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Amoxicillin Clavulanate (Augmentin) versus Other Medications
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Azithromycin (Zithromax) versus Other Medications

Azithromycin (Zithromax) vs. Clarithromycin (Biaxin)
  • Pneumonia
    Azithromycin (3-day, once-daily course) is as effective and well tolerated as clarithromycin (10-day, twice-daily course) in the treatment of mild to moderate community-acquired pneumonia.
    Randomized, multicentre study7 compared azithromycin versus clarithromycin in the treatment of adults with mild to moderate community-acquired pneumonia. A satisfactory clinical response was recorded at the end of therapy in 83 of 88 (94%) evaluable azithromycin-treated and 84 of 88 (95%) evaluable clarithromycin-treated patients. At day 19-23, only one patient in each treatment group had relapsed. Thirty-one of 32 (97%) pathogens isolated from patients in the azithromycin group were eradicated, compared with 32 of 35 (91%) isolated from clarithromycin patients. Incidences of treatment-related adverse events were similar for the two groups. Two (2%) clarithromycin patients discontinued therapy due to severe treatment-related adverse events; none in the azithromycin group did.
  • Acute exacerbation of chronic bronchitis
    Three-day treatment with azithromycin 500 mg once daily is equivalent to a 10-day treatment with clarithromycin 500 mg twice daily in adults with acute exacerbation of chronic bronchitis (AECB).
    Randomized, double-blind, multicenter study6 compared the efficacy and safety of oral azithromycin 500 mg once daily for 3 days with those of oral clarithromycin 500 mg twice daily for 10 days. The clinical cure (based on direct observation of the patient) rates were equivalent in the two treatment groups at 85% with azithromycin and 82% with clarithromycin. Bacteriologic success rates were also equivalent between the azithromycin and clarithromycin treatment groups at test of cure for S. pneumoniae (90.6% and 85.2%, respectively), H. influenzae (71.4% and 81.3%, respectively) and M. catarrhalis (100% and 86.7%, respectively). The overall incidence of treatment-related adverse events was similar in the azithromycin and clarithromycin groups (20.9% and 26.8%, respectively), with the most common being abdominal pain (6.3% and 6.1%, respectively), diarrhea (4.4% and 5.5%, respectively), and nausea (4.4% and 3.7%, respectively).
  • Otitis media (infection of the middle ear)
    Both azithromycin and clarithromycin are effective for the treatment of children with acute otitis media.
    A randomized, open clinical trial8 compared the efficacy, safety and tolerance of azithromycin and clarithromycin in pediatric patients with acute otitis media. Of 100 patients enrolled, 97 were considered evaluable. The most common middle ear pathogens were Streptococcus pneumoniae (60%), Haemophilus influenzae (15%) and Staphylococcus aureus (13%). Fifty patients (100%) treated with azithromycin and 45 (95.7%) patients treated with clarithromycin had a satisfactory clinical response. Rates of persistence of middle ear effusion and possible drug related side effects were comparable.

Azithromycin (Zithromax) vs. Doxycycline
  • Chlamydia trachomatis infections
    In clinical trials2, the bacteriological cure rate of single dose azithromycin 1000 mg (95 to 100%) was similar to that of oral doxycycline 200 mg/day for 7 days (88 to 100%).
    However, according to the recent research1 Azithromycin may be particularly effective against persistent chlamydial infection. In contrast, doxycycline may not be as effective in treating persistent infection.
    Chronic chlamydial infections such as pelvic inflammatory disease or trachoma involve persistent infection and uncomplicated infections are a mixture of acute and persistent infections. Therefore azithromycin would be more effective for the treatment of chlamydial infections than doxycycline1.
  • Endocervicitis
    Both azithromycin and doxycycline are effective in the treatment of non-gonococcal endocervicitis.
    Prospective-randomised study3 compared azithromycin versus doxycycline in the treatment of non-gonococcal mucopurulent endocervicitis. The eradication rate of bacteria in the azithromycin group was 71.4%, and 77.3% in the doxycycline group.
  • Acne
    Azithromycin 500 mg once a day for four days per month appears to be as effective as daily doxycycline 100 mg4.
  • Lyme disease (Erythema migrans)
    Azithromycin is equally effective as doxycycline in the treatment of Lyme disease.
    A randomized, multicenter, open clinical trial5 compared the effectiveness of azithromycin and doxycycline in the treatment of Lyme disease associated with erythema migrans. Clinical success (based on direct observation of the patient) was observed in 95.8% azithromycin- and 82.5% doxycycline-treated patients.
Azithromycin (Zithromax) vs. Minocycline
  • Acne
    Azithromycin is at least as effective as minocycline in the treatment of facial comedonic and papulopustular acne.
    An open study10 compared the clinical efficacy and tolerability of azithromycin and minocycline. Azithromycin was administered as a single oral dose (500 mg/day) for 4 days in four cycles every 10 days and minocycline was administered 100 mg daily for 6 weeks. Improvement was assessed 6 weeks after initiation of treatment with a four-graded scale. A satisfactory clinical response was observed in 75.8% of the patients treated with azithromycin and in 70.5% of those treated with minocycline. Both agents were well tolerated and mild side effects were reported in 10.3% of azithromycin and 11.7% of minocycline treated patients.

