Azithromycin vs Doxycycline: similarities, differences, side effects

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Azithromycin and doxycycline are common antibiotics used in treating several infectious diseases. The two drugs are sometimes prescribed to treat similar health conditions. This article gives an insight into the azithromycin vs doxycycline comparisons, side effects, drug interactions, and more.

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About Azithromycin

Azithromycin is a macrolide antibiotic for treating bacterial infections and sexually transmitted diseases. It is also used to treat pneumonia, bronchitis, chlamydia, and Mycobacterium Avium Complex (MAC). Further, it can help patients with infections in certain body parts like the skin, lungs, ears, and genitals. Azithromycin drugs are prescribed to stop these infections by inhibiting the growth of bacteria in the affected areas.

About Doxycycline

Doxycycline is a tetracycline antibiotic drug prescribed to treat bacterial infections throughout the body. For example, it is used to treat anthrax, an infection that may occur in a patient once exposed to compromised air. Doxycycline is also used to cure tularemia and the plague, and it serves as a common way to avoid being infected with malaria. In addition, it prevents further growth of bacteria in the body so that it does not spread and worsen.

Azithromycin vs Doxycycline Comparison

Azithromycin and doxycycline treat bacterial infections and can only be obtained through prescription. Both drugs do not have any known alcohol or food interactions. Therefore, neither of the two is considered to be “controlled” drugs.

Azithromycin has a half-life of 53 hours, while doxycycline only has a half-life of 23 hours. Taking doxycycline seems to have more risks during pregnancy, as it received a Category D ranking. In contrast, azithromycin received a lighter Category B.

Alternatives to Azithromycin

Doxycycline can substitute for azithromycin in certain conditions. For bacterial infections, some alternatives are amoxicillin, Clindamycin, ciprofloxacin, cephalexin, Ceftriaxone, and metronidazole.

Alternatives to Doxycycline

Azithromycin can substitute for doxycycline. Other alternatives include Augmentin, ciprofloxacin, Clindamycin, metronidazole, Solodyn, Malarone, and Bactrim.

Comparison of Clinical Efficacy: Azithromycin vs Doxycycline

Azithromycin and doxycycline yielded similar results in treating rosacea. They were both found to be effective and had no significant advantage in efficacy over the other. Similar results were found in a clinical trial for erythema migrans.

An extensive study on the efficacy of azithromycin vs doxycycline was also conducted in 1993. You may rent this article via DeepDyve.

Azithromycin and Doxycycline: Usage Comparisons

Doxycycline is known to treat 37 conditions, while azithromycin treats 12 conditions. Read the full list here. Azithromycin is used for gonorrhea, urethritis, cervicitis, strep throat, and more.

List of health conditions treated by doxycycline

Doxycycline covers a long list of diseases. It can treat diseases and infections like Q fever, cholera, brucellosis, amebiasis, and more.

Dosage Forms Available for Azithromycin and Doxycycline

Azithromycin is administered orally or intravenously. Therefore, azithromycin powder may either come in oral powder or a separate intravenous powder.

Doxycycline can be administered in six methods: oral capsule, oral delayed-release capsule, oral delayed-release tablet, oral tablet, oral powder, and injectable doxycycline powder.

What Drugs Interact With Azithromycin and Doxycycline?

Azithromycin has 333 drug interactions listed. Significant interactions have been found in Benadryl, Fexinidazole, Grepafloxacin, and many more.

Doxycycline interacts with 192 drugs. Significant interactions include acitretin, aminolevulinic acid, BCG, cholera vaccine, live etretinate, vitamin A, and many more. Kindly check the complete list of drug interactions for azithromycin and doxycycline before use.

Alcohol Interactions With Azithromycin and Doxycycline

Decreased efficacy from doxycycline may occur if the patient has had a history of alcoholism or chronic drinking or is a heavy drinker with liver problems. Otherwise, they have no notable interactions.

Are Azithromycin or Doxycycline Safe To Use While Pregnant or Breastfeeding?

