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Key takeaways
Alternatives to sulfamethoxazole-trimethoprim include penicillin antibiotics, cephalosporin antibiotics, macrolide antibiotics, urinary antiinfectives, and quinolone or fluoroquinolone antibiotics, each with unique bacterial coverage and usage.
Sulfamethoxazole-trimethoprim, approved by the FDA in 1973, is effective against a variety of organisms and is used to treat infections such as UTIs, pneumonia, and skin infections, but may not be suitable for everyone due to potential for allergic reactions or resistance.
Significant considerations for choosing an alternative include allergies, resistance, and the specific infection being treated, with healthcare providers able to perform tests to determine the most effective antibiotic.
Natural prevention methods and early intervention strategies for infections include cranberry products for UTIs, immune-boosting supplements, and good hygiene practices, although they are not substitutes for antibiotics once an infection has occurred.
Bactrim (sulfamethoxazole/ trimethoprim, trimethoprim-sulfamethoxazole, TMP-SMX) is a combination antibiotic. Sulfamethoxazole is a sulfonamide antibiotic, and trimethoprim is an additional antimicrobial agent. It was approved by the Food and Drug Administration (FDA) in 1973. This medication was initially used primarily to treat urinary tract infections (UTIs) but has proven to be a versatile product. Bactrim can be used for skin and soft tissue infections and even pneumonia caused by dangerous microorganisms.
Bactrim has been proven effective against the following types of organisms:
- Aerobic gram-positive bacteria: streptococcus pneumoniae
- Aerobic gram-negative bacteria: Escherichia coli, Klebsiella species, Enterobacter species, Haemophilus influenzae, Morganella morganii, Proteus mirabilis, Proteus vulgaris, Shigella flexneri, Shigella sonnei
- Other Microorganisms: Pneumocystis jirovecii
Fortunately, the combination of sulfamethoxazole and trimethoprim has been generic for quite some time. Thanks to this, Medicare and major insurance plans cover it, but it is still affordable even if one is not covered by insurance. With a coupon from SingleCare, a standard treatment is available generically for less than $10 at most major participating pharmacies. Sulfamethoxazole-trimethoprim may be prescribed under the Bactrim, Bactrim DS, or Septra names.
If someone finds themselves in a situation where Bactrim doesn’t seem the right choice, other treatment options may be available.
What can I take in place of sulfamethoxazole-trimethoprim?
There are some scenarios where Bactrim may not be the best choice for an infection or condition, even if it is caused by one of the above organisms. First, there are a significant number of individuals who have a sulfa allergy or hypersensitivity. Typically, this involves an undesirable rash and itching and could lead to a life-threatening emergency reaction. Known as anaphylaxis, it can impair breathing and stop the heart without immediate intervention.
An infection may already be resistant to Bactrim if it has been exposed to the drug recently or repeatedly. The prescriber must know the history of any antibiotic therapy before they choose treatment. Inappropriate use of antibiotics can lead to antibiotic resistance. A pathogen can be very adaptive, and because of this, we have to be very careful in how we prescribe and use our relatively small selection of antibiotics.
These options are not intended to be interpreted as medical advice. Only a prescriber can determine which antibiotic, if any, is appropriate for the condition needing treatment. This also does not include all appropriate dosing, uses, risk factors, or drug interactions for each alternative. Most antibiotics have specific dosing for the pediatric population, but those are not listed here. A pharmacist can provide more information.
