Compare Augmentin (Amoxicillin and Clavulanate) with Alternatives: What Works Best?

When you’re prescribed Augmentin, you’re getting a one-two punch: amoxicillin to kill bacteria and clavulanate to block the enzymes that make some bugs resistant. It’s a go-to for sinus infections, ear infections, and skin bugs that won’t quit with plain amoxicillin. But it’s not the only option. If you’ve had side effects, if it didn’t work, or if your doctor is looking for something cheaper or gentler, you’ve got choices. Here’s how Augmentin stacks up against the most common alternatives - and when each one actually makes sense.

What Exactly Is Augmentin?

Augmentin is a combo drug: 875 mg of amoxicillin and 125 mg of clavulanate potassium per tablet. It’s not just stronger amoxicillin - it’s amoxicillin with a shield. Clavulanate stops bacteria from breaking down amoxicillin, letting it work where regular amoxicillin fails. That’s why doctors reach for it when infections don’t clear up after 3-5 days on plain amoxicillin. Common uses include sinusitis, pneumonia, urinary tract infections, and infected bites or wounds.

But it comes with trade-offs. About 1 in 10 people get diarrhea. One in 20 gets nausea or vomiting. Rarely, it causes liver issues or severe allergic reactions. And it’s not cheap - a 10-day course in the UK can cost £25-£40 without a prescription. That’s why many patients and doctors look at alternatives.

Amoxicillin Alone: The Simpler Option

Before Augmentin, doctors prescribed plain amoxicillin. It’s still first-line for strep throat, ear infections in kids, and mild pneumonia. It’s cheaper, gentler on the gut, and just as effective for infections caused by bacteria that don’t produce beta-lactamase enzymes - the kind that break down penicillin.

Studies show that for uncomplicated sinus infections, amoxicillin works just as well as Augmentin in 80% of cases. The CDC and NICE guidelines still recommend amoxicillin as the starting point for most bacterial respiratory infections. You only need Augmentin if the infection is severe, recurring, or if you’ve already tried amoxicillin and it failed.

Bottom line: If your infection is mild and you’ve never had antibiotic resistance before, start with plain amoxicillin. Save Augmentin for when it’s truly needed.

Cephalexin: The First Alternative for Penicillin Allergies?

Many people think if you’re allergic to penicillin, you can’t take any antibiotics. That’s not always true. About 90% of people who say they’re allergic to penicillin aren’t - or their allergy faded over time. But if you have a confirmed allergy, cephalexin (Keflex) is often the next choice.

Cephalexin is a first-generation cephalosporin. It kills many of the same bacteria as Augmentin, including Staph and Strep. It’s less likely to cause diarrhea than Augmentin. And it’s usually cheaper. A 10-day course costs around £15-£25 in the UK.

But here’s the catch: cephalexin doesn’t block enzyme resistance like clavulanate does. So if your infection is caused by a resistant strain - like some skin abscesses or recurrent UTIs - cephalexin might fail where Augmentin works. It’s also not as effective against anaerobic bacteria, which are common in dental or deep tissue infections.

Use cephalexin when you need a penicillin-free option for a simple skin or soft tissue infection. Skip it if your infection is deep, recurrent, or suspected to be from resistant bugs.

Doxycycline: For When Bacteria Are Sneaky

Doxycycline is a tetracycline antibiotic. It doesn’t look or act like penicillin at all. It works differently - blocking protein production in bacteria instead of attacking their cell walls. That makes it useful for infections that don’t respond to amoxicillin-based drugs.

It’s the top pick for acne, Lyme disease, tick-borne infections, and some types of pneumonia caused by atypical bacteria like Mycoplasma. It’s also used for skin infections from MRSA in some cases, especially when clindamycin isn’t suitable.

But it’s not a direct replacement for Augmentin. It doesn’t cover the same range of common bugs. It can’t be used in kids under 12 or pregnant women. And it causes sun sensitivity - you can’t spend time in the sun without getting burned. It also needs to be taken on an empty stomach, which makes it harder to stick with.

Choose doxycycline if your infection is unusual, linked to ticks, or if you’ve failed penicillin-class drugs. Don’t use it for routine ear or sinus infections unless your doctor has reason to suspect something else is going on.

