Azithromycin For Strep: Dosage,Side Effects and Usage

Sick Woman Having Sore Throat, Tonsillitis, Feeling Sick
Medically reviewed by Dr. Ola Tarabzuni

Key Takeaways

  • Strep throat is an infection caused by Bacterium Streptococcus Pyogenes and presented with a set of discomforting symptoms including sore throat, and swollen tonsils/lymph Nodes.
  • Penicillin is the choice of drug/first line of treatment for strep throat. Azithromycin comes second with more effectiveness in those having penicillin allergy or resistance.


Do you know what sucks? Runny nose with difficulty in swallowing even with the slightest change in weather. Well! That can be hell tricky to understand whether you are allergic or you started to develop strep throat.

Let’s start understanding this by the basic term used when we try to get the medication for our sore throat and difficulty swallowing,strep-throat.

Strep throat is an infection caused by the bacterium streptococcus pyogenes which presents with similar symptoms of viral sore throat, runny nose and nausea. A person can catch this bacteria if exposed to such a surface or environment having streptococcus bacteria. Examples may include touching such surfaces and then touching back to your nose and mouth or when sharing utensils with a person already suffering from a strep throat infection. 

You might have heard of the cute candy-like antibiotic with the name “Z-pak” and was prescribed immediately for strep throat for 5 days. Let’s tear into this Z-PAK EASY TO-GO Medication for strep throat in a bit of detail.

What Is Azithromycin or Z-Pak?

Z-pak, the pink small candy-like tablets are the macrolide antibiotic (Azithromycin) prescribed for the bacterium streptococcus as a second line of treatment to stop its widespread use by targeting its protein synthesis. It was the easiest to get medication for just 5 days. One tablet of 250 mg/day, starting with the 2 tablets of 250mg for the first day as the initial starting dose.  

But wait! What’s the first line of treatment for strep throat? It’s Penicillin. The reason it’s not as common as the Z-pak Azithromycin is because of its allergy and resistance present in most of the individuals that used penicillin for many other medical reasons in the past. Just the FYI, the second line of treatment comes when the first line fails to treat the patient due to any reason. 

Penicillin allergy and sometimes its resistance prevented most people from having it for the common strep throat infection instead choosing azithromycin as the preferred one.

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How to Treat Strep Throat With Azithromycin?

Strep throat can be treated effectively 100% by azithromycin macrolide antibiotic as It will inhibit its further growth and stops the bacteria from further affecting you. Its starting dose is 500mg on the first day ( 2 tablets of 250mg) and 250 mg each day for the rest of the 4 days. It’s a total 5 days course of azithromycin to totally eradicate the symptoms and soreness you feel.

Usage of Azithromycin

Usage of Azithromycin or any antibiotic comes with one very important and basic caution which is “ Compliance to Antibiotic”  which means completing the prescribed dose for the prescribed period. For example, azithromycin should be taken 5 days even if you feel better after 2 days of taking the medication. The reason for that is “ Antibiotic Compliance is the development of antibiotic resistance”. It happens when our body and the present bacteria start to be resistant to the medication and it becomes difficult to treat the same condition with the same medication. As a solution, we then need to change the antibiotic to get good results.

Dosage of Azithromycin

Usually, the prescribed dosage for Azithromycin is 250 mg/day for 5 days with or without food. The Actual dosage regimen will comprise the altogether 5 days, loading dose of 500mg/QD (2 tablets of 250mg each) on the first day of the azithromycin. The continuing dose will be 250 mg/day for 4 days. 

Food consumption does not really affect the absorption of the Antibiotics but if it irritates your stomach, it’s better to have a chunk of meal after it.

Azithromycin Side Effects:

Common Side effects are

  • Diarrhea (stomach upset)
  • Vomiting
  • Nausea
  • Headache

Serious side effects of Azithromycin are as follows:

  • Irregular heartbeat/ rhythm
  • Blisters or peeling of skin
  • Unconsciousness/ fainting 
  • Loss of appetite/ lethargic
  • Topical itching
  • Dark coloured urine
  • Unusual muscle weakness. 

