If amoxicillin won’t work for you—because of an allergy, side effects, or bacteria that resist it—you still have good options. Picking the right drug depends on the infection type, whether you’re allergic to penicillin, pregnancy status, and local resistance patterns. Below I’ll list common alternatives and simple rules to help you talk with your clinician.
Cephalosporins (cephalexin, cefuroxime, cefdinir): These are often the first swap for skin infections, sinusitis, and some ear infections. If you had a mild penicillin rash long ago, many doctors use a cephalosporin safely. Severe immediate penicillin allergy (anaphylaxis) is different—tell your provider.
Macrolides (azithromycin, clarithromycin): Useful for many respiratory infections and for people with penicillin allergy. Azithromycin is popular because of short courses, but resistance for common bugs is rising. Good for some cases of bronchitis, pneumonia, or strep throat if alternatives are needed.
Doxycycline: Works well for respiratory infections, some skin infections, and tick-borne diseases. It’s oral and affordable. Avoid doxycycline in young children and pregnant people unless the benefit clearly outweighs the risk.
Clindamycin: A go-to for skin and soft tissue infections in people allergic to penicillin. It’s strong against certain bacteria but can cause diarrhea or, rarely, C. difficile infection—so it’s used when clearly needed.
Trimethoprim-sulfamethoxazole (TMP-SMX): Often used for uncomplicated urinary tract infections and some skin infections. Not suitable in pregnancy or for people with certain blood disorders or sulfa allergies.
Nitrofurantoin: A top choice for uncomplicated bladder infections in women. It targets urinary bacteria well but won’t treat kidney infections or other types of infections.
Fluoroquinolones (levofloxacin, moxifloxacin): Powerful and broad, they can treat many types of infections but carry higher risks (tendons, nerves, and other side effects). Because of those risks, doctors reserve them for cases when safer options won’t work.
Start with the infection site: UTI drugs differ from skin or lung infection drugs. Ask for a culture if possible—lab testing helps target therapy and avoids guesswork. Mention any true penicillin allergy, pregnancy, breastfeeding, or liver/kidney problems.
Think about side effects and resistance. If you’ve had bad diarrhea on a drug before, mention it. If your community has high macrolide resistance, azithromycin may not be a smart choice. When in doubt, ask your provider why they chose a specific alternative.
Antibiotics matter—use them only when needed, follow the full course, and check back if symptoms don’t improve within 48–72 hours. If you’re unsure, ask for an antibiotic stewardship-minded clinician or an infectious disease consult for complex cases.
Want help preparing questions for your doctor? I can draft a quick list you can bring to your appointment.
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