Clindamycin: The Deep Infection Specialist

Clindamycin is the go-to for serious skin and soft tissue infections - think abscesses, cellulitis, or infections after dental work. It’s especially good against anaerobic bacteria and MRSA, which Augmentin sometimes misses.

It’s often used in hospitals when patients are allergic to penicillin and need something strong. A 7-day course costs about £20-£30. It’s not first-line for sinus or ear infections, but it’s a solid backup for stubborn skin boils or infected wounds.

Big downside: it carries a high risk of C. diff diarrhea - a serious, sometimes life-threatening gut infection. That’s why doctors avoid it unless absolutely necessary. If you’ve had C. diff before, you should never take clindamycin.

Use clindamycin for deep skin infections or if you’re allergic to penicillin and Augmentin isn’t an option. Avoid it for simple infections.

Azithromycin: The Once-Daily Alternative

Azithromycin (Zithromax) is a macrolide. It’s popular because you take it once a day for just 3-5 days. That’s easier than Augmentin, which usually needs two or three doses a day for 7-10 days.

It works well for bronchitis, some sinus infections, and pneumonia caused by atypical bacteria. It’s also used for strep throat if someone can’t take penicillin.

But it’s not better than Augmentin for most common infections. A 2023 study in the British Journal of General Practice found azithromycin was less effective than Augmentin for acute bacterial sinusitis. It also has a higher risk of heart rhythm problems in older adults or those with existing heart conditions.

Use azithromycin if you need a short course, have trouble remembering multiple daily pills, or have a penicillin allergy. Don’t use it as a first-line replacement for Augmentin if you’re treating a known resistant infection.

When to Stick With Augmentin

Augmentin isn’t perfect - but it’s often the right tool for the job. You should stick with it if:

• Your infection didn’t improve after 3-5 days on plain amoxicillin
• You have a recurrent sinus or ear infection
• Your doctor suspects beta-lactamase-producing bacteria
• You’re treating a bite wound, dental abscess, or infected ulcer

It’s also the most studied option for these scenarios. The evidence is clear: when resistance is likely, Augmentin wins.

Cost, Accessibility, and NICE Guidelines

In the UK, Augmentin is available on the NHS. A 10-day course of 625 mg tablets costs around £5-£8 with a prescription. Without one, pharmacies charge £25-£40. Most alternatives - amoxicillin, cephalexin, doxycycline - are cheaper, often under £10.

NICE guidelines (2024) say: start with amoxicillin for most infections. Only move to Augmentin if symptoms worsen or don’t improve after 48-72 hours. That’s not just cost-saving - it’s about stopping unnecessary antibiotic use. Overuse drives resistance.

So even if Augmentin works, it’s not always the best first step. Let your doctor know if you’ve had side effects before, or if you’re trying to avoid certain drugs.

What About Natural Remedies or Herbal Antibiotics?

You’ll see ads for garlic, honey, oregano oil, or colloidal silver as "natural antibiotics." Some lab studies show weak antibacterial effects. But none have been proven in clinical trials to treat infections like sinusitis or pneumonia.

Manuka honey can help with wound healing - but only as a topical aid, not as a replacement for oral antibiotics. Garlic might slightly reduce cold duration - but won’t cure a bacterial sinus infection.

Delaying real antibiotics for unproven remedies can turn a simple infection into a serious one. If you’re considering alternatives because you’re scared of side effects, talk to your doctor. There are safer prescription options - not just herbal guesses.

Final Decision Guide

Here’s a quick reference:

What to Do Next

If you’re on Augmentin and having side effects, don’t stop cold turkey. Call your doctor. You might need a different antibiotic - or just supportive care like probiotics for diarrhea.

If you’re wondering whether you really need antibiotics at all - ask. Many sinus and ear infections are viral. Antibiotics won’t help those. A watch-and-wait approach is often safer.

And if you’ve had multiple courses of antibiotics in the past year, talk to your doctor about reducing future need. Good hygiene, vaccination (like pneumococcal and flu shots), and avoiding unnecessary antibiotics now protect you later.

Antibiotics save lives. But they’re not candy. Choosing the right one - not just the most familiar one - makes all the difference.