regardless if you are taking azithromycin or an alternative, you can always find savings when using a SingleCare discount card.