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Reviewed on Mar 11, 2026. by Dr Alexandra Cristina Cowell Writer & Clinical Content Reviewer Next review due on February 25, 2029.
Dr Alexandra Cristina Cowell

Last updated on Mar 11, 2026.

Antibiotic for strep throat for those who can’t take penicillin.

Azithromycin is an FDA-approved antibiotic that’s used to treat strep throat. Strep throat is a sore throat (sometimes accompanied by a fever) that’s caused by an infection of Streptococcus bacteria. Azithromycin stops these bacteria from growing and multiplying, clearing up the infection.

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250mg
$89.95
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Azithromycin Azithromycin

What is Azithromycin?

Azithromycin is an antibiotic tablet that targets and eliminates the bacteria that cause strep throat. It’s a type of macrolide antibiotic, which means it’s a treatment that might be suitable for you if you have a penicillin allergy. It can be prescribed to treat strep throat if you can’t use penicillin or amoxicillin, which are generally the first line treatments used for strep throat.

How does Azithromycin work?

Azithromycin works by interfering with the production of essential proteins that the bacteria responsible for strep throat need to grow and multiply.[1] This stops the infection from spreading, and eliminates the bacteria causing strep throat.

How do Azithromycin doses work?

Azithromycin tablets come in two doses: 250 mg and 500 mg. For the treatment of strep throat, we offer the 250 mg tablets.

What is the active ingredient in Azithromycin?

Azithromycin is a generic medicine that gets its name from its active ingredient: Azithromycin. It’s a type of macrolide antibiotic that stops bacteria from producing essential proteins, stopping them from multiplying and killing off the infection.

Treated trusted source:

  1. Sandman, Z. Iqbal, O.A. (2024). Azithromycin. StatPearls. Treasure Island (FL): StatPearls Publishing.
Dr Alexandra Cristina Cowell 23938
This page was medically reviewed by Dr Alexandra Cristina Cowell on February 25, 2026. Next review due on February 25, 2029.

How we source info.

When we present you with stats, data, opinion or a consensus, we’ll tell you where this came from. And we’ll only present data as clinically reliable if it’s come from a reputable source, such as a state or government-funded health body, a peer-reviewed medical journal, or a recognised analytics or data body. Read more in our editorial policy.

Azithromycin Azithromycin

How to take Azithromycin

You should always follow your prescribers instructions when using Azithromycin for strep throat. Guidance on the optimum dose for antibiotics can sometimes change, and any recent updates will be taken into account by your prescriber.

Usually, you’ll take 500mg (two 250 mg tablets) in one dose on the first day of treatment, and then 250 mg once daily for the next four days.

Swallow your tablets whole with a drink of water.

You can take the tablets with or without food.

For other versions of Azithromycin, like the capsules, you may have to take them at least one hour before food, or two hours after eating.

Always read the leaflet before using your treatment for more detailed instructions on how to take it.

Dr Alexandra Cristina Cowell 23938
This page was medically reviewed by Dr Alexandra Cristina Cowell on February 25, 2026. Next review due on February 25, 2029.

How we source info.

When we present you with stats, data, opinion or a consensus, we’ll tell you where this came from. And we’ll only present data as clinically reliable if it’s come from a reputable source, such as a state or government-funded health body, a peer-reviewed medical journal, or a recognised analytics or data body. Read more in our editorial policy.

Azithromycin Azithromycin

Azithromycin isn’t suitable for everyone, and there are some things that you need to be aware of when taking it.

Here’s all the official info on it. If anything is unclear, let our clinician know, and they can talk with you about it.

Azithromycin Azithromycin

Azithromycin: FAQ

Have something specific you want to know? Search our info below, or ask our experts a question if you can’t find what you’re looking for.

Are there any alternatives to Azithromycin?

Answer:
Yes. Penicillin and Amoxicillin are generally the first line treatments for strep throat. They work by targeting the cell walls of the bacteria causing strep throat. This causes the cell walls of the bacteria to weaken, allowing water into the cell, which kills it off and eliminates the infection.[1]

But if you can’t take Penicillin or Amoxicillin, and Azithromycin hasn’t been effective, you might be offered another antibiotic like cephalexin. It works in a different way to macrolides, so it might be effective when other treatments haven’t been.

How effective is Azithromycin for strep throat?

