Augmentin alternatives: practical options and when to use them

Augmentin (amoxicillin/clavulanate) is a go-to for many bacterial infections, but it's not perfect for every situation. Maybe you reacted badly to penicillin, local resistance is high, or the bug causing your infection needs a different drug. This page walks through real alternatives, why a doctor might pick one over another, and key safety points to keep in mind.

When to consider an alternative

Three common reasons to choose something other than Augmentin: a true penicillin allergy, an infection type that responds better to another class, or side effects (severe diarrhea, repeated nausea). Also, lab results can show which antibiotic the bacteria are sensitive to—culture and sensitivity testing is the best way to pick an effective drug.

If you have a documented severe penicillin allergy (hives, swelling, difficulty breathing), do not take Augmentin again without testing. Mild rash in the past still warrants a talk with your prescriber about risks and alternatives.

Common alternatives and when they fit

Choose the alternative based on the infection site and local resistance patterns. Here are practical options clinicians use:

Amoxicillin alone — If clavulanate isn’t needed (low beta-lactamase risk), plain amoxicillin can work for simple ear or throat infections.

Cephalosporins (cephalexin, cefuroxime) — Good for many skin and soft-tissue infections and some respiratory infections. Cephalosporins share some cross-reactivity with penicillins but are often safe if your penicillin reaction was mild.

Doxycycline — Useful for respiratory infections, some skin infections, and tick-borne illnesses. Not recommended in pregnancy or young children.

Macrolides (azithromycin) — An option for people with penicillin allergy, especially for certain respiratory infections. Resistance rates are rising, so effectiveness depends on local patterns.

Trimethoprim-sulfamethoxazole (TMP-SMX) — Often chosen for certain skin infections (including MRSA in some areas) and urinary tract infections, when the bug is known to be susceptible.

Clindamycin — Useful for skin infections and some dentals. It covers many gram-positive bugs but carries a higher risk of C. difficile diarrhea.

Fluoroquinolones (levofloxacin, ciprofloxacin) — Very broad, sometimes used when other options fail. They have significant safety concerns (tendons, nerves) and should be reserved for cases where benefits outweigh risks.

Always tell your provider about pregnancy, breastfeeding, other drugs you take, and any past allergic reactions. When possible, doctors prefer targeting therapy to the specific bacteria rather than guessing—ask about cultures if your infection is severe or not improving.

Need help figuring out which option fits your situation? Ask your prescriber about local resistance, allergy testing, and the safest, most effective choice for your infection.