Azithromycin (Zithromax) vs. Amoxicillin
  • Chlamydia infection
    Chlamydia infection during pregnancy. Both amoxicillin and azithromycin are effective in the treatment of cervical Chlamydia trachomatis infection during pregnancy. However, azithromycin seems to have a lower rate of recurrent infection12. Amoxicillin is slightly better tolerated than azithromycin.
    In a randomized controlled trial11 comparing amoxicillin and azithromycin there was similar treatment efficacy between amoxicillin and azithromycin (58% vs 64%, respectively). In the study 5.5% of women were intolerant to amoxicillin, compared with 10.9% to azithromycin.
  • Otitis media
    Single dose azithromycin is as effective as high dose amoxicillin for 10 days for the treatment of children with otitis media. Diarrhea occurs more frequently with amoxicillin therapy than with azithromycin.
    In a randomized, multicenter, double blind trial13 children (6-30 months of age) with acute otitis media (AOM) were randomized to treatment with single dose azithromycin (30 mg/kg) or high dose amoxicillin (90 mg/kg/d, in 2 divided doses) for 10 days. The clinical success rates for azithromycin and amoxicillin were comparable for all patients (84% and 84%, respectively) and for children < or =2 years of age (82% and 82%, respectively). The clinical efficacies among all microbiologic modified intent-to-treat evaluable subjects were comparable for patients treated with azithromycin (80%) and patients treated with amoxicillin (83%). The rates of side effects for azithromycin and amoxicillin were 20% and 29%, respectively. Diarrhea was more common with amoxicillin therapy than with azithromycin (17.5% and 8.2%, respectively). Compliance was higher in the azithromycin group (100%) than in the amoxicillin group (90%).
  • Lyme disease
    Amoxicillin is more effective than azithromycin for erythema migrans.
    In a double-blind, randomized, controlled trial14 patients treated with amoxicillin were significantly more likely than those treated with azithromycin to achieve complete resolution of disease at day 20, the end of therapy (88% compared with 76%). More azithromycin-treated patients (16%) than amoxicillin-treated patients (4%) had relapse. For patients treated with azithromycin, development of an antibody response increased the possibility of achieving a complete response (81% of seropositive patients achieved a complete response compared with 60% of seronegative patients). Patients with multiple erythema migrans lesions were more likely than patients with single erythema migrans lesions to have a positive antibody titer at baseline. Fifty-seven percent of patients who had relapse were seronegative at the time of relapse.
Azithromycin (Zithromax) vs. Augmentin
  • Otitis media
    Azithromycin and amoxicillin/clavulanate have similar efficacy in the treatment of acute otitis media in children. However, azithromycin is significantly better tolerated than amoxicillin/clavulanate.
    Randomized, double-blind study15 compared azithromycin and amoxicillin/ clavulanate for the treatment of acute otitis media in children. One hundred and eighty-eight children (mean age 3.5 years) were randomized to azithromycin and 185 to co-amoxiclav. At day 10, the clinical success rate was 153/185 (83%) in children treated with azithromycin and 159/181 (88%) in children treated with co-amoxiclav. At day 28, 134/182 (74%) of the children were cured on azithromycin compared with 124/180 (69%) on co-amoxiclav. Also at day 28, signs of acute otitis media, such as abnormal reflectometry (45% versus 59%), bulging of the eardrum (10% versus 16%) and loss of tympanic membrane landmarks (11% versus 22%) were seen less frequently in azithromycin- than co-amoxiclav-treated children, respectively. Treatment-related side effects were seen in 11% of azithromycin patients compared with 20% on co-amoxiclav.
  • Sinusitis
    Azithromycin and amoxicillin/clavulanate have similar efficacy in the treatment of sinusitis. However, azithromycin is better tolerated than amoxicillin/clavulanate.
    Randomized double-blind study16 compared 3- and 6-day regimens of azithromycin with a 10-day amoxicillin-clavulanate regimen for treatment of acute bacterial sinusitis. Clinical success (based on direct observation of the patient) rates were equivalent among patients at the end of therapy (azithromycin 3 days, 88.8%; azithromycin 6 days, 89.3%; amoxicillin/clavulanate, 84.9%) and at the end of the study (azithromycin 3 days, 71.7%; azithromycin 6 days, 73.4%; amoxicillin/clavulanate, 71.3%). Patients treated with amoxicillin/clavulanate reported a higher incidence of treatment-related side effects (51.1%) than azithromycin-3 (31.1%) or azithromycin-6 (37.6%). More amoxicillin/clavulanate patients discontinued the study (n = 28) than azithromycin-3 (n = 7) and azithromycin-6 (n = 11). Diarrhea was the most frequent treatment-related side effect.
  • Lower respiratory tract infections
    Azithromycin and amoxicillin/clavulanate have similar efficacy in the treatment of lower respiratory tract infections, but azithromycin is better tolerated than amoxicillin/clavulanate. An additional advantage of the azithromycin is the easy administration and short duration of therapy.
    Multicentre randomized double-blind, double-dummy study17 compared the efficacy, safety and tolerability of a 3 day course of azithromycin with a 10 day course of co-amoxiclav in the treatment of children with acute lower respiratory tract infection. Of 110 patients, 56 and 54 patients, respectively, were treated with azithromycin or co-amoxiclav. The percentage of patients cured or clinically improved at days 10-13 (primary endpoint) was 91% for azithromycin and 87% for co-amoxiclav. This difference of 4% was not statistically significant. Significantly more treatment-related side effects were found in the co-amoxiclav group. This was largely due to a higher percentage (43% versus 19%) of gastrointestinal complaints.
Azithromycin (Zithromax) vs. Penicillin
  • Streptococcal pharyngitis/tonsillitis
    Azithromycin (10 or 20 mg/kg/day one daily for 3 days) is as safe and effective as penicillin V (4 times daily for 10 days) in the treatment of paediatric patients with acute pharyngitis/tonsillitis.
    The efficacy and safety of azithromycin and penicillin V in the treatment of acute streptococcal pharyngitis/tonsillitis in paediatric patients were compared in a double-blind, double-dummy prospective study9. A satisfactory clinical response (cure or improvement) was recorded in 99% of the 10 mg/kg azithromycin group, 100% of the 20 mg/kg azithromycin group, and 97% of the penicillin V group at the end of therapy (day 12-14). At the follow-up evaluation (day 28-30), relapse rates in patients cured or improved at the end of therapy were 6%, 5%, and 2%, respectively. Bacteriological eradication rates at the end of therapy were 98% in both azithromycin groups and 92% in patients who received penicillin V; pathogen recurrence was recorded at follow-up in 4% of the 20 mg/kg azithromycin group and in 6% of both the 10 mg/kg azithromycin and penicillin V groups. Treatment-related adverse events, the majority of mild to moderate severity, occurred in 13% of patients in the 20 mg/kg azithromycin group, 9% in the 10 mg/kg azithromycin group, and 5% in the penicillin V group.

