Augmentin vs. Azithromycin
See how Augmentin and Azithromycin compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Augmentin combines amoxicillin with a beta-lactamase inhibitor to fight resistant bacteria, while azithromycin is a macrolide often used for short, convenient courses.
Azithromycin's 3- to 5-day or single-dose regimens are easy to complete, but the drug carries an FDA warning for QT prolongation and irregular heart rhythms.
Augmentin generally covers resistant bacteria more reliably but needs multiple daily doses and cannot be used by people with penicillin allergies.
Augmentin vs. Azithromycin Drug Summary
Augmentin
Augmentin is a penicillin-class antibiotic that combines amoxicillin with clavulanate, a beta-lactamase inhibitor that helps it work against bacteria resistant to amoxicillin alone. It treats infections like sinusitis, ear infections, pneumonia, skin infections, and urinary tract infections. It comes as a tablet, chewable tablet, or oral suspension, taken two to three times a day depending on the dose.
Azithromycin
Azithromycin is a macrolide antibiotic used for many of the same respiratory, skin, and sexually transmitted infections as Augmentin, plus pneumonia and pelvic inflammatory disease. It is best known for short treatment courses, often a 5-day pack or even a single dose, because it stays active in tissue for days. It comes as a tablet, oral suspension, or IV infusion.
Augmentin vs. Azithromycin Side Effects
Augmentin
Azithromycin
Augmentin vs. Azithromycin Dosage
Augmentin
Azithromycin
| STAGE | DOSE | WHEN |
| Starting dose | 250 mg/125 mg every 8 hrs | At the start |
| Maximum dose | 2000 mg/125 mg every 12 hrs | If needed |
| Dose changes | 4 increases | As tolerated |
| STAGE | DOSE | WHEN |
| Starting dose | 500 mg once | Day 1 |
| Maximum dose | 5 mg/kg once daily | Days 2-5 |
| Dose changes | 6 increases | As tolerated |
Augmentin
| STAGE | DOSE | WHEN |
| Starting dose | 250 mg/125 mg every 8 hrs | At the start |
| Maximum dose | 2000 mg/125 mg every 12 hrs | If needed |
| Dose changes | 4 increases | As tolerated |
Azithromycin
| STAGE | DOSE | WHEN |
| Starting dose | 500 mg once | Day 1 |
| Maximum dose | 5 mg/kg once daily | Days 2-5 |
| Dose changes | 6 increases | As tolerated |
Augmentin vs. Azithromycin Indications
Augmentin
Augmentin is FDA-approved for common bacterial infections including ear, sinus, lung, skin, and urinary tract infections. Adding clavulanate lets it treat bacteria that would otherwise resist plain amoxicillin. It is not effective against viral infections and should not be used by people with a history of penicillin allergy.
Acute bacterial otitis media (ear infections)
Acute bacterial sinusitis
Community-acquired pneumonia (Augmentin XR)
Skin and skin structure infections
Urinary tract infections
Azithromycin
Azithromycin is FDA-approved for many bacterial infections of the lungs, sinuses, throat, skin, and reproductive tract, including chlamydia and pelvic inflammatory disease. Its long tissue half-life allows short treatment courses compared with other antibiotics. It does not treat viral illnesses like the common cold or flu.
Community-acquired pneumonia
Pharyngitis and tonsillitis
Urethritis and cervicitis (chlamydia)
Pelvic inflammatory disease
Acute otitis media
Augmentin vs. Azithromycin Pros and Cons
Augmentin
Augmentin's added clavulanate broadens its coverage to bacteria that produce beta-lactamases, making it a reliable first-line choice for many common infections. It has been used since 1984 with a well-established safety record and no FDA boxed warning. It does require more frequent daily dosing and cannot be used by people with penicillin allergies.
Pros
Covers beta-lactamase-producing resistant bacteria
No FDA boxed warning, long safety track record since 1984
Available as chewable tablets and pediatric suspension
No QT-prolongation warning on the label
Cons
Requires dosing two to three times daily
Cannot be used in people with penicillin allergy
Higher rate of diarrhea than typical short-course antibiotics
Roughly $80 to $150 per course without insurance, generally pricier than generic azithromycin
Azithromycin
Azithromycin's long tissue half-life allows short 3- to 5-day or even single-dose regimens, which many patients find easier to complete. It can be used by people with penicillin allergies since it belongs to a different antibiotic class. It carries an FDA warning for QT prolongation and should be used cautiously in people with heart rhythm problems.
Pros
Short 3- to 5-day or single-dose regimens
Safe option for people with penicillin allergy
Generic 5-day course typically $15 to $50, less than Augmentin
Long tissue half-life keeps working after the course ends
Cons
FDA warning for QT prolongation and cardiovascular death risk
Higher rates of nausea and diarrhea than Augmentin
Less reliable against beta-lactamase-producing bacteria
Reports of infantile pyloric stenosis with use in newborns
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