Key takeaways
Azithromycin, also known as Zithromax or Zithromax Z-Pak, is a common antibiotic used to treat a broad spectrum of bacterial infections, but it may not be the right antibiotic for every situation.
Healthcare professionals can draw on a wide range of antibiotics as effective substitutes for azithromycin.
The top alternatives to azithromycin are amoxicillin, Augmentin, cefdinir, doxycycline, and levofloxacin.
Azithromycin (the generic version of Zithromax and Z-Pak) is a commonly prescribed macrolide antibiotic used to treat a wide range of bacterial infections, from strep throat and sinus infections to certain sexually transmitted infections. It’s often chosen for its convenient once-daily dosing and relatively short treatment courses.
However, azithromycin isn’t the best fit for everyone. Some people may need an alternative to azithromycin due to allergies, side effects, pregnancy considerations, or concerns about drug interactions. In certain cases, other antibiotics may be more effective depending on the type of infection or local resistance patterns, making it important to understand how azithromycin compares to other treatment options.
Save up to 80% on Azithromycin with SingleCare Different pharmacies offer different prices for the same medication. SingleCare helps find the best price for you.
RELATED: What is a Z-Pak?
What can I take instead of azithromycin?
Azithromycin belongs to the macrolide class of antibiotics. Other class members include clarithromycin and erythromycin. These other class members might be considered if azithromycin is unavailable.
Macrolide antibiotics typically target bacteria that infect the lungs, skin, or soft tissues, but fortunately, other classes of antibacterials also work well against the same bacteria that cause these infections. These alternative classes include penicillins, cephalosporins such as cefdinir, tetracyclines such as doxycycline, quinolones such as levofloxacin, the lincosamide named clindamycin, and sulfonamides such as sulfamethoxazole. The chart below compares alternatives to azithromycin based on the common bacterial infections each is approved to treat.
Azithromycin alternatives cost comparison |
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| Drug name | Price without insurance | SingleCare price | Savings options |
| Zithromax (azithromycin) | $323 per 1, 500 mg solution | $8 per 1, 500 mg solution of brand-name Zithromax at Kroger | See latest prices |
| Azithromycin | $78 per 1, 6-tablet box of generic azithromycin | $6 per 1, 6-tablet box of generic azithromycin at Kroger | See latest prices |
| Amoxicillin | $20 per 21, 500 mg capsules of generic amoxicillin | $9 per 21, 500 mg capsules of generic amoxicillin at Kroger | See latest prices |
| Augmentin (amoxicillin-clavulanic acid) | $768 per 1, 125-31.25 mg/5 mL, 100 mL bottle | $11 per 20, 875-125 mg tablets of generic Augmentin at Kroger | See latest prices |
| Cefdinir | $115 per 20, 300 mg capsules of generic cefdinir | $15 per 20, 300 mg capsules of generic cefdinir at Kroger | See latest prices |
| Doxycycline hyclate | $97 per 14, 100 mg capsules of generic doxycycline | $8 per 14, 100 mg capsules of generic doxycycline at Kroger | See latest prices |
| Levofloxacin | $167 per 10, 500 mg tablets of generic levofloxacin | $8 per 10, 500 mg tablets of generic levofloxacin at Kroger | See latest prices |
| Clarithromycin | $148 per 28, 500 mg tablets of generic clarithromycin | $23 per 28, 500 mg tablets of generic clarithromycin at Kroger | See latest prices |
| Erythromycin | $124 per 6, 500 mg tablets of generic erythromycin | $26 per 6, 500 mg tablets of generic erythromycin at CVS Pharmacy | See latest prices |
| Cleocin (clindamycin) | $411 per 30, 300 mg capsules | $9 per 30, 300 mg capsules of generic clindamycin at Kroger | See latest prices |
| Cephalexin | $45 per 28, 500 mg capsules of generic cephalexin | $9 per 28, 500 mg capsules of generic cephalexin at Walmart | See latest prices |
| Tetracycline | $755 per 56, 500 mg capsules of generic tetracycline | $46 per 56, 500 mg capsules of generic tetracycline at CVS Pharmacy | See latest prices |
| Ciprofloxacin | $62 per 14, 500 mg tablets of generic ciprofloxacin | $7 per 14, 500 mg tablets of generic ciprofloxacin at Walmart | See latest prices |
| Bactrim DS (sulfamethoxazole-trimethoprim) | $49 per 14, 800-160 mg tablets | $3 per 14, 800-160 mg tablets of generic Bactrim DS at Kroger | See latest prices |
Top 5 azithromycin alternatives
The following are some of the most common alternatives to azithromycin (or Zithromax Z-Pak). It’s important to keep in mind that the type of infection, type of bacteria, and local resistance patterns will help guide treatment.