Using doxycycline during pregnancy may result in adverse events, including problems in the tooth and bone development of the baby. Therefore, breastfeeding mothers should only use doxycycline for a short time.

There is no evidence of adverse effects during breastfeeding, but patients should always consult their attending doctor before use.

Azithromycin is typically transferred to breast milk while breastfeeding. Still, small amounts of the drug usually do not cause any harm to babies. However, there are cases where the drug has caused some babies to experience vomiting, rashes, or diarrhea.

Which Is Better for Chlamydia? Azithromycin or Doxycycline?

A 2015 study has found that doxycycline has displayed 97% effectiveness in treating genital chlamydia infections for women, while azithromycin showed only 82%. You may view author publications through this link.

Some patients cannot handle doxycycline. However, another trial by KoreaMed Synapse has determined that azithromycin pulse therapy offers the same level of efficacy as 12 weeks of doxycycline treatment for those who cannot use doxycycline.

Most trials have displayed similar efficacy for both drugs, as demonstrated in a study called Azithromycin versus Doxycycline for Genital Chlamydial Infections: a Meta-Analysis of Randomized Clinical Trials.

This study showed nearly similar recovery rates of 97% for azithromycin and 98% for doxycycline. Similarly, another study reported 97% and 100% efficacy for azithromycin and doxycycline, respectively.

Azithromycin and Doxycycline for Asthma Exacerbations

meta-analysis of a single participant found that maintenance of azithromycin displayed reduced exacerbations in patients diagnosed with eosinophilic, non-eosinophilic, and severe asthma.

separate study has also shown that 48 weeks of oral azithromycin treatment have reduced the number of asthma exacerbations in patients with persistent asthma.

As for doxycycline, a 2012 study suggests that the drug may be used as a long-term treatment for chronic asthma. However, further testing and research are needed to validate and measure its full efficacy.

Azithromycin With Doxycycline in Non-gonococcal Urethritis

Non-gonococcal Urethritis (NGU) is commonly treated with antibiotics. In most cases, doctors will prescribe a patient a week-long prescription for doxycycline or a single dosage of azithromycin. Other macrolide antibiotics may also be prescribed.

Treatment for NGU should be administered to both partners to prevent the further spread of the disease.

If adverse events or allergic reactions occur, consult your doctor for an alternative.

What Is the Dosage of Azithromycin and Doxycycline?

The dosage for doxycycline usually consists of 100 to 200 mg per day for one to two weeks. Oral doxycycline can be taken once or twice daily as prescribed by your doctor.

Azithromycin is administered in single or multiple doses of 500 to 2000 mg, depending on the situation. Most conditions require five days of azithromycin treatment, taken once per day.

However, conditions like bacterial sinusitis may require only three days of azithromycin treatment.

The first dose of the drug is the strongest, and the quantity administered must be twice the amount of regular doses. Taking azithromycin (except Zmax) may cause an upset in your stomach, so taking it with a full stomach is recommended. Zmax must be taken at least an hour before a meal for maximum absorption.

Azithromycin vs doxycycline is an interesting comparison

Azithromycin and Doxycycline: Possible Side Effects

Azithromycin and doxycycline share similar side effects, such as abdominal pain, vomiting, diarrhea, and nausea.

Children under eight years old may experience severe sunburn and tooth discoloration upon using doxycycline. In addition, oral doxycycline may cause many other side effects, including chills, bloating, fever, hives, headaches, palpitations, and much more.

Meanwhile, patients that have used azithromycin have reported symptoms of rashes, tongue discoloration, nervousness, indigestion, vaginitis, and a ringing sensation in the ears.

Oral administration of azithromycin may also cause extensive side effects, such as fever, swelling, congestion, dark or cloudy urine, and more.

Azithromycin versus Doxycycline and Male Fertility

A study on doxycycline treatment for male infertility patients with low-level leukocytopenia displayed positive results. The results suggest that antibiotic treatment may enhance the likelihood of pregnancy for an infertile couple.

