Price Check! Antibiotics.

Do you remember when doxycycline used to be 5 cents a pill?  Not anymore!  Doxycycline has been relatively expensive for a few months now.

Do you remember when drug reps incessantly touted Rocephin as the antibiotic “Wonder Drug” that would kill any bacteria and also clean your kitchen?  It was ridiculously expensive but sold very well! Now it is not so expensive—and nobody is promoting it.

How about Levaquiin and Zithromycin?  Those are really expensive drugs–right?  Wrong!

Antibiotic drug prices are a-changing. images Here are the most recent prices per single pill for several common antibiotics according to the Actual Average Acquisition Cost compiled by Idaho Medicaid.  These are updated every two weeks.  Your prices may not be exactly the same as these, but they will be close.  There is no reason to check the price of every antibiotic, of course.  Some you just never use and some are redundant “Me Too” Drugs which are only of interest when their price drops somewhere into our solar system.

Penicillins

Generic Name Brand Name Dose Price per pill
Penicillin VK PCN VK 500mg $0.15
Amoxicillin Amoxil 500mg $0.08
Amoxicillin-clavulinate Augmentin 875-125mg 0.71

 

Note that Augmentin has dramatically fallen in price since becoming generic.  Personally, though, I still don’t like to prescribe it because it has such a high incidence of side effects (1 out of 4 get significant diarrhea, for example).

Penicillin VK and amoxicillin both fall into the “inexpensive drug” category, since for both, the pharmacy fill fee will be the most expensive part of the prescription.

Cephalosporins

Generic Name Brand Name Dose Price per pill/dose
Cephalexin Keflex 500mg $0.09
Cefuroxime Ceftin 500mg $0.70
Cefixime Suprax 400mg $16.36
Ceftriazone Rocephin 500mg vial $1.94

 

Note that uncomplicated gonorrhea infections can be treated either with a single dose of cefixime ($16.36) or a much less expensive single shot of ceftriaxone ($1.94).

Cephalexin is still quite a bit less expensive than any alternative cephalosporins.

Macrolides

Generic Name Brand Name Dose Price per pill
Azithromycin Zithromax 250mg $0.97
    500mg $2.23
Erythromycin Ery-tab 500mg $3.35
Erythromycin ES EES 400mg $2.61
Clarithromycin Biaxin 500mg $2.13

 

Note that Zithromax is now the least expensive macrolide, especially when you take into account that you need only six  250mg pills for a ten day antibiotic course compared with 30 erythromycin tablets.

Quinolones

Generic Name Brand Name Dose Price per pill
Ciprofloxacin Cipro 500mg $0.14
Levofloxacin Levaquin 500mg $0.29

 

Remember that Cipro is a twice-a-day medication, whereas Levaquin is given only once a day.  That makes them almost identical in price with the ease-of-administration edge going to Levaquin since the nurses only have to dispense it once a day.

Tetracyclines

Generic Name Brand Name Dose Price per pill
Doxycycline Vibramycin 100mg $0.52
Minocycline Minocin 100mg $0.25
Tetracycline Sumycin 500mg $0.05

 

It was not that long ago that doxycycline only cost around 5 cents a pill.  The price since then peaked at over a dollar and now seems to be falling again.  But as of this moment, minocycline is much less expensive, especially considering that it is a once-a-day drug, whereas doxycycline is twice a day.  Doxycycline is one of our go-to MRSA antibiotics, but minocycline is also approved for this indication.  Even though tetracycline is very cheap, I don’t use it too much because of its worse side effect profile and because it is supposed to be dispensed four times a day.

Note also that the two alternative treatments for chlamydia are Doxycycline 100mg BID for 7 days and a one time dose of 1000mg of azithromycin.  Azithromycin is much easier AND less expensive.

Others

Generic Name Brand Name Dose Price per pill
Trimethoprim-sulfamethoxazole Bactrim DS (160mg/800mg) $0.06
Metronidazole Flagyl 500mg $0.43

 

Note that Bactrim, our main MRSA antibiotic is still very inexpensive.  Minocyline can be our second line drug for those patients who are sulfa allergic.frank-cotham-the-answer-isn-t-more-troops-what-you-need-is-an-antibiotic-new-yorker-cartoon

Check drug prices once in a while!  It is well worth it.

The prices I quoted here come from the Idaho Medicaid website.  These may not exactly reflect the price your pharmacy will charge you!  But I’ll bet they are pretty close.  It is certainly OK to ask!  Just send this article to your pharmacy provider and ask what their prices are for these antibiotics.  When I do this, I get real numbers the same day.

But remember that drug prices change with time, sometimes rapidly!  It is well worthwhile to keep up with these changes in drug prices periodically. If you have a helpful pharmacist who will do this for you, so much the better! But you can also track drug prices yourself.  Having done this recently, I can tell you that it will only take you about an hour a month to review the changes in drug prices for your most frequently prescribed medications.

Do you track changing drug prices at your institution?  Do you have an opinion as to preferred antibiotics?  Please Comment!

7 thoughts on “Price Check! Antibiotics.

  1. ANDREW DORFMAN, MD

    HELPFUL, PRACTICAL AND NOW CHECKING PRICES FOR COMMONLY PRESCRIBED MEDICATIONS AT MY OWN INSTITUTION WILL BE PART OF MY REGULARLY PLANNED TASKS. THE CARTOON IS PERFECT AND HELPS TO EXPLAIN MUCH OF THE RAMPANT BUG RESISTANCES WE ARE ALL EXPERIENCING. THANKS, JEFFREY.

    Reply
    1. Mark C.

      Suprax is no longer recommended for GC.

      Bactrim scares me due to frequent and dangerous allergic reactions. Multiple interactions with coumadin.

      Minocin seems to have a lot of side effects., mostly headache.
      Can minocin be substituted for sulfa in MRSA?

      Reply
      1. Jeffrey Keller MD Post author

        It is true that no oral cephalosporin is recommended first line vs. GC now. However, They are still listed as second line drugs and seem still to be used in the community! I should have made that more clear. Thanks for pointing that out!

        Minocycline may indeed be used vs. MRSA!

        Reply
  2. Bill Wright MD

    Not to get off the subject of price, but GC is a slippery one, especially with the new drug-resistant strains. CDC is recommending Rocephin 250 mg IM plus Azithromycin 1000 mg as the primary choice, but you can also treat orally with Suprax 400 mg plus Azithromycin 1000 mg as a single dose. Although the Azithromycin isn’t a recommended monotherapy for GC, it can be treated in cephalosporin-allergic patients with 2 grams as a single dose with a test-of-cure a week later. Likewise with Suprax, you should do a test-of-cure in a week as well.

    I’m a fan of Bactrim for MRSA infections. Maybe I’m not looking closely enough, but I don’t see significant side effects that often.

    Reply
  3. Mike Hanson

    These prices are far lower than what I pay. Augmentin is 2.85/pill, clindamycin $2.50/pill, and moxafloxacin $24.10/pill (all at WM)

    Mike

    Reply
    1. Jeffrey Keller MD Post author

      Well, Mike, the article was published over a year ago, and prices in the pharmaceutical world change rapidly. Also, do you know how your pharmacy is determining your prices? Are they using AWP? Retail? Medicaid prices? You should check it out if you do not know.

      Reply

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