Antibiotic Selection Tool
Which Antibiotic Is Right for You?
This tool helps identify the most appropriate antibiotic based on infection type, patient characteristics, and clinical considerations. Select options below to see recommendations.
Key Decision Factors
Remember: Antibiotics are only effective against bacterial infections. Azithromycin is not effective for viral illnesses like colds and flu.
Azithromycin has a long half-life (68 hours) allowing short courses, but rising resistance is a concern. Choose alternatives when appropriate.
When a doctor prescribes azithromycin, the brand name often reads Azee DT. It’s a popular choice for everything from a sore throat to a sexually transmitted infection, but it isn’t the only option on the shelf. This guide breaks down how Azee DT works, where it shines, where it falls short, and which antibiotics can step in when you need a different solution.
What is Azee DT (Azithromycin)?
Azithromycin is a macrolide antibiotic that blocks bacterial protein synthesis by binding to the 50S ribosomal subunit. The branded formulation Azee DT combines the drug with a delayed‑release tablet, allowing once‑daily dosing for 3-5 days depending on the infection. First approved in the early 1990s, its long half‑life (about 68 hours) means the drug stays in the body far longer than many other antibiotics, which is why short courses work.
How Azithromycin Is Used
- Upper respiratory infections (sinusitis, bronchitis)
- Community‑acquired pneumonia
- Chlamydia trachomatis infection (single‑dose 1 g regimen)
- Skin infections like impetigo
- Travel‑related diarrhoea caused by Campylobacter
The typical dose for adults is 500 mg on day 1, followed by 250 mg daily for four more days (the so‑called “Z‑pack”). Children receive weight‑based dosing, usually 10 mg/kg on day 1 then 5 mg/kg daily.
Why Some Clinicians Prefer Azithromycin
- Convenient dosing: once‑daily, short‑course regimen improves adherence.
- Broad spectrum against Gram‑positive, some Gram‑negative, and atypical organisms.
- Fewer gastrointestinal side‑effects compared with many beta‑lactams.
- Safe in pregnancy (Category B) and in children over six months.
Limitations and Safety Concerns
Despite its popularity, azithromycin isn’t a magic bullet. Resistance rates have climbed, especially in Streptococcus pneumoniae and Neisseria gonorrhoeae. Cardiac safety is another hot topic: it can prolong the QT interval, so it’s best avoided in patients with known arrhythmias or those on other QT‑prolonging drugs.
Common side‑effects include mild nausea, diarrhoea, and abdominal cramping. Rare but serious reactions-like liver injury or severe skin rashes-should prompt immediate medical attention.
Key Alternatives to Azithromycin
When azithromycin isn’t suitable, clinicians turn to a handful of other antibiotics. Below is a snapshot of five widely used alternatives.
| Antibiotic | Class | Typical Adult Dose | Key Indications | Major Side‑Effects | Resistance Concerns |
|---|---|---|---|---|---|
| Azithromycin | Macrolide | 500 mg day 1, then 250 mg × 4 days | Respiratory, STI, skin, travel‑diarrhoea | Nausea, diarrhoea, QT prolongation | Rising in S. pneumoniae, N. gonorrhoeae |
| Doxycycline | Tetracycline | 100 mg BID for 7‑14 days | Lyme disease, acne, rickettsial infections | Photosensitivity, oesophagitis, gut flora disruption | Low‑level resistance in atypicals |
| Clarithromycin | Macrolide | 500 mg BID 7‑14 days | Helicobacter pylori eradication, bronchitis | Diarrhoea, drug‑interaction (CYP3A4) | Cross‑resistance with azithro |
| Amoxicillin | Beta‑lactam (penicillin) | 500 mg TID 7‑10 days | Otitis media, sinusitis, strep throat | Allergic rash, GI upset | β‑lactamase producing strains |
| Levofloxacin | Fluoroquinolone | 500 mg daily 5‑7 days | Complicated UTIs, severe pneumonia | Tendonitis, CNS effects, QT prolongation | Growing resistance in Gram‑negatives |
When to Choose an Alternative
Think of the decision as a simple flowchart:
- If the patient has a known macrolide allergy or a history of QT prolongation, skip azithromycin.
