Amoxicillin alternatives: what works when you can’t or shouldn’t take it

Can’t take amoxicillin because of allergy, side effects, or resistance? You still have good options. The right substitute depends on the infection, your age, pregnancy status, and local resistance patterns. Below I list common alternatives, what they cover, and quick tips to talk with your doctor.

Common prescription alternatives

Augmentin (amoxicillin + clavulanate) — Use when bacteria produce beta-lactamase and ordinary amoxicillin fails. It covers many sinus, ear, and skin infections better than plain amoxicillin but can cause more stomach upset.

Cephalosporins (cephalexin, cefuroxime) — Good for many skin, throat, and urinary infections. If you have a mild penicillin allergy (rash only), doctors often feel safe using these. For a history of severe anaphylaxis to penicillin, avoid or discuss with an allergy specialist.

Macrolides (azithromycin, clarithromycin) — Often used for people with true penicillin allergy. They’re handy for respiratory infections but local resistance to azithromycin is rising, so they’re not always the best choice.

Doxycycline — Works for some respiratory infections, skin infections, and certain tick-borne diseases. Not for kids under 8 or pregnant people.

Trimethoprim-sulfamethoxazole (Bactrim) — Good for many skin infections and some urinary tract infections. Avoid if you’re pregnant or have certain blood disorders.

Clindamycin — Useful for skin and soft-tissue infections and for some dental infections. It can cause diarrhea or C. difficile, so doctors weigh that risk.

Nitrofurantoin — A first-line choice for uncomplicated bladder infections (cystitis) in women. It doesn’t treat kidney infections.

Fluoroquinolones (ciprofloxacin, levofloxacin) — Broad coverage and useful for certain serious infections, but they have significant side effects and are usually avoided unless necessary.

How to pick the right one

Tell your clinician if you’ve had a real allergic reaction to penicillin (hives, swelling, breathing trouble). That changes choices. Also mention pregnancy, breastfeeding, liver or kidney problems, and current meds — these affect safety and dosing.

Ask whether a culture or rapid test is possible. Cultures let your doctor pick a narrow antibiotic that actually kills the bug instead of guessing. Always take the full prescribed course unless told otherwise and don’t use leftover antibiotics or share them.

If you’re concerned about resistance or side effects, ask for alternatives and for why one drug is preferred. If you have severe allergy history, consider referral for allergy testing — many people labeled “penicillin allergic” can actually tolerate it after testing.

Want help preparing for a doctor visit? Make a short list: your allergy details, recent antibiotics, pregnancy status, and symptoms timeline. That makes picking a safe, effective alternative much faster.