Azithromycin (Zithromax®) versus Penicillin

Based on "Antibiotic and Chemotherapy"
written by Roger G. Finch

Streptococcal pharyngitis/tonsillitis

Azithromycin is as safe and effective as penicillin V in the treatment of children with acute pharyngitis/tonsillitis9. Azithromycin regimen of 10 mg/kg once daily for 3 days is associated with low levels of eradication of bacterial pathogens1.


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Results of double-blind, double-dummy prospective study of paediatric patients with acute streptococcal pharyngitis/tonsillitis 2 Azithromycin Penicillin V
Regimen 10 or 20 mg/kg once daily for 3 days 125-250 mg 4 times daily for 10 days
Satisfactory clinical response (cure or improvement) rate at the end of therapy (day 12-14) 99-100% 97%
Relapse rates by day 28-30 in patients cured or improved at the end of therapy 5-6% 2%
Bacteriological eradication rates 98% 92%
Adverse events 9-13% 5%

Results of multicenter, randomized, comparative, open label study of children with acute group A streptococcal pharyngitis 1 Azithromycin Penicillin V
Regimen 10 mg/kg once daily for 3 days 100,000 IU/kg/day in 3 divided doses for 10 days
Clinical success (cure or improvement) at Day 14 95% 97%
Clinical success at Day 28 94% 95%
Bacteriologic eradication at Day 14 38% 81%
Bacteriologic eradication at Day 28 31% 68%

Lyme disease

Azithromycin appears to be as effective as penicillin V for the treatment of early Lyme disease and it may clear the erythema migrans more promptly3.

Results of randomized multicenter therapeutic trial of patients with erythema migrans 3 Azithromycin
(32 patients)
Penicillin V
(33 patients)
Regimen 500 mg once daily for 10 days 1 million U 3 times daily for 10 days
Number of patients who was completely free of all signs and symptoms of erythema migrans and did not develop new ones subsequently, 4 weeks after initiation of therapy 20 (62%) 17 (51%)
Number of patients who was completely free of all signs and symptoms 3 months after initiation of therapy 25 (78%) 28 (85%)
Side effects, number of patients 12 5

Syphilis

Azithromycin is comparable to benzathine penicillin in the treatment of early syphilis4. Gastrointestinal side effects of azithromycin are significantly more common than those of penicillin G benzathine.

Results of multicenter, randomized clinical trial of persons with early syphilis 4 Azithromycin Penicillin G
benzathine
Regimen single 2.0 g dose 2.4 million units intramuscularly
Serological cure, number of patients (%) 180 of 232 (77.6%) 186 of 237 (78.5%)
Nonserious adverse events 61.5% 46.3%

Results of randomized, controlled trial conducted in a in developing countries of persons with confirmed early symptomatic syphilis (primary or secondary) or high-titer latent syphilis 5 Azithromycin Penicillin G
benzathine
Regimen single 2.0 g dose 2.4 million units intramuscularly
Cure rates 97.7% 95%
Cure rates at 3 months 59.4% 59.5%
Cure rates at 6 months 85.5% 81.5%

Further reading

References

  • 1. Schaad UB, Kellerhals P, Altwegg M; Swiss Pharyngitis Study Group. Azithromycin versus penicillin V for treatment of acute group A streptococcal pharyngitis. Pediatr Infect Dis J. 2002 Apr;21(4):304-8. PubMed
  • 2. O'Doherty B. Azithromycin versus penicillin V in the treatment of paediatric patients with acute streptococcal pharyngitis/tonsillitis. Eur J Clin Microbiol Infect Dis. 1996 Sep;15(9):718-24. PubMed
  • 3. Weber K, Wilske B, Preac-Mursic V, Thurmayr R. Azithromycin versus penicillin V for the treatment of early Lyme borreliosis. Infection. 1993 Nov-Dec;21(6):367-72.
  • 4. Hook EW 3rd, Behets F, Van Damme K, Ravelomanana N, Leone P, Sena AC, Martin D, Langley C, McNeil L, Wolff M. A phase III equivalence trial of azithromycin versus benzathine penicillin for treatment of early syphilis. J Infect Dis. 2010 Jun 1;201(11):1729-35. PubMed
  • 5. Riedner G, Rusizoka M, Todd J, Maboko L, Hoelscher M, Mmbando D, Samky E, Lyamuya E, Mabey D, Grosskurth H, Hayes R. Single-dose azithromycin versus penicillin G benzathine for the treatment of early syphilis. N Engl J Med. 2005 Sep 22;353(12):1236-44. PubMed

Published: January 12, 2014
Last updated: February 08, 2017

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