What are alternatives to Zithromax (Azithromycin)?

From the Guidelines

Alternatives to Zithromax (Azithromycin) include Clarithromycin, Erythromycin, and Doxycycline.

Macrolide Alternatives

• Clarithromycin is an acceptable alternative to Azithromycin when it is not available or not tolerated, as stated in the guidelines for treating macrolide-susceptible MAC pulmonary disease 1.
• Erythromycin is another alternative, although it may have more drug interactions and a higher pill burden compared to Azithromycin and Clarithromycin.

Non-Macrolide Alternatives

• Doxycycline can be used as an alternative for certain infections, such as those caused by Chlamydia trachomatis or Chlamydophila pneumoniae, especially in adolescents with skeletal maturity 1.
• Levofloxacin and Moxifloxacin are also alternatives for certain infections, but their use may be limited by resistance patterns and age restrictions 1. It's essential to consider the specific infection, patient population, and local resistance patterns when choosing an alternative to Azithromycin. The dose and duration of therapy should be guided by evidence-based recommendations and clinical judgment.

From the FDA Drug Label

NOTE: Penicillin by the intramuscular route is the usual drug of choice in the treatment of Streptococcus pyogenes infection and the prophylaxis of rheumatic fever. Pharyngitis/tonsillitis caused by Streptococcus pyogenes as an alternative to first-line therapy in individuals who cannot use first-line therapy

Alternatives to Zithromax (Azithromycin) include:

• Penicillin by the intramuscular route for the treatment of Streptococcus pyogenes infection and the prophylaxis of rheumatic fever. Azithromycin is used as an alternative to first-line therapy in individuals who cannot use first-line therapy for pharyngitis/tonsillitis caused by Streptococcus pyogenes 2 2

From the Research

Alternatives to Zithromax (Azithromycin)

• Clarithromycin: a macrolide antibiotic that is equivalent to azithromycin in treating respiratory tract and soft tissue infections, but has better activity against atypical respiratory pathogens such as Legionella 3, 4
• Moxifloxacin: a fluoroquinolone antibiotic that has been shown to be clinically and bacteriologically equivalent to azithromycin in treating acute exacerbations of chronic bronchitis 5
• Erythromycin: a macrolide antibiotic that is less potent than azithromycin and clarithromycin, but can be used as an alternative in some cases 3, 4

Comparison of Alternatives

• Clarithromycin and azithromycin have better activity against Haemophilus influenzae and Moraxella catarrhalis than erythromycin, making them better choices for community-acquired pneumonia 4
• Clarithromycin is more effective than azithromycin against Mycobacterium avium complex (MAC) in patients with AIDS, while azithromycin is preferred for the treatment of Chlamydia trachomatis infections 4
• Moxifloxacin has excellent in-vitro activity against antibiotic-resistant respiratory pathogens, making it a good alternative for patients with acute exacerbations of chronic bronchitis 5

Considerations for Choosing an Alternative

• The type of organism causing the infection, as well as the patient's medical history and potential drug interactions, should be taken into account when choosing an alternative to azithromycin 4
• The cost of the alternative antibiotic, as well as its convenience and tolerability, should also be considered 6, 4