Azithromycin (Zithromax) vs. Cefadroxil (Duricef)
  • Skin and skin structure infections
    Azithromycin may be somewhat more effective than cefadroxil for treating uncomplicated skin and skin structure infections. Also, azithromycin is better tolerated.
    Multicenter, investigator-blind study18 compared the efficacy and safety of azithromycin and cefadroxil for the treatment of uncomplicated skin and skin structure infections. Clinical and bacteriologic response was assessed between days 10 and 13 (primary end point) and between days 28 and 32. Clinical success (resolution of symptoms) rates assessed between days 10 and 13 were 97% (111/114) for azithromycin and 96% (101/105) for cefadroxil. For azithromycin and cefadroxil, corresponding rates of bacteriologic eradication for Staphylococcus aureus were 94% (64/68) and 86% (60/70), respectively, and for Streptococcus pyogenes, 80% (4/5) and 100% (6/6), respectively. Clinical success rates assessed between days 28 and 32 were 100% (82/82) for azithromycin compared with 90% (75/83) for cefadroxil. Corresponding rates of eradication for S aureus were 100% (59/59) versus 89% (56/63), respectively; and for S pyogenes, 100% (4/4) versus 83% (5/6), respectively. The incidence of treatment-related side effects was similar in the 2 treatment groups. However, 5 of the 139 patients (4%) in the cefadroxil group discontinued therapy because of treatment-related side effect compared with none of the 152 patients in the azithromycin group.

