Azithromycin vs. amoxicillin: Differences, similarities, and which is better for you

In this article:

• Main differences
• Conditions treated
• Efficacy
• Coverage and cost
• Side effects
• Interactions
• Warnings
• FAQs

In this article

• Main differences
• Conditions treated
• Efficacy
• Coverage and cost
• Side effects
• Interactions
• Warnings
• FAQs

If you’ve ever had a sinus infection, strep throat, or another bacterial illness, there’s a good chance you’ve taken azithromycin or amoxicillin. Both of these antibiotics, which are approved by the Food and Drug Administration (FDA), are commonly prescribed to treat various bacterial infections, but they work in different ways and have different uses, side effects, and costs. So, which one is better for you?

Main differences between azithromycin and amoxicillin
	Azithromycin	Amoxicillin
Drug class	Macrolide antibiotic	Penicillin antibiotic
Brand/generic status	Brand and generic	Generic
What is the brand name?	Zithromax	Amoxil
What form(s) does the drug come in?	Tablets, suspension, injection, powder packet, eye drops (AzaSite)	Capsule, suspension, tablet, chewable tablet Also: tablet, chewable tablet, and suspension in combination with clavulanic acid (amoxicillin-clavulanate) as Augmentin; in combination with lansoprazole and clarithromycin as generic Prevpac
What is the standard dosage?	Z-Pak: 2 tablets by mouth on day 1, then 1 tablet daily on days 2 through 5	Varies; example: 500 mg by mouth 3 times a day for 10 days
How long is the typical treatment?	5 days; varies	7-10 days; varies
Who typically uses the medication?	Adults and children	Adults and children

What are the main differences between azithromycin and amoxicillin?

Azithromycin is a macrolide antibiotic, known by its brand name Zithromax. Zithromax is made by Pfizer. Azithromycin is commonly prescribed as a tablet, in the form of a Zithromax Z-Pak (a six-tablet, 5-day course of azithromycin) or Zithromax Tri-Pak (a 3-day course of azithromycin). Used in both adults and children, the dosage varies by indication. Other macrolide antibiotics you may have heard of include erythromycin and clarithromycin.

Amoxicillin is a penicillin antibiotic known by the brand name Amoxil. It is most commonly prescribed as capsules or as a combination drug called Augmentin that also contains clavulanic acid (to prevent resistance). Amoxicillin is commonly used in adults and children, and the dosage varies by indication. (Unless noted, this article will focus on amoxicillin, not Augmentin.)

It’s important to note that when prescribed an antibiotic, you should take it as directed and finish the full course of treatment, even if you start to feel better. However, if you have been taking an antibiotic for several days and feel worse or do not feel any better, contact your healthcare provider for guidance.

Conditions treated by azithromycin and amoxicillin

Azithromycin

Azithromycin is used to treat various bacterial infections in both adults and children. It is often used in people allergic to penicillin or need a shorter treatment course.

Azithromycin may be prescribed for bacterial infections such as:

• Acute bronchitis
• Sinusitis (sinus infections)
• Community-acquired pneumonia 
• Strep throat 
• Skin infections
• Certain sexually transmitted infections (STIs), such as chlamydia or gonorrhea
• Acute otitis media, or middle ear infections (in pediatric patients over 6 months)

Many of these infections are caused by Streptococcus pneumoniae, a common type of bacteria.

Azithromycin should not be used for pneumonia in people who are older, hospitalized, or have weakened immune systems.

Amoxicillin

Amoxicillin is also used to treat many common bacterial infectious diseases in adults and children. It is often considered a first-line treatment for ear, nose, and throat infections.

Amoxicillin may be prescribed for:

• Ear infections
• Sinusitis
• Strep throat and tonsillitis
• Skin infections
• Urinary tract infections (UTIs)
• Lower respiratory tract infections, such as pneumonia
• Certain sexually transmitted infections, such as gonorrhea
• Stomach infections caused by H. pylori, as part of combination therapy

To reduce the development of antibiotic resistance, azithromycin or amoxicillin should only be used in bacterial infections when your healthcare provider determines it is appropriate. In fact, the Centers for Disease Control and Prevention (CDC) is promoting the appropriate use of antibiotics by helping healthcare providers choose the right antibiotic (including the right dose and duration) and reduce unnecessary antibiotic use. This is called antibiotic stewardship.

Is azithromycin or amoxicillin more effective?

Both azithromycin and amoxicillin are very commonly prescribed and generally well-tolerated. If you think you have a bacterial infection, see your healthcare provider as soon as possible. They can examine you, assess your need for antibiotics, and determine which one is most appropriate based on your symptoms and medical history, along with other drugs you take that may interact with azithromycin or amoxicillin.

Effectiveness depends on the infection and the bacteria involved. For example, both are effective for middle ear infections and pneumonia. Some research suggests azithromycin may be better tolerated in children due to fewer gastrointestinal side effects. 

A 2024 study compared azithromycin and amoxicillin for pediatric community-acquired pneumonia. The researchers found that both drugs were similarly effective in treating this condition.

Ultimately, only your healthcare provider can advise which antibiotic is right for you based on your condition, medical history, and current medications.

