Cost Comparison: Amoxicillin vs Azithromycin
Amoxicillin is substantially less expensive out-of-pocket than azithromycin for treating common bacterial infections in adults.
Price Differential
Amoxicillin is consistently recommended as a first-line agent in multiple guidelines specifically because of its low cost, in addition to its proven efficacy against common respiratory pathogens like Streptococcus pneumoniae 1, 2.
European and CDC guidelines explicitly cite amoxicillin's cost-effectiveness as a key advantage, noting it as "inexpensive" compared to macrolides and other alternatives 1.
Azithromycin, while offering once-daily dosing convenience, is more expensive than amoxicillin and this cost difference is acknowledged in treatment guidelines 1, 2.
Clinical Context Supporting Cost Considerations
For previously healthy adults with community-acquired pneumonia, amoxicillin 1 gram three times daily for 5-7 days is the preferred first-line therapy based on strong evidence, with cost being one factor favoring its selection 2, 3.
Azithromycin should only be used as first-line monotherapy when local pneumococcal macrolide resistance is documented to be <25%, further limiting its appropriate use compared to amoxicillin 2, 3.
The combination of amoxicillin-clavulanate is noted as "more expensive" than plain amoxicillin, and azithromycin falls into a similar higher-cost category compared to basic penicillins 1, 4.
Practical Implications
Generic amoxicillin is widely available at very low cost (often $4-10 for a full course at major pharmacy chains), while azithromycin typically costs $20-50 or more for a Z-pack, even in generic form.
The shorter duration of azithromycin (3-5 days) does not offset its higher per-pill cost compared to amoxicillin's longer course (7-10 days).
For patients without insurance or with high deductibles, choosing amoxicillin over azithromycin can result in significant out-of-pocket savings while maintaining excellent clinical efficacy for susceptible organisms 1, 2.