A separate study indicates that using doxycycline has no significant effects on semen parameters and may induce positive effects on sperm count and motility.

Another study on antibiotic therapy was conducted in 2021 to test the effects of antibiotics on couple infertility.

In this study, the antibiotic treatment also included azithromycin. After being treated with 100 mg of doxycycline, 500 mg of azithromycin, and 400 mg of moxifloxacin for two months, the study showed that antibiotic treatment might increase the likelihood of natural pregnancy for infertile couples.

Azithromycin versus Doxycycline and Female Fertility

Doxycycline and azithromycin (Zmax) may be prescribed to support In-vitro fertilization (IVF). Women are prescribed doxycycline to control the bacteria that may accumulate during implantation. Zmax is not typically prescribed, but it can be effective if the individual is allergic or experiences side effects from doxycycline.

There are currently no recorded adverse effects of using doxycycline and azithromycin for fertility.

Azithromycin vs Doxycycline and Contraception

Azithromycin has no known effects on the efficacy of hormonal birth control. However, the effects of doxycycline on contraceptives display mixed results. The USA FDA states that taking doxycycline may lessen the effectiveness of birth control pills and recommends other forms of

birth control when using the drug. However, a study of oral contraceptives and antibiotic interactions has also found that using doxycycline has no significant effects on the efficacy of hormonal birth control.

Azithromycin vs Doxycycline: Which Works Better To Treat Acne?

Doxycycline is typically used to treat acne. However, azithromycin may also be used as an alternative treatment option. A 2018 study has found that patients who cannot take doxycycline may opt for azithromycin pulse therapy as an alternative treatment for severe acne vulgaris.

Oral azithromycin pulse therapy is equivalent to 12 weeks of doxycycline treatment. Both were deemed as effective treatment options in another 2020 study. However, participants administered with doxycycline displayed significant improvement after 12 weeks.

Can You Combine Azithromycin With Doxycycline?

There are no recorded interactions between the two drugs. In some cases, such as NGU, administering azithromycin treatments with doxycycline enhances its efficiency. This is based on a 2020 study combining both drugs for NGU treatment.

Always consult your doctor before attempting to take two different drugs simultaneously to prevent any harmful effects.

Frequently Asked Questions

There are no significant drug interactions between azithromycin and doxycycline. However, the patient should proceed cautiously and consult a doctor immediately if any symptoms arise.

They are both macrolide antibiotics, but erythromycin is an entirely different drug. 

Patients may experience an increased risk of developing an irregular heart rhythm. It is a relatively uncommon side effect. However, patients should still be vigilant and contact their doctor if any symptoms arise. 

It depends on the condition being treated. However, as seen in the previous sections of the article, both drugs offer a close range in efficacy. 

Azithromycin was initially used as a COVID-19 treatment due to its antiviral and anti-inflammatory properties. However, the findings of a 2021 study report that the use of azithromycin for COVID-19 patients is not justified and may cause increased antimicrobial resistance. 

Doxycycline has shown higher efficacy in treating several conditions such as chlamydia and acne. However, azithromycin often offers similar results and can be used as an alternative, depending on the treated condition. 

Doxycycline was proven to be more effective in treating chlamydia. However, azithromycin can also be used as an alternative. See our article above for more information.

Azithromycin is commonly used to treat pneumonia. It has also been proposed to treat COVID-19 patients and is still undergoing further testing and research.

Doxycycline has shown increased efficacy compared to azithromycin in treating various conditions. However, they offer a close range of effectiveness, and azithromycin is often used as a doxycycline substitute for some conditions.

Doxycycline displayed a higher efficacy for treating acne. However, azithromycin can also be used as a substitute with the approval of your attending doctor.

The content on Doctor Alexa’s blog is reviewed by Advanced practice registered nurses or pharmacist and is intended for educational purposes only. This information should not be relied upon as professional medical counsel. Be sure to always consult with your physician about the dangers and benefits of any medication, treatment or procedure.

You shouldn’t wait to see the doctor for simple health needs.