Augmentin alternatives
Augmentin (amoxicillin/clavulanate) works well for many infections, but sometimes you need a different drug — allergy, side effects, resistance, or a specific bug. Below I’ll walk through practical alternatives, when they make sense, and key safety points you can bring to your clinician.
When to consider an alternative
Think about an alternative if you have a true penicillin allergy (hives, swelling, anaphylaxis), repeated stomach upset or severe diarrhea on Augmentin, treatment failure, or lab results showing resistance. Also consider different drugs based on the infection site — urinary infections, skin infections, and respiratory infections each have preferred options.
Common alternatives by infection
Respiratory infections (sinusitis, bronchitis, some ear infections): Doxycycline or a macrolide like azithromycin can work when Augmentin isn’t suitable. Doxycycline is a good broad choice for adults and often effective against resistant strains. Azithromycin can help if you need a short course, but resistance to macrolides is rising in some areas.
Skin and soft tissue infections: First-line alternatives include cephalexin (a first-generation cephalosporin) and clindamycin. Cephalexin treats many staph and strep infections well; clindamycin covers common skin bugs and some MRSA strains. If MRSA is likely, discuss targeted therapy with your doctor.
Urinary tract infections: Augmentin isn’t usually first choice for uncomplicated UTIs. Nitrofurantoin, trimethoprim-sulfamethoxazole (TMP-SMX), or fosfomycin are more commonly recommended depending on local resistance patterns. Tell your clinician if you’re pregnant — nitrofurantoin is often used, but there are specific timing rules in pregnancy.
When penicillin allergy is present: Many people labeled "penicillin allergic" can actually tolerate cephalosporins. If the allergy was severe, avoid beta-lactams and consider doxycycline, azithromycin, or clindamycin depending on the infection. Ask your clinician about allergy testing if the history is unclear.
Serious infections or resistant bacteria: For complicated infections, culture-guided therapy is the safest route. Drugs like ceftriaxone, levofloxacin, or carbapenems are sometimes used but require close medical supervision because of side effects and resistance concerns.
Practical tips before you switch: Ask if a culture is possible, check local resistance patterns, and discuss pregnancy, breastfeeding, kidney or liver issues, and other meds you take. Shorter, targeted antibiotic courses often work as well as long ones and reduce side effects and resistance.
Side effects to watch for: Antibiotics can cause diarrhea, yeast infections, allergic reactions, and, rarely, liver injury. Fluoroquinolones and clindamycin have specific risks (tendon problems and C. difficile, respectively). If you get severe diarrhea, rash, breathing trouble, or yellowing skin/eyes, contact your clinician right away.
If you’re unsure which alternative fits your situation, ask your prescriber two direct questions: "Is a culture or test recommended before choosing an antibiotic?" and "What are the top two alternatives if I can’t take Augmentin?" That keeps the decision focused and safe.