Azithromycin (Zithromax) vs. Cefdinir (Omnicef)
  • Pneumococcal pulmonary infections.
    Cefdinir or azithromycin have comparable effectiveness in the treatment of acute otitis media.
    A multicenter, prospective, single-blind study19 compared cefdinir and azithromycin in children with acute otitis media. Three hundred fifty-seven patients were enrolled in the study. The majority of evaluable children (77%) had previously received conjugated heptavalent pneumococcal vaccine (PCV7) against Streptococcus pneumoniae. At the end-of-therapy visit, clinical cure (resolution of symptoms) rates were comparable for cefdinir and azithromycin (87%, [151/174] and 85% [149/176], respectively). In addition, clinical cure rates at the end-of-therapy visit in the children who had been vaccinated with PCV7 were comparable between cefdinir and azithromycin (86% vs 83%). No significant difference in clinical cure rates was observed at the follow-up visit (76% and 86%). Parental satisfaction was similar between treatment groups with regard to ease of use, taste, compliance, health care resource utilization, and missed days of work and day-care. Both antibiotics were well tolerated; diarrhea and abnormal stools were the most common antibiotic-related side effects.

Azithromycin (Zithromax) vs. Cefuroxime axetil (Ceftin)
  • Exacerbations of chronic obstructive pulmonary disease
    Both azithromycin and cefuroxime are effective treatments for exacerbations in patients with chronic obstructive pulmonary disease. Azithromycin has a lower rate of side effects.
    A randomized study20 compared 3 days of azithromycin treatment and 10 days of cefuroxime treatment in exacerbations in patients with chronic obstructive pulmonary disease. 50 patients were treated with azithromycin and 51 with cefuroxime. The evolution of the symptoms was similar although with a trend to greater improvement in those treated with azithromycin. Functional and gasometric evolution was similar in the two schedules. Three patients treated with azithromycin required hospital admission, as did 5 treated with cefuroxime. A greater number of treatment-related side effects were observed in patients treated with cefuroxime (18%) than in those receiving azithromycin (10%), with gastrointestinal side effects being the most commonly observed.

Azithromycin (Zithromax) vs. Ciprofloxacin (Cipro)
  • Chronic prostatitis (Chlamydia trachomatis)
    Azithromycin is significantly more effective than ciprofloxacin 21.
    Significantly higher eradication and a significantly higher clinical cure were achieved in the group of patients treated with azithromycin than in the ciprofloxacin group.
  • Shigellosis
    Ciprofloxacin is somewhat more effective than azithromycin in the treatment of Shigellosis (a type of infective diarrhea) 22.
    In a double-blind, randomized, controlled trial azithromycin therapy was clinically successful in 28 (82%) patients and ciprofloxacin therapy in 32 (89%) patients. Therapy was bacteriologically successful in 32 (94%) patients receiving azithromycin and 36 (100%) patients receiving ciprofloxacin.
  • Gonorrhea
    1 g azithromycin is at least as effective and well tolerated as 500 mg of ciprofloxacin in the treatment of gonococcal infections. Azithromycin is particularly useful for sailors and people constantly on the move 23.
    59 men and 49 women with gonococcal infection were enrolled in clinical study. Data of 50 patients treated with azithromycin and 51 with ciprofloxacin were evaluable for efficacy and tolerability at the end of the study. After 2 weeks clinical and microbiological cure rates were 96.0% (48 out of 50) for the patients treated with azithromycin and 92.15% (47 out of 51) for the patients treated with ciprofloxacin. Side effects were reported in 5 patients treated with azithromycin and 6 with ciprofloxacin.