Compare sulfamethoxazole-trimethoprim (Bactrim) alternatives
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| Drug name | Uses | Dosage | Savings options |
| Bactrim (sulfamethoxazole-trimethoprim) | UTI, Pneumocystitis pneumonia (PCP), otitis media, bronchitis, pertussis | 800 mg/ 160 mg by mouth twice daily for 3 days to 7 days, depending on the infection | Sulfamethoxazole-trimethoprim coupons |
| Cipro (ciprofloxacin) | UTI, Lower respiratory infections (LRTI), skin infections, animal bites, diarrhea, gastroenteritis, sinus infection, gonorrhea | 250 mg to 750 mg by mouth twice daily for 3 to 10 days, depending on the diagnosis | Cipro coupons |
| Levaquin (levofloxacin) | Sinus infection, UTI, bronchitis, community-acquired pneumonia (CAP), skin infections | 500 mg to 750 mg by mouth twice daily for 5 days to 10 days, depending on the infection | Levaquin coupons |
| PenVK (penicillin) | Pharyngitis, tonsillitis, skin infections, animal bites, scarlet fever | 500 mg by mouth two to three times daily for 10 days, depending on the infection | Pen VK coupons |
| Amoxil (amoxicillin) | Pharyngitis, tonsillitis, otitis media, skin infections, UTI | 500 mg by mouth every 8 to 12 hours for 10 days, depending on the infection | Amoxil coupons |
| Augmentin (amoxicillin/ clavulanic acid) | Otitis media, sinus infection, LRTI, CAP, skin infection, UTI | 500 mg/ 125 mg every 8 hours or 875 mg/ 125 mg every 12 hours by mouth for 10 days, depending on the infection | Augmentin coupons |
| Keflex (cephalosporin) | URI, skin infection, otitis media | 250 mg every 6 hours or 500 mg every 12 hours by mouth for 7 to 14 days, depending on the infection | Keflex coupons |
| Omnicef (cefdinir) | Otitis media, bronchitis, sinus infection, CAP, pharyngitis, tonsillitis, skin infections | 300 mg by mouth every 12 hours for 5 to 7 days, depending on the infection | Omnicef coupons |
| Vantin (cefpodoxime) | CAP, gonorrhea, UTI, skin infections, pharyngitis, tonsillitis, sinus infections | 200 mg by mouth every 12 hours for a minimum of 5 days, depending on the infection | Vantin coupons |
| Vibramycin (doxycycline hyclate) | Skin infections, cellulitis, animal bites, skin ulcers, UTI, URI, LRTI, acne, gastroenteritis | 100 mg by mouth every 12 hours for 7 to 10 days, depending on the infection | Vibramycin coupons |
| Ery-Tab (erythromycin) | Acne, LRTIs, CAP, URIs, Legionnaires disease, chlamydia | 250 mg every 6 hours or 333 mg every 8 hours by mouth for 7 to 10 days, depending on the infection | Ery-Tab coupons |
| Zithromax (azithromycin) | CAP, bronchitis, pharyngitis, tonsillitis, sinus infection, otitis media, conjunctivitis (eye infection), skin infection, pelvic inflammatory disease | 500 mg by mouth on day 1, followed by 250 mg by mouth once daily for 4 additional days | Zithromax coupons |
| Biaxin (clarithromycin) | Bronchitis, CAP, sinusitis, skin infections, otitis media, | 250 mg to 500 mg by mouth twice daily for 5 to 7 days, depending on the diagnosis | Biaxin coupons |
| Cleocin (clindamycin) | Sepsis, LRTIs, CAP, intra-abdominal infections, bone and joint infections, skin infections | 150 mg to 450 mg by mouth every 6 hours for 7 to 10 days, depending on the diagnosis | Cleocin coupons |
| Macrobid (nitrofurantoin) | UTI, UTI prophylaxis | 100 mg by mouth every 12 hours for 7 days | Macrobid coupons |
Other alternatives to sulfamethoxazole-trimethoprim
- Avelox (moxifloxacin)
- Duricef (cefadroxil)
- Ancef (cefazolin)
- Cefzil (cefprozil)
- Rocephin (ceftriaxone)
- Suprax (cefixime)
- Spectracef (cefditoren)
- Minocin (minocycline)
- Urex (methenamine)
- Proloprim (trimethoprim)
- Macrodantin (nitrofurantoin)
Top 5 sulfamethoxazole-trimethoprim alternatives
There are multiple classes of antibiotics, and within each class, there are multiple products to choose from. Each class uniquely fights bacterial infections, and each product may have unique bacterial coverage. A healthcare provider may utilize laboratory tests, including blood or tissue samples, to determine the most effective products for the infection. Other antibiotics available include quinolones or fluoroquinolones, beta-lactams, macrolides, and aminoglycosides.
The following are some of the most common alternatives to sulfamethoxazole-trimethoprim.
1. Penicillin antibiotics
Penicillin was the first commercially available antibiotic, dating back to the 1940s. It was discovered accidentally by a scientist who left an uncovered petri dish of staphylococcus aureus out where it grew mold. It was noted that the bacteria was not growing near the mold spores, and the mold substance was isolated and named penicillin. Penicillins are effective against gram-positive and gram-negative bacteria. Unfortunately, because this class of antibiotics has been around for quite some time, the antimicrobial resistance to penicillin is a growing concern. Some formulations have a beta-lactamase inhibitor that helps fight resistance but can still occur. It is important not to “underdose” this class of drugs when used, as this can propagate resistance more. Penicillins are commonly used for otitis media (ear infections), upper respiratory tract infections (URI), and some urinary tract infections (UTIs). Penicillin allergies are possible, and penicillin should not be taken if an allergic reaction to penicillin or a related product has occurred. This can include rashes, itching, or anaphylaxis.
