Erythromycin vs Azithromycin
ErythromycinAzithromycin
Macrolide antibioticDrug ClassMacrolide antibiotic
Inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit, blocking translocation.Mechanism of ActionSimilar mechanism, binds to the 50S ribosomal subunit to inhibit bacterial protein synthesis.
Effective against gram-positive and some gram-negative bacteria.Spectrum of ActivityBroad spectrum, including gram-positive, gram-negative, and atypical bacteria (e.g., Chlamydia, Mycoplasma).
Respiratory infections, skin infections, pertussis, diphtheria, and STIs.IndicationsRespiratory infections, skin infections, otitis media, STIs, and community-acquired pneumonia.
Typically requires multiple daily doses (2–4 times a day).Dosing ScheduleUsually taken once daily due to a longer half-life.
7–14 days, depending on the infection.Duration of Therapy3–5 days (shorter duration due to extended tissue penetration).
1.5–2 hoursHalf-life68 hours (much longer than erythromycin).
Reduced by food; best taken on an empty stomach.AbsorptionCan be taken with or without food.
Metabolized in the liver and excreted in bile and urine.ExcretionExcreted primarily in bile, with minimal renal excretion.
Gastrointestinal upset (nausea, vomiting, diarrhea), liver toxicity, QT prolongation, allergic reactions.Adverse EffectsSimilar side effects, but usually better tolerated; less gastrointestinal upset. QT prolongation possible.
Significant interactions due to inhibition of CYP3A4 enzymes (e.g., warfarin, statins).Drug InteractionsFewer interactions; weak inhibitor of CYP3A4.
Category B (safe for use in pregnancy).Pregnancy CategoryCategory B (safe for use in pregnancy).
Approved for use in children for specific infections.Pediatric UseCommonly used in children; convenient dosing.
Effective for specific infections; multiple formulations available.AdvantagesLonger half-life allows shorter and simpler dosing regimens.
Frequent dosing and higher rates of side effects, particularly gastrointestinal.DisadvantagesHigher cost compared to erythromycin in some cases.
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