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.  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.

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!