Answer:
Azithromycin has proven to be an effective treatment for strep throat in clinical trials. One study, comparing Azithromycin treatment over five days with Penicillin treatment over 10 days, found that 99% of individuals using Azithromycin were clinically cured, or their condition improved after treatment. This shows that Azithromycin has about the same level of effectiveness as first-line Penicillin treatment for clearing up strep throat infections.[2]

Do I need a prescription for Azithromycin?

Answer:
Yes. Azithromycin is an antibiotic, which means you’ll need a prescription for a healthcare professional before you’re able to use it. This is because taking antibiotics when you don’t need them can increase bacterial antibiotic resistance, so they might not be as effective when you do need them.

What should I do if I make a mistake when taking Azithromycin?

Answer:
If you miss a dose of Azithromycin, take it as soon as you remember. But if it’s almost time for your next dose, skip the one you missed and carry on as normal from the upcoming one. This means you’ll finish your course a day later than originally scheduled. Never take a double dose to make up for a missed one.

If you take more Azithromycin than you should, get medical attention right away. You may experience symptoms like:

  • Loss of hearing

  • Nausea and vomiting

  • Diarrhea

How long does it take Azithromycin to work for strep throat?

Answer:
You’ll normally take Azithromycin for five days to fully clear up cases of strep throat. But you may start to feel better as soon as the first day of treatment with Azithromycin.[3] However, to limit the risk of antibiotic resistance or the infection coming back, you should continue taking the treatment and complete the course, even if you feel like your symptoms have cleared up.

Does Azithromycin cause side effects?

Answer:
Like any medicine you may take, Azithromycin has some risk of associated side effects. They’re rare, but if you experience any of the following symptoms, speak to your doctor right away, as they can be serious:

  • Sudden wheezing, difficulty breathing, difficulty swallowing

  • Swelling of your eyelids, face, or lips

  • Rash, itching, or flaking skin

  • Extreme dizziness or fainting

  • Severe or persistent diarrhea, which may have blood or mucus in it

  • Rapid or irregular heartbeat

  • Low blood pressure

  • Blistering of the skin, mouth, eyes, and genitals

  • Skin rash alongside fever, swollen glands, and an increase in certain types of white blood cells

  • Urinating more or less frequently than normal

  • Traces of blood in your urine

  • Sudden appearance of red skin covered in small blisters filled with fluid

  • Yellowing of the skin or whites of the eyes

  • Severe abdominal and back pain

  • Sensitivity to sunlight

  • Bruising or prolonged bleeding after injury.


The most common side effects of Azithromycin, affecting more than one in ten people, include:

  • Diarrhea

  • Abdominal pain

  • Nausea

  • Wind

  • Stomach cramps


Other common side effects, affecting up to one in ten people, can include:

  • Lack of appetite

  • Headaches

  • Dizziness

  • Pins and needles or numbness

  • Changes in your sense of taste

  • Visual disturbances

  • Vomiting and stomach pain

  • Joint pain

  • Fatigue

  • Tiredness or weakness


This isn’t a comprehensive list of every side effect reported with Azithromycin. If you’ve got any questions or concerns, check the package insert that comes with your treatment, or speak with your doctor.

Can I get Azithromycin through private health insurance?

Answer:
You may be able to get it through a health insurance provider. But it’s always best to check your insurer’s formulary, and to speak with them to check if prior authorization is necessary. This is a conversation between your physician and insurer to confirm that Azithromycin is a medical necessity for your condition.

If you’re able to get Azithromycin through your insurance, they may only cover part of the cost of the medication – or only offer coverage if you get it from a specific healthcare provider. If you’re not able to get Azithromycin through your health insurance, you should still be able to obtain it through an online pharmacy service (if it’s a suitable treatment for you) but you’ll likely have to cover the cost.

Treated trusted source:

  1. Yip, D.W. Gerriets, V. (2024). Penicillin. StatPearls. Treasure Island (FL): StatPearls Publishing.
  2. Hooton, T.M. (1991). A comparison of azithromycin and penicillin V for the treatment of streptococcal pharyngitis. The American Journal of Medicine. 91(3). pp. S23-S26.
  3. Westphalen, D. (2019). Using Z-Pack to Treat Strep Throat. Healthline. Mar 27.

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