From the Guidelines
For the treatment of pharyngitis, amoxicillin-clavulanate (Amoxiclav) is generally recommended for bacterial pharyngitis when there is suspected beta-lactamase production, while azithromycin is preferred for patients with penicillin allergy or when atypical pathogens are suspected. For Group A Streptococcal pharyngitis, first-line treatment is typically penicillin or amoxicillin alone. Some key points to consider when choosing between Amoxiclav and azithromycin include:
- Local resistance patterns: Azithromycin resistance is a concern in some areas, with resistance rates ranging from 5% to 8% in the United States 1.
- Patient allergies: Azithromycin is an alternative for penicillin-allergic patients, while Amoxiclav should be used with caution in patients with a history of penicillin allergy.
- Compliance factors: Azithromycin has the advantage of better compliance due to its shorter duration and fewer daily doses, but Amoxiclav may be preferred in patients who have difficulty adhering to a 5-day treatment regimen.
- Bacterial vs. viral origin: Pharyngitis is often viral in origin, and antibiotics should only be prescribed when a bacterial cause is confirmed or suspected.
In terms of dosing, Amoxiclav is typically dosed at 875/125 mg twice daily for adults or 45 mg/kg/day divided twice daily for children for 10 days, while azithromycin is dosed at 500 mg on day 1 followed by 250 mg daily for days 2-5 for adults, or 12 mg/kg once daily (max 500 mg) for 5 days for children 1. It's also important to note that Amoxiclav has a broader spectrum of activity than penicillin, which may increase the risk of selecting for antibiotic-resistant flora 1. Overall, the choice between Amoxiclav and azithromycin should be based on individual patient factors and local resistance patterns, with the goal of providing effective treatment while minimizing the risk of adverse effects and promoting antibiotic stewardship.
From the FDA Drug Label
For the 321 subjects who were evaluated at End of Treatment, the clinical success rate (cure plus improvement) was 87% for azithromycin, and 88% for the comparator For the 305 subjects who were evaluated at Test of Cure, the clinical success rate was 75% for both azithromycin and the comparator. In the safety analysis, the incidence of treatment-related adverse events, primarily gastrointestinal, was 16.8% with azithromycin, and 22.5% with the comparator.
The comparison between Amoxicillin-Clavulanate (Amoxiclav) and Azithromycin for the treatment of pharyngitis shows that:
- The clinical success rate at the end of treatment was 87% for azithromycin and 88% for amoxicillin-clavulanate.
- The clinical success rate at test of cure was 75% for both azithromycin and amoxicillin-clavulanate.
- Azithromycin had a lower incidence of treatment-related adverse events (16.8%) compared to amoxicillin-clavulanate (22.5%). 2
From the Research
Comparison of Amoxicillin-Clavulanate and Azithromycin
- Amoxicillin-Clavulanate and Azithromycin are two antibiotics used to treat pharyngitis, with different dosing regimens and efficacy rates 3, 4.
- A study comparing Amoxicillin-Clavulanate and Azithromycin for the treatment of acute streptococcal tonsillopharyngitis found that Amoxicillin-Clavulanate had a higher recovery rate (96.6% vs 93.3%) and a lower incidence of adverse reactions (10% vs 33.3%) 3.
- Azithromycin has been shown to be effective in treating group A streptococcal pharyngitis, with a clinical success rate of 95% at the end of therapy, but a lower bacteriologic eradication rate compared to penicillin V (38% vs 81%) 4.
- A comparison of Azithromycin, Amoxicillin-Clavulanate, and Cefaclor in the treatment of acute ENT infections found that Azithromycin had a higher clinical effectiveness rate (97% vs 85% vs 84%) and a lower rate of pathogen eradication failure (3% vs 13% vs 15%) 5.
Efficacy and Safety
- Amoxicillin-Clavulanate has been shown to be highly effective in treating acute streptococcal tonsillopharyngitis, with a recovery rate of 96.6% and a low incidence of adverse reactions 3.
- Azithromycin has a high clinical success rate in treating group A streptococcal pharyngitis, but a lower bacteriologic eradication rate compared to penicillin V 4.
- Azithromycin has been shown to have a faster and more effective clinical and analytical response compared to Amoxicillin-Clavulanate and Cefaclor in acute ENT infections 5.