- For infections where Mycoplasma pneumoniae or Chlamydia pneumoniae are suspected, a macrolide (azithro or clarithro) remains first‑line.
- If the target organism is a β‑lactam‑sensitive streptococcus (e.g., strep throat), amoxicillin offers a narrower spectrum and lower resistance pressure.
- When dealing with intracellular bacteria like Rickettsia or Borrelia, doxycycline is the go‑to drug.
- For severe community‑acquired pneumonia in an older adult, levofloxacin may be preferred because of its excellent lung penetration, but only after weighing tendon‑risk.
Bottom line: match the drug’s strengths to the bug’s weaknesses and the patient’s safety profile.
Cost and Accessibility Snapshot (2025)
- Azithromycin (Azee DT) - NZ$15 for a 5‑day pack.
- Doxycycline - NZ$12 for a 14‑day supply.
- Clarithromycin - NZ$20 for a 7‑day course.
- Amoxicillin - NZ$8 for a 10‑day course.
- Levofloxacin - NZ$25 for a 7‑day pack (requires prescription).
Price differences matter in public‑health settings; a narrower‑spectrum, cheaper drug often wins when efficacy is comparable.
Quick Decision Checklist
- Is the patient allergic to macrolides? → Choose doxycycline, amoxicillin, or levofloxacin.
- Is there a cardiac risk (QT, arrhythmia)? → Avoid azithromycin and levofloxacin.
- Is the infection intracellular (rickettsial, chlamydial)? → Doxycycline is optimal.
- Do you need a single‑dose regimen for compliance? → Azithromycin (Azee DT) is unmatched.
- Are you treating a β‑lactam‑susceptible throat infection? → Amoxicillin is cheaper and equally effective.
Potential Pitfalls and How to Dodge Them
Resistance creep: Overusing azithromycin for viral colds fuels resistance. Always confirm bacterial aetiology when possible.
Drug interactions: Clarithromycin and azithromycin both inhibit CYP3A4, raising levels of statins, some anti‑arrhythmics, and certain antipsychotics. Check the patient’s med list before prescribing.
Pediatric dosing errors: The delayed‑release tablet is formulated for adults. For kids, use the oral suspension or a weight‑based tablet, not the adult Azee DT pack.
Key Takeaways
- Azithromycin (Azee DT) offers convenient dosing and broad coverage but faces rising resistance and cardiac safety concerns.
- Doxycycline, clarithromycin, amoxicillin, and levofloxacin each fill specific gaps-intracellular bugs, narrow‑spectrum needs, severe pneumonia, or allergy avoidance.
- Match drug choice to infection type, patient risk factors, and cost to optimise outcomes.
Frequently Asked Questions
Can I take azithromycin for a common cold?
No. The cold is caused by viruses, and azithromycin only works on bacteria. Using it unnecessarily adds to resistance and can cause side‑effects.
Is a single 1 g dose of Azee DT safe for everyone?
It’s safe for most adults, but not for pregnant women in the third trimester, people with severe liver disease, or anyone on drugs that prolong the QT interval. Always check medical history first.
When should I choose doxycycline over azithromycin?
Doxycycline is preferred for intracellular infections (Lyme disease, rickettsial fevers), acne, and when a patient has a macrolide allergy or needs a drug that isn’t associated with QT prolongation.
Does azithromycin interact with common over‑the‑counter meds?
Yes. Antacids containing aluminum or magnesium can reduce absorption, and certain antihistamines may increase the risk of cardiac side‑effects. Space doses by at least two hours.
What is the main reason azithromycin resistance is rising?
Frequent prescription for viral illnesses and the drug’s long half‑life create selective pressure, allowing resistant strains of S. pneumoniae and N. gonorrhoeae to proliferate.
Are there any natural alternatives to azithromycin?
Herbs and supplements can support immune health but cannot replace antibiotics for bacterial infections. Using them alone in place of a prescribed drug risks complications.
Written by Martha Elena
I'm a pharmaceutical research writer focused on drug safety and pharmacology. I support formulary and pharmacovigilance teams with literature reviews and real‑world evidence analyses. In my off-hours, I write evidence-based articles on medication use, disease management, and dietary supplements. My goal is to turn complex research into clear, practical insights for everyday readers.
All posts: Martha Elena