Examples: PenVK (penicillin potassium), Amoxil (amoxicillin), Augmentin (amoxicillin/ clavulanic acid)
2. Cephalosporin antibiotics
Cephalosporins come in multiple generations: first-generation, second-generation, third-generation, and fourth-generation. As each generation advanced, they offered more sophisticated mechanisms to fight bacterial infections. The differences between the generations affect dosing, absorption, administration length, and bacterial coverage spectrum. In general, cephalosporins are used to treat ear infections, skin infections, URIs, UTIs, and bone infections. If there is an allergy to penicillins, there is a possibility of also being allergic to cephalosporins. It’s important to discuss this potential risk with your healthcare provider or pharmacist
Examples: Keflex (cephalosporin), Omnicef (cefdinir), Vantin (cefpodoxime)
3. Macrolide antibiotics
Macrolide antibiotics are primarily effective against gram-positive bacteria. They block protein synthesis in the bacterial cell, stopping the continued growth of the bacteria. Macrolides are effective against certain sexually transmitted infections or diseases (STI or STD), skin infections, ear infections, and eye infections. Patients with hepatic impairment or liver disease may not be good candidates for macrolide therapy.
Examples: Zithromax (azithromycin), Biaxin (clarithromycin), Ery-Tab (erythromycin)
4. Urinary antiinfectives
Urinary antiinfectives are a unique class because their effectiveness stems from their high concentration in the urine. They are antibiotics used against bacteria responsible for UTIs and are highly concentrated in the urine. Patients with liver or kidney disease may not be able to take these medications as they could experience toxicity. Do not take these if pregnant and in the last month of a pregnancy.
Examples: Macrobid (nitrofurantoin monohyd macro ), Macrodantin (nitrofurantoin macrocrystal)
5. Quinolone or Fluoroquinolone antibiotics
Fluoroquinolone antibiotics have potentially severe adverse effects and are rarely used as a first-line treatment for infections. Their prevalence of use greatly decreased after the retrospective correlation to a few severe adverse reactions once these drugs had been on the market for several years. They can cause QT prolongation and tendon weakness, leading to debilitating injuries. However, they are very effective against various bacteria types and may need to be considered if other antibiotics are not working. It is imperative to use the shortest course possible when prescribing fluoroquinolones. Cipro (ciprofloxacin) covers some organisms responsible for UTIs and may be the best option when Bactrim is not treated adequately.
Examples: Cipro (ciprofloxacin), Levaquin (levofloxacin), Avelox (moxifloxacin)
Natural alternatives to sulfamethoxazole-trimethoprim
There are no natural antibiotics available to purchase off the shelf. Natural alternatives for fighting infections are aimed more at early intervention, detection, and prevention.
For urinary tract infections, cranberry products have been shown to have value in symptomatic relief and prevention. The acidic environment created in the urine after ingesting cranberry products is thought to create an environment where it is hard for the bacteria to continue to grow and spread. The body’s natural immune system can continue its attack on the infection. Good genital hygiene helps prevent conditions that could make UTIs more common. This includes washing with mild soap and water and good cleaning habits after urinating.
Taking immune-boosting supplements such as vitamin C, zinc, and D will boost the body’s natural ability to fight infections.
Good hygiene habits such as bathing and handwashing help prevent the spread of bacteria responsible for infections.
Once a bacterial infection occurs, it may be difficult for the body to eradicate. Delaying treatment with an antibiotic can be dangerous and leave the infection harder to treat. Seek help immediately for open and oozing wounds, fever, inflamed and warm skin, and symptoms that do not resolve independently in a reasonable amount of time (ear pain, sinus pain, etc.).
How to switch to a sulfamethoxazole-trimethoprim alternative
Suppose one is being treated for a bacterial infection with Bactrim or another form of sulfamethoxazole/trimethoprim. In that case, a healthcare provider will prescribe it as a multi-day regimen (typically 7, 10, or 14). While taking this antibiotic, if the symptoms worsen, contact the healthcare provider immediately, as they may need to make a fast change in therapy. If one completes their prescribed course and experiences no worsening of symptoms but still does not see improvement, and if the symptoms persist, it is advisable to schedule a follow-up with the prescriber. Prolonging the treatment with the same medication or considering an alternative might be necessary. The crucial step is to engage in a conversation with the prescriber. If uncertainty remains about the effectiveness of the medication, a pharmacist can provide assistance and address concerns or liaise with the prescriber. Clinicians want to completely treat the infection to decrease the likelihood of it returning and being harder to treat.
Fortunately, most antibiotics have coverage on Medicare and commercial drug insurance plans. If paying out of pocket or uninsured, use a SingleCare prescription discount card to find the lowest price for antibiotics and save from the hassle of going from pharmacy to pharmacy when not feeling well.