1. Amoxicillin
Amoxicillin is a penicillin antibiotic approved to treat infections of the ear, nose, throat, skin, and urinary tract, among others. Amoxicillin kills bacteria by breaking the bonds that hold the bacterial cell wall together.
While both amoxicillin and azithromycin are considered broad-spectrum antibiotics, i.e., are effective against a broad range of bacterial infections, azithromycin has a bit greater coverage than amoxicillin. The most common side effects of amoxicillin are gastrointestinal complaints like nausea, vomiting, diarrhea, and skin rash. Amoxicillin is available as capsules, chewable tablets, and liquid suspensions.
2. Augmentin (amoxicillin and clavulanate)
Augmentin is a brand-name antibiotic that contains amoxicillin and clavulanate. The addition of clavulanate helps to block bacterial enzymes that make amoxicillin less effective. This activity means the combination form has a broader range of activity and may be used for more persistent infections that no longer respond to amoxicillin alone.
The most common side effects of Augmentin, as with amoxicillin, are diarrhea, nausea, vomiting, and rash. Augmentin is more likely to cause diarrhea than amoxicillin. Because clavulanate may also contribute to adverse events, it is possible that more patients on Augmentin may experience diarrhea than with amoxicillin alone. Augmentin is available as tablets, liquid suspension, chewable tablets, and extended-release tablets. It is also available in generic form as amoxicillin-clavulanate.
3. Cefdinir
Cefdinir is a third-generation cephalosporin used to treat a variety of bacterial infections, including respiratory, ear, skin, and urinary tract infections. Cephalosporins kill bacteria by preventing them from building cell walls.
Clinical evidence points to cefdinir as an effective and generally well tolerated antibiotic for the treatment of mild-to-moderate respiratory tract infections and skin infections. The most common side effects of cefdinir include diarrhea, nausea, stomach upset, and skin rash. Cefdinir is available as a capsule and liquid suspension.
4. Doxycycline
Doxycycline, also known by various brand names, including Doryx and Oracea, is a member of the tetracycline class of antibiotics. This class kills bacteria by preventing them from producing the proteins they need to multiply. Doxycycline is effective against many of the same bacterial infections as azithromycin, and may even be more efficacious in certain infections, such as chlamydia.
Common side effects of doxycycline include diarrhea, nausea, abdominal pain, and vomiting. Side effects of doxycycline that are different from those of azithromycin include photosensitivity and tooth discoloration, particularly in young children. Doxycycline is available as capsules, tablets, liquid suspensions, and injectable formulations.
5. Levofloxacin
Levofloxacin is in the fluoroquinolone (or quinolone) class of antibiotics. Quinolone antibiotics decrease the bacteria’s ability to grow. Levofloxacin is used to treat bacterial infections such as pneumonia, bronchitis, sinusitis, chlamydia, and skin infections, particularly when there is a concern that the bacteria might be resistant to other classes of antibiotics.