Azithromycin (Zithromax) vs. Levofloxacin (Levaquin)
  • Acute bacterial exacerbations of chronic bronchitis
    Standard 5-day course of oral azithromycin was clinically and bacteriologically equivalent to a 7-day course of oral levofloxacin in the treatment of ABECB. Favorable results were demonstrated in 89% of patients receiving azithromycin and in 92% of patients receiving levofloxacin by day 4 of therapy. At day 24 favorable responses were approximately 82% and 86%, respectively. The bacterial eradication rates of respiratory pathogens were 96% for azithromycin and 85% for levofloxacin24. Both treatments are well-tolerated, with the majority of adverse events being GI in nature.
  • Community-acquired pneumonia
    A single 2 g dose of azithromycin microspheres is at least as effective as a 7-day course of levofloxacin in the treatment of mild to moderate community-acquired pneumonia25.
    The cure rates were 89.7% for azithromycin microspheres and 93.7% for levofloxacin. Bacteriologic success at test of cure in the "bacteriologic per protocol" population was 90.7% for azithromycin microspheres and 92.3% for levofloxacin. Both medications were well tolerated. The incidence of side effects was 19.9% for azithromycin and 12.3% for levofloxacin.
  • Sinusitis
    Single 2 g dose azithromycin microspheres has efficacy comparable to 10 days of levofloxacin in the treatment of acute bacterial sinusitis26.
    Clinical success rates were 94.5% with azithromycin-microspheres and 92.8% with levofloxacin. In patients with Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis, clinical cure rates were 97.3%, 96.3%, and 100%, respectively, for the azithromycin and 92.3%, 100%, and 90.9%, respectively, for the levofloxacin.

Further reading

References
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  • 2. Lau CY, Qureshi AK. Azithromycin versus doxycycline for genital chlamydial infections: a meta-analysis of randomized clinical trials. Sex Transm Dis. 2002 Sep;29(9):497-502. PubMed
  • 3. Sendag( F, Terek C, Tuncay G, Ozkinay E, Guven M. Single dose oral azithromycin versus seven day doxycycline in the treatment of non-gonococcal mucopurulent endocervicitis. Aust N Z J Obstet Gynaecol. 2000 Feb;40(1):44-7. PubMed
  • 4. Parsad D, Pandhi R, Nagpal R, Negi KS. Azithromycin monthly pulse vs daily doxycycline in the treatment of acne vulgaris. J Dermatol. 2001 Jan;28(1):1-4. PubMed
  • 5. Barsic B, Maretic T, Majerus L, Strugar J. Comparison of azithromycin and doxycycline in the treatment of erythema migrans. Infection. 2000 May-Jun;28(3):153-6. PubMed
  • 6. Swanson RN, Lainez-Ventosilla A, De Salvo MC, Dunne MW, Amsden GW. Once-daily azithromycin for 3 days compared with clarithromycin for 10 days for acute exacerbation of chronic bronchitis: a multicenter, double-blind, randomized study. Treat Respir Med. 2005;4(1):31-9. PubMed
  • 7. O'Doherty B, Muller O. Abstract Randomized, multicentre study of the efficacy and tolerance of azithromycin versus clarithromycin in the treatment of adults with mild to moderate community-acquired pneumonia. Azithromycin Study Group. Eur J Clin Microbiol Infect Dis. 1998 Dec;17(12):828-33. PubMed
  • 8. Arguedas A, Loaiza C, Rodriguez F, Herrera ML, Mohs E. Comparative trial of 3 days of azithromycin versus 10 days of clarithromycin in the treatment of children with acute otitis media with effusion. J Chemother. 1997 Feb;9(1):44-50. PubMed
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Published: March 31, 2008
Last updated: January 09, 2010