Augmentin replacements: what to use when amoxicillin-clavulanate isn’t right

Augmentin (amoxicillin with clavulanate) works well for many common infections because clavulanate blocks beta-lactamase enzymes made by resistant bacteria. But sometimes you need a replacement—because of allergy, side effects, resistance, or drug interactions. Here’s a practical, no-nonsense guide to common alternatives and how doctors pick them.

Common alternatives by infection

Sinusitis, otitis, bronchitis: If Augmentin isn’t an option, options often include high-dose amoxicillin (if resistance isn’t a concern), doxycycline, cefuroxime or cefdinir, and in some adults respiratory fluoroquinolones (levofloxacin or moxifloxacin) when other choices fail. Macrolides like azithromycin used to be common but resistance limits their usefulness.

Skin and soft tissue infections: Cephalexin is a go-to for non-resistant staph and strep. For suspected MRSA or beta-lactamase producers, doxycycline, clindamycin, or trimethoprim-sulfamethoxazole (TMP-SMX) are common picks. Choice depends on local resistance patterns and whether the wound is purulent.

Urinary tract infections: Augmentin is rarely first-line for simple cystitis. Nitrofurantoin and fosfomycin are preferred for uncomplicated lower UTIs. TMP-SMX is another option when local resistance rates are low. For complicated UTI or pyelonephritis, broader agents guided by urine culture are used.

Dental or deep tissue infections with anaerobes: Metronidazole covers anaerobic bugs well and is often combined with another antibiotic if needed. Clindamycin also works for oral infections, especially in patients allergic to penicillin.

How clinicians decide — quick rules

Match the drug to the bug and the body site. If a culture is available, use its results. If you’re allergic to penicillin, avoid cephalosporins only if the allergy was severe (anaphylaxis); many people with mild rashes can still take some cephalosporins, but confirm with your doctor.

Consider safety and patient factors: pregnancy, breastfeeding, age, kidney or liver disease, and drug interactions matter. Doxycycline isn’t used in young children or pregnant patients. Fluoroquinolones can cause tendon and nerve problems in some people. Nitrofurantoin is not for kidney infections or late pregnancy.

Use antibiotics responsibly. Take the right dose for the right length of time, and don’t pressure a prescriber for antibiotics for viral infections. If symptoms worsen or you develop a new fever, return to your clinician—sometimes a change of antibiotic or drainage is needed.

If you’re unsure which alternative fits your situation, ask for a culture, mention any drug allergies, and explain other medical problems. A short conversation with your provider will help pick a safe, effective replacement for Augmentin.