Coverage and cost comparison of azithromycin vs. amoxicillin

Get the SingleCare prescription discount card

	Azithromycin	Amoxicillin
Typically covered by insurance?	Yes	Yes
Typically covered by Medicare prescription plans?	Yes	Yes
Standard dosage	1 Z-Pak (#6, 250 mg tablets)	#21, 500 mg capsules
SingleCare cost	$6 per 1 package of 6 tablets at Kroger	$9 per 21, 500 mg capsules at Kroger

Prescription drug prices often change. These are the most accurate medication prices at the time of publishing in zip code 23666 as of Oct. 20, 2025. The listed price without insurance references the price of brand-name drugs (unless otherwise specified). The listed SingleCare price references the price of generic drugs if available.

Related: Ampicillin dosage

Common side effects of azithromycin vs. amoxicillin

The most common side effects of azithromycin are diarrhea, nausea, and abdominal pain. Other side effects, which are less common and occur in less than 1% of patients, include vomiting, gas, dizziness, headache, sleepiness, and rash.

The most common side effects of amoxicillin are related to penicillin sensitivity. They include nausea, vomiting, diarrhea, a black/hairy tongue, and rash/hypersensitivity reactions. 

In general, antibiotic therapy may make you more susceptible to a yeast infection. Ask your healthcare provider if you should take a probiotic.

This is not a full list of side effects. Other side effects may occur. Consult your healthcare provider for a full list of potential adverse events.

Drug interactions of azithromycin vs. amoxicillin

Taking either azithromycin or amoxicillin in combination with an anticoagulant (blood thinner) such as warfarin may increase the risk of bleeding, which can be life-threatening. Patients should be closely monitored during antibiotic treatment if this combination is prescribed. 

Oral contraceptives (birth control pills), when taken in combination with antibiotics, can be less effective—though evidence is limited. Still, it’s a good idea to consult your healthcare provider about the need for effective backup birth control to prevent pregnancy, such as a condom, while you are on an antibiotic.

Azithromycin drug interactions may also occur with digoxin or colchicine. Drugs that prolong the QT interval, including certain antiarrhythmics, should not be taken with azithromycin due to the risk of life-threatening or fatal arrhythmia.

Allopurinol in combination with amoxicillin can lead to a greater incidence of rash.

This is not a complete list of drug interactions. Other drug interactions may occur. Consult your healthcare provider for professional medical advice.

Drug	Drug Class	Azithromycin	Amoxicillin
Amitriptyline Desipramine Fluoxetine Haloperidol Methadone Quetiapine Sertraline	Drugs that prolong the QT interval	Yes	No
Colchicine	Anti-gout agent	Yes	No
Coumadin (warfarin)	Blood thinner	Yes	Yes
Lanoxin (digoxin)	Cardiac glycosides	Yes	No
Oral contraceptives	Oral contraceptives	Yes	Yes
Viracept (nelfinavir)	Protease inhibitor	Yes	No
Zyloprim (allopurinol)	Xanthine oxidase inhibitor (used for gout)	No	Yes

Warnings of azithromycin and amoxicillin

You should not take azithromycin or amoxicillin if you’ve had a serious allergic reaction to similar antibiotics. Be sure to tell your healthcare provider if you are allergic to macrolide antibiotics, penicillins, or cephalosporins.

Serious warnings, which require immediate or urgent medical attention, include:

• C. diff-associated diarrhea: Can occur during or up to several months after treatment—report watery diarrhea or bloody stools to your healthcare provider right away
• Liver toxicity: Especially with azithromycin
• Severe allergic reactions: Anaphylaxis can be life-threatening—get emergency medical help for symptoms like hives, trouble breathing, or swelling of the face, lips, tongue, or throat
• QT prolongation: Azithromycin may increase the risk of heart arrhythmias
• Drug-induced enterocolitis syndrome (DIES): A rare but serious allergic reaction associated with amoxicillin that usually occurs in children. It can cause vomiting up to four hours after taking this medicine, along with symptoms like fatigue, pale skin, or diarrhea. 

Tell your healthcare provider if you are pregnant, planning to become pregnant, or breastfeeding. 

Frequently asked questions about azithromycin vs. amoxicillin

Are azithromycin and amoxicillin the same?

Both medications are used to treat bacterial infections in adults and children. Azithromycin is a macrolide antibiotic, while amoxicillin is a beta-lactam/penicillin antibiotic. They work in different ways and have some differences, such as in indications and drug interactions.

Can I take amoxicillin with azithromycin?

Not usually. Your provider may prescribe both in rare cases, such as when multiple bacteria may be involved.

Is azithromycin or amoxicillin better?

While both drugs are effective, your healthcare provider can determine if you have a bacterial infection. A viral infection does not respond to antibiotics and can increase drug resistance. Your healthcare provider can decide if one of these drugs is appropriate for you based on the type of infection and which particular bacteria are suspected or known to be causing it.

Can I use azithromycin or amoxicillin while pregnant or breastfeeding?

Both are considered relatively safe but should only be taken under medical supervision. Tell your healthcare provider if you are pregnant, planning to become pregnant, or breastfeeding.

Can I use azithromycin or amoxicillin with alcohol?

While not strictly prohibited, alcohol can worsen side effects and delay recovery.

Azithromycin vs amoxicillin: Which is stronger?

Neither is inherently stronger. Effectiveness depends on the infection and bacterial resistance.