Azasite Shortage: A Provider Briefing for 2026

Azasite (Azithromycin ophthalmic solution 1%) remains in limited supply as of early 2026. For ophthalmologists, optometrists, and primary care providers who prescribe this medication, the shortage creates prescribing challenges — particularly for patients with bacterial conjunctivitis, posterior blepharitis, and meibomian gland dysfunction (MGD).

This briefing covers the current supply status, historical context, prescribing implications, alternative therapies, cost considerations, and tools to support patient access.

Supply Timeline: How We Got Here

Azasite's availability problems are not new. Understanding the timeline helps contextualize the current situation:

• 2007: Azasite (Azithromycin 1% in DuraSite) approved by the FDA for bacterial conjunctivitis. Originally manufactured by Inspire Pharmaceuticals.
• 2011: Merck acquires Inspire Pharmaceuticals.
• 2013: Merck sells Azasite to Akorn for $50 million. Supply disruptions occur during the transition.
• 2019: Intermittent shortages reported. Ophthalmologists note difficulty obtaining Azasite for off-label blepharitis use.
• 2022: Akorn files for Chapter 11 bankruptcy. Azasite production ceases.
• 2023: Thea Pharma acquires the Azasite NDA and restores production. FDA confirms Thea Pharma as the new manufacturer.
• 2024-2025: Supply gradually improves but remains inconsistent. The erythromycin ophthalmic shortage increases demand for Azasite.
• 2026 (current): Azasite remains on the FDA drug shortage list. Supply is available but limited and unevenly distributed.

Prescribing Implications

For Bacterial Conjunctivitis

Azasite's 7-day dosing regimen (BID x 2 days, then QD x 5 days, total 9 drops per course) offers a compliance advantage over fluoroquinolones and aminoglycosides that require TID or QID dosing. However, given current supply constraints, providers should consider the following:

• Reserve Azasite prescriptions for cases where its unique properties offer clear clinical benefit — particularly when compliance with multi-dose-per-day regimens is a concern.
• Consider first-line alternatives for straightforward bacterial conjunctivitis: Moxifloxacin 0.5% (generic available, ~$15-$50), Tobramycin 0.3% (generic, ~$10-$30), or Besifloxacin 0.6% (brand only, ~$200-$300).
• Document the clinical rationale if prescribing Azasite, as insurers increasingly require prior authorization.

For Blepharitis and MGD

This is where the shortage hits hardest. Azasite's combination of macrolide antimicrobial activity and anti-inflammatory properties makes it a preferred off-label treatment for posterior blepharitis and MGD-associated evaporative dry eye. No other single topical medication offers the same dual mechanism.

When Azasite is unavailable, consider these management approaches:

• Oral Azithromycin: 500 mg day 1, then 250 mg days 2-4, or a pulsed dosing regimen. Provides systemic macrolide anti-inflammatory benefit.
• Oral Doxycycline: 50-100 mg daily for 4-12 weeks. Well-established for chronic blepharitis management with anti-inflammatory properties at sub-antimicrobial doses.
• Lid hygiene protocols: Warm compresses (10-15 minutes daily), lid massage, hypochlorous acid cleansers.
• In-office treatments: Intense pulsed light (IPL) therapy, thermal pulsation (LipiFlow), manual meibomian gland expression.
• Anti-inflammatory adjuncts: Low-dose topical corticosteroids (short-term), cyclosporine (Restasis), or lifitegrast (Xiidra) for associated dry eye disease.

Current Availability Picture

Azasite supply is available but inconsistent. Key points for practice management:

• Wholesale availability varies by region and distributor. Some wholesalers have stock while others are backordered.
• No generic version exists. Thea Pharma remains the sole manufacturer under the original NDA.
• The erythromycin ophthalmic shortage continues to redirect prescribing toward Azasite, straining available supply. The FDA and AAO have recommended reserving erythromycin for neonatal prophylaxis.
• Patient-reported difficulty finding Azasite at retail pharmacies remains high, particularly at major chains.

Cost and Access Considerations

Cost is a significant barrier for many patients:

• Cash price: $205-$260 per 2.5 mL bottle (one 7-day course)
• Insurance: Coverage varies. Many plans require prior authorization or step therapy. Tier placement is typically specialty or non-preferred brand.
• Discount programs: GoodRx and SingleCare may reduce out-of-pocket cost to approximately $190-$220.
• No manufacturer savings program: Thea Pharma does not currently offer a copay card or patient assistance program for Azasite.

For patients facing cost barriers, switching to generic Moxifloxacin ($15-$50) or generic Tobramycin ($10-$30) for conjunctivitis can provide substantial savings. For blepharitis patients, oral Doxycycline (often under $20 generic) may be the most cost-effective alternative.

Tools and Resources for Your Practice

Medfinder for Providers

Medfinder offers a pharmacy availability search that can help your staff direct patients to pharmacies with Azasite in stock. Rather than having patients call multiple pharmacies themselves, you can check availability and provide a specific recommendation.

Patient Education Resources

Consider directing patients to these resources when Azasite is unavailable:

• Azasite shortage update for patients
• Alternatives to Azasite
• How to find Azasite in stock
• Saving money on Azasite

FDA Drug Shortage Database

Monitor the FDA Drug Shortage Database for official updates on Azasite supply status, estimated resolution dates, and manufacturer communications.

Looking Ahead

Several factors could improve the Azasite supply situation:

• Generic development: While no ANDA has been approved, the commercial opportunity created by the shortage may incentivize generic manufacturers. The DuraSite delivery system complexity remains a barrier.
• Erythromycin supply recovery: If erythromycin ophthalmic production stabilizes, redirected demand for Azasite should ease.
• Thea Pharma production scaling: The company continues to work toward increasing manufacturing capacity.

In the meantime, a multi-pronged approach — maintaining awareness of supply status, preparing alternative treatment protocols, and leveraging tools like Medfinder — will help your practice navigate the shortage with minimal disruption to patient care.

Final Thoughts

The Azasite shortage exemplifies the fragility of single-source, brand-only drug supply chains. For providers, the key is staying informed, having alternative protocols ready, and helping patients navigate both availability and cost barriers. The shortage is inconvenient but manageable with the right preparation and resources.

For a provider-focused guide on helping patients access this medication, see our companion article: How to help your patients find Azasite in stock.