Considerations and Precautions

It’s good to have an electronic file or record of the medical history for any or all medications before seeking a medical prescription from your healthcare provider. It will help you avoid any drug-drug interactions and allergies. 

The observed precautions for azithromycin are usually avoided with antacids, anticoagulants (Blood Thinning agents) and SSRIs. In case you feel any adverse effects or sudden reactions after the first one or two doses of Azithromycin it’s good to consult your provider ASAP.  

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When Should You Seek Medical Attention?

By the time you start feeling difficulty in swallowing or pain in your throat, it’s good to get yourself checked by a healthcare practitioner or go to the lab for a rapid strep swab test.

Other symptoms of strep throat are fever, swollen tonsils, white pus on tonsils and swollen lymph nodes should not be ignored. 

How can we help?

You can get easy consultations with our healthcare providers providing online services at the ease of your home.

FAQs About Rash on Inner Thigh

How fast does a Z-Pak work for strep throat?

Z-pak is only prescribed for just 5 days ( 250 mg each day)  as it will work faster and might show results in the initial few days of starting the treatment but it’s essential to complete the course.

How well do Z-paks treat strep throat?

Z-pak (Azithromycin) is an effective and short-term course to treat strep throat bacterial infections.

Are antibiotics always necessary to treat strep throat?

Yes. Antibiotics are the only way to treat strep throat as it’s a bacterial infection with a set of discomforting symptoms that can only be treated by the right antibiotics.
Other than antibiotics only natural remedies will work to ease symptoms. For instance drinking warm liquids, gargling with warm salt water and black pepper tea can help immensely.

When is the best time to take azithromycin?

Antibiotics like azithromycin can be taken in the morning or night with or without a meal. There is no specific time to take azithromycin. Although taking antibiotics at the same time of the day till it’s prescribed can help greatly in the process of getting better.

Is azithromycin the only antibiotic used to treat strep throat?

No, Strep throat is a bacterial Infection caused by the bacterium streptococcus and it can be treated by Penicillin (First line of treatment) as well as azithromycin (if you are allergic or Resistant to Azithromycin).

Can azithromycin be taken with other medications?

No, Azithromycin can not be tolerated with all medications for instance  Antivirals including nelfinavir can not be taken together. Azithromycin shows interaction with antacids, anticoagulants and SSRIs as well. It’s better to tell all the medications you plan to take to your healthcare provider before starting an azithromycin prescription.

Your Doctors Online uses high-quality and trustworthy sources to ensure content accuracy and reliability. We rely on peer-reviewed studies, academic research institutions and medical associations to provide up-to-date and evidence-based information to the users.

  • Casey JR, Pichichero ME. Higher dosages of azithromycin are more effective in treatment of group A streptococcal tonsillopharyngitis. Clin Infect Dis. 2005 Jun 15;40(12):1748-55. doi: 10.1086/430307. Epub 2005 May 13. PMID: 15909262.
  • Schaad UB, Kellerhals P, Altwegg M; Swiss Pharyngitis Study Group. Azithromycin versus penicillin V for treatment of acute group A streptococcal pharyngitis. Pediatr Infect Dis J. 2002 Apr;21(4):304-8. doi: 10.1097/00006454-200204000-00009. PMID: 12075761.
  • Medscape. Strep Throat: Where Does Azithromycin Fit?
  • Centers for Disease Control and Prevention. Pharyngitis (Strep Throat)
  • Mayo Clinic. Azithromycin (Oral Route)
  • McMullan BJ, Mostaghim M. Prescribing azithromycin. Aust Prescr. 2015 Jun;38(3):87-9. doi: 10.18773/austprescr.2015.030. Epub 2015 Jun 1. PMID: 26648627; PMCID: PMC4653965.
  • Food and Drug Authority. Azithromycin (marketed as Zithromax or Zmax) Information

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