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
- Azithromycin (Zithromax) facts
- Azithromycin vs Amoxicillin
- Azithromycin vs Amoxicillin/Clavulanate
- Azithromycin vs Cefdinir
- Azithromycin vs Ciprofloxacin
- Azithromycin vs Clarithromycin
- Azithromycin vs Doxycycline
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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