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Suprax vs. azithromycin: Antibiotics Side Effects, Dosage, Uses

Suprax (cefixime) vs. azithromycin: What’s the difference?

What are Suprax and azithromycin?

Suprax (cefixime) is a cephalosporin antibiotic used to treat middle ear infections (otitis media), throat infections (pharyngitis), laryngitis, tonsillitis, bronchitis, pneumonia, urinary tract infections (UTIs), gonorrhea, and acute bacterial bronchitis in patients with chronic obstructive pulmonary disease (COPD). Other cephalosporins include cephalexin (Keflex), cefaclor (Ceclor), cefuroxime (Zinacef), cefprozil (Cefzil), cefpodoxime (Vantin), and some injectable forms. Suprax stops bacteria from multiplying by preventing bacteria from forming walls that are necessary to protect the bacteria from their environment and to keep the contents of the bacterial cell together. Most bacteria cannot survive without a cell wall. Suprax is active against a wide spectrum of bacteria including Streptococcus pneumoniae, Staphylococcus aureus, Streptococcus pyogenes, Hemophilus influenzae, E. coli, Moraxella catarrhalis, Klebsiella, Proteus mirabilis, Salmonella, Shigella, and Neisseria gonorrhoeae.

Azithromycin is a macrolide antibiotic related to clarithromycin (Biaxin) and erythromycin that is used to treat otitis media (middle ear infection), tonsillitis, laryngitis, bronchitis, pneumonia, sinusitis, uncomplicated skin and skin structure infections, Mycobacterium avium complex, acute bacterial flare-ups of chronic obstructive pulmonary disease (COPD), acute pelvic inflammatory disease, and certain sexually transmitted infectious diseases (STDs) such as nongonococcal urethritis and cervicitis. It is effective against a variety of bacteria including Streptococcus pneumoniae, Hemophilus influenzae, Mycoplasma pneumoniae, Staphylococcus aureus, Mycobacterium avium, and many others.


Bowel regularity means a bowel movement every day.
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What are the side effects of Suprax and azithromycin?


Common side effects of Suprax include:

Other side effects include:


The most common side effects of azithromycin are:

Other possible side effects of azithromycin include:

Possible serious side effects of azithromycin include:

Antibiotics can alter the normal bacteria in the colon and encourage overgrowth of some bacteria such as Clostridium difficile, which causes inflammation of the colon (pseudomembranous colitis). Patients who develop signs of pseudomembranous colitis after starting azithromycin (diarrhea, fever, abdominal pain, and possibly shock) should contact their physician immediately.

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What is the dosage of Suprax vs. azithromycin?


  • The recommended adult dose for otitis media, tonsillitis, pharyngitis, and urinary tract infections is 400 mg once daily or divided and given as 200 mg every 12 hours.
  • Pediatric patients (6 months and older) have a recommended dose of 8 mg/kg/day once daily or in two doses of 4/mg/kg every 12 hours.


  • Azithromycin (except Zmax) can be taken with or without food, but food reduces stomach upset.
  • Zmax should be taken on an empty stomach 1 hour before or 2 hours after a meal since food reduces its absorption.
  • The adult azithromycin dose is 500-2000 mg in multiple or single doses.
  • For most infections, azithromycin is taken once daily for a relatively short course of treatment (usually five days).
  • The first dose is often a "double dose," twice as much as the remainder of the doses given.
  • For acute bacterial sinusitis, azithromycin may be taken once daily for three days.
  • Zmax usually is given as a single 2 g dose.

What drugs interact with Suprax and azithromycin?


  • Probenecid (Benemid) may increase the blood concentration of Suprax by decreasing removal of Suprax by the kidney. This interaction sometimes is used to enhance the effect of cephalosporins.
  • Combining Suprax with aminoglycosides — for example, tobramycin (Tobradex) — produces additive bacterial killing effects but also may increase the risk of harmful effects to the kidney.
  • Exenatide (Byetta) may delay or reduce the absorption of cephalosporins. Cephalosporins should be administered one hour before exenatide.
  • Suprax may cause a false positive urine ketone test.


  • Azithromycin (except Zmax) should not be taken at the same time as aluminum- or magnesium-based antacids, such as Mylanta or Maalox, because antacids will bind the azithromycin and prevent it from being absorbed from the intestine.

Are Suprax and azithromycin safe to use while pregnant or breastfeeding?


Safety in pregnancy has not been established for Suprax. There are no adequate studies in pregnant women; however, studies in animals suggest no important effects on the fetus.

Safety in nursing mothers has not been established. It is not known if Suprax is excreted in breast milk.


There are no adequate studies of azithromycin in pregnant women. Azithromycin should only be used during pregnancy if it is clearly necessary.

It is not known if azithromycin is secreted in breast milk.


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