In one clinical trial comparing levofloxacin and azithromycin for the treatment of acute bronchitis, both antibiotics were found to be equally effective. Common side effects of levofloxacin include nausea, vomiting, diarrhea, and stomach pain. More serious adverse effects include insomnia, restlessness, disorientation, tendonitis, and tendon rupture. Fluoroquinolones also have more drug interactions than other antibiotics. Levofloxacin dosage forms include tablets, oral solutions, and injectable formulations.
Are any antibiotics available over the counter?
While some antibiotics are available over the counter (OTC), they are not substitutes for prescription antibiotics used to treat internal infections. OTC antibiotic products, such as Neosporin or Triple Antibiotic, are topical medications intended to prevent or treat minor skin infections, like those associated with small cuts, scrapes, or burns. These products typically contain neomycin, polymyxin, or bacitracin.
There are no over-the-counter macrolide antibiotics. OTC antibiotics do not belong to the major prescription antibiotic drug class that azithromycin falls under, nor are they used to treat infections like pneumonia, strep throat, or sexually transmitted infections.
Other over-the-counter antimicrobial products, such as benzoyl peroxide, are also designed for use on the skin only. None of these medications are safe or effective for treating internal bacterial infections and should never be swallowed or used in the ear, nose, mouth, or other body cavities.
Natural alternatives to azithromycin
Healthcare providers rarely recommend natural remedies over antibiotics for serious infections. There are naturally occurring compounds, such as honey, garlic, oregano, or echinacea, that can slow or even kill bacteria responsible for infectious diseases, but they should not be used in place of a prescribed antibiotic.
How to switch to an azithromycin alternative
If azithromycin causes problems such as side effects, talk with the prescribing healthcare provider. Sometimes, azithromycin side effects can be improved by taking doses with food.
If the prescriber switches treatments, do not stop taking azithromycin until the alternative antibiotic is started. If you do, the bacterial infection may return and become even more difficult to treat due to the development of antibiotic resistance.
Choosing the right path for respiratory tract treatment
People most commonly get a Z-Pak prescription for a respiratory tract infection, such as strep throat, community-acquired pneumonia, bronchitis, tonsillitis, or a sinus infection.
If you’re experiencing symptoms of a respiratory infection:
- Start with supportive care. Rest, drink plenty of fluids, and use over-the-counter remedies to manage symptoms.
- Know when to see a doctor. Seek medical care if you’re pregnant, older than 65, develop a high or worsening fever, cough up blood, or have a cough lasting longer than three weeks.
- Get an accurate diagnosis. A clinician will determine whether the infection is viral or bacterial before prescribing treatment. If the infection is bacterial, azithromycin (Z-Pak) may be an option, though other antibiotics such as amoxicillin, cephalosporins, tetracyclines, fluoroquinolones, or sulfa drugs may be recommended depending on the case.
- Take antibiotics exactly as prescribed. Do not skip doses or stop early, even if you start to feel better.
- Watch for side effects. Contact a healthcare professional right away if you experience signs of an allergic reaction or severe side effects.
RELATED: Does azithromycin treat the flu?
The SingleCare prices in this article are the most accurate at the time of publishing in ZIP code 23666 as of May. 4, 2026. Prices vary by pharmacy. Visit our coupon page for updated drug prices at pharmacies near you.
- An open comparative study of azithromycin versus cefaclor in the treatment of patients with upper respiratory tract infections, Journal of Antimicrobial Chemotherapy (1996)
- Azithromycin versus doxycycline for the treatment of genital chlamydia infection: a meta-analysis of randomized controlled trials, Clinical Infectious Diseases (2014)
- Doxycycline capsule prescribing information, DailyMed (NIH National Library of Medicine)
- Efficacy and safety of azithromycin vs levofloxacin in the outpatient treatment of acute bacterial exacerbations of chronic bronchitis, Chest Journal (2003)
- Levofloxacin tablet prescribing information, DailyMed (NIH National Library of Medicine)
- Cefdinir capsule prescribing information, DailyMed (NIH National Library of Medicine)
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