Augmentin vs. Zithromax
See how Augmentin and Zithromax compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Augmentin is a penicillin-class antibiotic with a beta-lactamase inhibitor, while Zithromax is a macrolide, so they work differently against bacteria and cover different infections.
Augmentin typically requires multiple daily doses for 7 to 10 days, while Zithromax often uses a short 5-day pack or even a single dose.
Zithromax carries a risk of heart rhythm problems that Augmentin does not, while Augmentin carries a higher rate of diarrhea linked to its clavulanate component.
Augmentin vs. Zithromax Drug Summary
Augmentin
Augmentin combines amoxicillin with clavulanate, a beta-lactamase inhibitor, making it a penicillin-class antibiotic effective against bacteria that would otherwise resist amoxicillin alone. It treats infections like sinusitis, ear infections, urinary tract infections, and pneumonia. It comes as a tablet, chewable, or liquid suspension, usually taken every 8 to 12 hours for 7 to 10 days.
Zithromax
Zithromax, known generically as azithromycin, is a macrolide antibiotic that treats respiratory infections, skin infections, and certain sexually transmitted infections. It is taken as a tablet or liquid, often as a 5-day tapering dose pack known as the Z-Pak, or sometimes as a single dose. Its long tissue half-life lets it keep working after the last dose is taken.
Augmentin vs. Zithromax Side Effects
Augmentin
Zithromax
Augmentin vs. Zithromax Dosage
Augmentin
Zithromax
| STAGE | DOSE | WHEN |
| Starting dose | 250 mg/125 mg q8h | At the start |
| Maximum dose | 2000 mg/125 mg q12h | If needed |
| Dose changes | 4 increases | As tolerated |
| STAGE | DOSE | WHEN |
| Starting dose | 500 mg once daily | Day 1 |
| Maximum dose | 30 mg/kg single dose | If needed |
| Dose changes | 5 increases | As tolerated |
Augmentin
| STAGE | DOSE | WHEN |
| Starting dose | 250 mg/125 mg q8h | At the start |
| Maximum dose | 2000 mg/125 mg q12h | If needed |
| Dose changes | 4 increases | As tolerated |
Zithromax
| STAGE | DOSE | WHEN |
| Starting dose | 500 mg once daily | Day 1 |
| Maximum dose | 30 mg/kg single dose | If needed |
| Dose changes | 5 increases | As tolerated |
Augmentin vs. Zithromax Indications
Augmentin
Augmentin is FDA-approved for common bacterial infections including sinus infections, ear infections, urinary tract infections, and pneumonia. It is not effective against viral infections like the common cold, and it should not be used in anyone with a history of penicillin allergy or prior liver problems linked to amoxicillin/clavulanate.
Lower respiratory tract infections
Acute bacterial otitis media
Acute bacterial sinusitis
Skin and skin structure infections
Urinary tract infections
Zithromax
Zithromax is FDA-approved for respiratory infections, skin infections, and sexually transmitted infections such as chlamydia and gonorrhea-related urethritis. It is also used off-label for traveler's diarrhea and chlamydial conjunctivitis, though these are not FDA-approved indications. Like Augmentin, it does not treat viral infections.
Community-acquired pneumonia
Acute bacterial sinusitis
Skin and skin structure infections
Urethritis/cervicitis (chlamydia, gonorrhea)
Pharyngitis/tonsillitis (alternative therapy)
Augmentin vs. Zithromax Pros and Cons
Augmentin
Augmentin's added clavulanate broadens coverage against bacteria that produce beta-lactamase, making it useful for infections resistant to amoxicillin alone. It has decades of clinical use and comes in several formulations for different ages. It requires more frequent dosing than Zithromax and carries a higher risk of diarrhea.
Pros
Clavulanate component overcomes bacterial resistance to amoxicillin alone
Available in chewable, liquid, and extended-release forms for all ages
No FDA boxed warning
Covers urinary tract infections, which Zithromax is not approved to treat
Cons
Requires dosing every 8 to 12 hours for a full 7 to 10 day course
Higher rate of diarrhea and GI upset from the clavulanate component
Contraindicated with any history of amoxicillin/clavulanate-related liver injury
Not effective against atypical bacteria like Chlamydia or Mycoplasma
Zithromax
Zithromax's long tissue half-life allows short courses, including single-dose treatment for some infections, which can improve completion rates. It covers atypical bacteria and certain sexually transmitted infections that Augmentin does not treat. It carries a cardiac risk that Augmentin does not share.
Pros
Short treatment courses, including single-dose options, improve adherence
Effective against atypical bacteria and certain sexually transmitted infections
Long-acting tissue levels continue working after the last dose
Approved for MAC disease prevention and treatment in immunocompromised patients
Cons
Carries a risk of QT prolongation and dangerous heart rhythm changes
Associated with increased cardiovascular death risk in certain regimens
Not first-line therapy for pharyngitis or tonsillitis
Rising bacterial resistance limits effectiveness of macrolides in some regions
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