Can't Find Azasite? Here Are Your Alternatives

If your doctor prescribed Azasite and your pharmacy can't fill it, you're not stuck. While Azasite has been hard to find due to ongoing shortages and its brand-only status, there are several effective alternatives your doctor can prescribe instead.

This guide covers what Azasite is, how it works, and the best alternative medications available in 2026 — so you can have an informed conversation with your eye doctor.

What Is Azasite?

Azasite is a prescription eye drop containing Azithromycin 1%, a macrolide antibiotic. It's the only topical ophthalmic form of Azithromycin available in the United States and is manufactured by Thea Pharma.

It's FDA-approved for treating bacterial conjunctivitis (pink eye) caused by common bacteria including Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus influenzae. Doctors also frequently prescribe it off-label for posterior blepharitis and meibomian gland dysfunction (MGD) — conditions that affect the oil-producing glands in your eyelids.

For a complete overview, see our guide to what Azasite is and how it's used.

How Does Azasite Work?

Azithromycin works by binding to the 50S ribosomal subunit of bacteria, which stops them from making the proteins they need to survive and multiply. In simpler terms, it kills the bacteria causing your eye infection.

What makes Azasite special compared to other antibiotic eye drops is its DuraSite delivery system — a mucoadhesive polymer that keeps the medication on your eye's surface longer. This extended contact time means:

• Higher drug concentrations in your eyelid tissue
• Fewer drops needed per day (twice daily for 2 days, then once daily for 5 days)
• Better patient compliance compared to drops that must be used 4+ times daily

Azithromycin also has anti-inflammatory properties, which is part of why it's so valued for treating blepharitis and MGD — conditions that involve both infection and inflammation. For more details, read our article on how Azasite works.

Alternative Medications to Azasite

The right alternative depends on what condition you're treating. Here are the most commonly prescribed options.

1. Moxifloxacin Ophthalmic 0.5% (Vigamox)

Drug class: Fluoroquinolone antibiotic

Best for: Bacterial conjunctivitis

Moxifloxacin is one of the most widely prescribed antibiotic eye drops in the United States. It's a fourth-generation fluoroquinolone with broad-spectrum activity against the same bacteria that Azasite targets, plus many others.

Key differences from Azasite:

• Dosed three times daily for 7 days (more frequent than Azasite)
• Available as both brand (Vigamox) and generic — generic versions are significantly cheaper
• Does not have the same anti-inflammatory properties as Azithromycin
• Preservative-free formulation available

Cost: Generic Moxifloxacin eye drops typically cost $15 to $50, making it much more affordable than Azasite's $205-$260 price tag.

2. Tobramycin Ophthalmic 0.3% (Tobrex)

Drug class: Aminoglycoside antibiotic

Best for: Bacterial conjunctivitis, superficial eye infections

Tobramycin has been a workhorse antibiotic eye drop for decades. It's effective against many common eye infection bacteria, particularly gram-negative organisms.

Key differences from Azasite:

• Dosed every 4-6 hours (more frequent dosing)
• Available as both drops and ointment
• Generic widely available at very low cost
• Does not have anti-inflammatory properties
• May cause more local irritation than Azasite

Cost: Generic Tobramycin eye drops typically cost $10 to $30 — a fraction of Azasite's price.

3. Besifloxacin Ophthalmic 0.6% (Besivance)

Drug class: Fluoroquinolone antibiotic

Best for: Bacterial conjunctivitis, especially if resistance is a concern

Besifloxacin is a newer fluoroquinolone designed specifically for ophthalmic use. It was never developed for oral or systemic use, which may help reduce the risk of bacterial resistance.

Key differences from Azasite:

• Dosed three times daily for 7 days
• Brand-only (no generic available), so it's also expensive
• Broad spectrum, effective against many resistant bacteria
• Preserved with a unique formulation that may cause fewer allergic reactions

Cost: Besivance typically costs $200 to $300 per bottle — similar to Azasite pricing.

4. Erythromycin Ophthalmic Ointment 0.5%

Drug class: Macrolide antibiotic

Best for: Bacterial conjunctivitis, superficial eye infections

Erythromycin is in the same macrolide family as Azithromycin and has been used for eye infections for decades. However, there's an important caveat: Erythromycin ophthalmic has also been in shortage, and the FDA has asked doctors to reserve remaining supplies for newborn prophylaxis (preventing eye infections in newborns).

Key differences from Azasite:

• Applied as an ointment, not drops — can cause temporary blurred vision
• Dosed 2-6 times daily depending on infection severity
• Generic available and normally very affordable
• Also currently in shortage, so may not be easier to find than Azasite

Cost: When available, generic Erythromycin ointment costs $10 to $25.

What About Blepharitis and Meibomian Gland Dysfunction?

If you're using Azasite for blepharitis or MGD rather than acute conjunctivitis, alternatives are more limited. Azasite's combination of antibiotic and anti-inflammatory effects makes it uniquely suited for these conditions.

Options your doctor might consider include:

• Oral Azithromycin (Zithromax) — a short course of oral antibiotics can sometimes help with severe blepharitis
• Warm compresses and lid hygiene — the first-line treatment for MGD
• Doxycycline oral — an oral antibiotic with anti-inflammatory properties, commonly used for chronic blepharitis
• Hypochlorous acid lid cleansers — over-the-counter options for eyelid cleaning
• Intense pulsed light (IPL) therapy — an in-office procedure for MGD

Talk to your ophthalmologist or optometrist about which approach is best for your situation. You can also learn more about finding a doctor who prescribes Azasite.

Still Want to Try Finding Azasite?

Before switching to an alternative, it's worth checking whether Azasite is available somewhere near you. Use Medfinder to search for pharmacies that have it in stock, or read our guide on how to find Azasite in stock near you for more tips.

You can also check out our Azasite shortage update for 2026 to get the latest information on supply and availability.

Final Thoughts

Not being able to fill your Azasite prescription is frustrating, but you have options. For bacterial conjunctivitis, alternatives like Moxifloxacin and Tobramycin are effective and much more affordable. For blepharitis and MGD, the conversation is more complex, but your eye doctor can help find the right treatment plan.

The most important thing is to not delay treatment. Eye infections can worsen without antibiotics, so if Azasite isn't available, work with your doctor to get started on an alternative as soon as possible.