Are Z-paks good for strep?

Strep throat is a bacterial infection responsible for up to 15% of sore throats in adults, and between 20%-30% of sore throat cases in kids. If you are a parent, you are probably quite familiar with strep throat, and all the stress it can bring. It’s most prevalent in school-aged kids, and accounts for a whopping 12 million doctor visits per year.

If you or your family has a nasty case of strep, you are likely looking for a quick solution to the problem, and you might be wondering if using a Z-pak—a popular antibiotic that treats bacterial infections in about 5 days—might be a smart way to treat strep.

But how do you know whether a Z-pak for strep is a good choice? First, talk to your healthcare provider, but then keep reading for specific dosage, side effects, and effectiveness.

What is strep throat? 

Strep throat is caused by a bacteria called Streptococcus pyogenes, or group A strep. The primary symptom of strep throat is a sore throat, but the other symptoms accompanying the sore throat are fever, pain with swallowing, swollen tonsils, white pus on the tonsils, red spots on the roof of the mouth, headaches, nausea, vomiting, and swollen lymph nodes.

Strep throat is contracted by touching strep bacteria on a surface, then touching your mouth or nose, breathing in respiratory droplets from a strep-infected person, or sharing cups or utensils with someone with strep. School-age (5-15) kids are most vulnerable to strep throat, as are their parents and caretakers. Most people with strep throat do not cough. The only way to know for sure if your sore throat is strep, and not a viral infection, is to get a “rapid strep” swab at the doctor’s office.

RELATED: Strep throat vs. sore throat

What is the best antibiotic for strep throat?

If you test positive for strep throat, you are probably wondering, “What will cure strep throat fast?” Healing quickly helps kids get back to school, you back to work, and everyone move on with life. While there are some methods for soothing strep sore throat symptoms (drinking warm liquids, gargling with warm salt water, and taking over-the-counter painkillers), antibiotics are usually recommended when you want to eradicate strep throat quickly and thoroughly.

Antibiotics are “the best option for treating strep throat,” says David Culpepper, MD, clinical director of LifeMD. “Overall, most antibiotics reduce the period of acute illness by about one day,” he explains. According to the CDC, the benefits of antibiotic use for strep throat include:

• Reduced number of days ill
• Fewer and more manageable symptoms
• Decreased risk of spreading strep to others

 Not everyone needs antibiotics for strep, though. People who are asymptomatic carriers likely don’t need a course of antibiotics, for example. Many cases of strep in healthy individuals will resolve on their own, without antibiotics, says Omid Mehdizadeh, MD, ENT and laryngologist at Providence Saint John’s Health Center. But the main reason he recommends antibiotics is to protect against long-term complications that can result from a strep infection.

“The medical therapy is used more so to prevent us from developing sequelae of infection due to the damage our own immune system is able to incur,” Dr. Mehdizadeh explains. “Such conditions include rheumatic fever, scarlet fever, and glomerulonephritis [inflammation of the kidney filters].” 

RELATED: The parent’s guide to strep throat in kids

Does Zithromax treat strep throat?

Z-pak (also known as Zithromax or sometimes called a Z-pack) is the brand name for the antibiotic azithromycin. Z-paks are available in pill and liquid form. Z-paks are packaged as a five-day course and are a fast and effective way to treat bacterial infections. Antibiotics don’t treat viral infections, like COVID-19, the flu, or the common cold.

Besides using Zithromax for strep, the antibiotic can be used to treat conditions like: 

• Pneumonia
• STDs
• Ear infections
• Sinus infections
• Bacterial bronchitis
• Skin infections like acne
• Lyme disease
• Infectious diarrhea

How Z-paks are used to treat strep throat?

Generally, the first line of defense for strep throat is the antibiotic penicillin, says Vicken Zeitjian, MD, a cardiologist who has treated strep throat through Teladoc. “However, some folks may have a penicillin allergy (which is very common) or may have had strep many times in their life and have therefore developed antibiotic resistance to strep (less common),” he explains. In these cases, second-line antibiotics, including azithromycin, may be prescribed for strep.

How fast does a Z-Pak work for strep throat?

One of the advantages of using Zithromax to treat strep throat is how quickly it works. “I’ve seen doctors prescribe Z-paks because of the shorter duration of treatment (usually 5 days) compared to other antibiotics, which require 7-10 days,” says Dr. Zeitjian.

Z-pak dosage for strep throat

If you are prescribed a Z-pak for strep throat, you will likely be prescribed a pack of Zithromax tablets meant to last five days. On the first day, you will take two 250 mg pills (a 500-milligram dose), and the following four days, you will take 250 milligrams per day. Most feel better within the first day or two, but you should take your full 5-day course. Children who are using Zithromax for strep throat will be dosed by their weight, 12 mg/kg on the first day, then 6 mg/kg per day for the remaining 4 days. 

Side effects of Z-paks for strep throat 

Side effects aren’t common when taking a multi-dose regimen of Zithromax, but they are possible. The most common side effects in adults include:

• Diarrhea
• Vomiting
• Stomach pain

Children taking Zithromax experience similar side effects to adults. In most cases, these side effects will rapidly resolve once the medication is stopped. Serious adverse effects are rare (less than 1%), and include heart issues, skin jaundice, dizziness, headache, and serious allergic reactions.

 People who have known allergies or hypersensitivities to Zithromax should not take a Z-pak. Z-paks are also not recommended for people with liver dysfunction and a history of cholestatic jaundice.

How well do Z-paks treat strep throat? 

Although Z-paks are not the first-line antibiotic for strep throat (penicillin is), it is easy to take and effective. “Z-paks are a reasonable second line choice to treat strep,” says Dr. Zeitjian. He says that it’s important to keep in mind that antibiotics are prescribed based on their spectrum of activities, and not necessarily on their level of strength. “Each class of antibiotics may be effective in different settings,” he notes, emphasizing that Z-paks work well for those allergic to penicillin, or who are looking for alternative options to penicillin.

Dr. Culpepper explains that Z-paks are a strong option when it comes to eliminating strep throat symptoms, like sore throat, fever, and swollen lymph nodes. “Z-paks do about as well as penicillin in helping patients recover from strep throat,” he says. The one advantage of penicillin over Z-paks is that it usually does a superior job of eradicating the strep bacteria from the body, Dr. Culpepper says. 

Are Z-paks the right antibiotic for you? 

If you or your family members are diagnosed with strep throat, and an antibiotic is recommended for treatment, you might be unsure if Z-paks are the best choice. There are various reasons why you might want to use a Z-pak for treatment—including a previous allergy or sensitivity to penicillin or another recommended antibiotic, the desire for a shorter course of antibiotics, or a previous positive experience with Z-paks.

Z-paks are a good antibiotic choice for strep throat, and can eliminate symptoms quickly, but they aren’t for everyone. Please talk to your healthcare provider about your health situation, and whether Z-paks are right for you.