Compare Keftab (Cephalexin) with Alternatives: What Works Best for Your Infection

Compare Keftab (Cephalexin) with Alternatives: What Works Best for Your Infection

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When your doctor prescribes Keftab (cephalexin), it’s usually because you have a bacterial infection-maybe a skin abscess, a urinary tract infection, or a respiratory bug. But you’re not alone if you’re wondering: Is cephalexin really the best option? What if you’re allergic to penicillin? Or if it made you sick last time? Or if your insurance won’t cover it? You’re not just looking for a name on a script-you want to know what else works, what’s safer, and what won’t cost you a fortune.

What Is Cephalexin (Keftab)?

Cephalexin is a first-generation cephalosporin antibiotic. It’s been around since the 1960s, and it’s still used today because it’s cheap, effective, and widely available. It kills bacteria by breaking down their cell walls-kind of like popping a balloon from the inside. It works best against common bugs like Staphylococcus aureus and Streptococcus pyogenes, which cause things like boils, cellulitis, strep throat, and some ear infections.

Most people take it two to four times a day, usually for 7 to 14 days. It’s available as capsules, tablets, and liquid. In Australia, it’s listed on the PBS (Pharmaceutical Benefits Scheme), so it’s heavily subsidized-often under $7 for a full course.

But here’s the catch: cephalexin doesn’t work on everything. It’s useless against viruses, and it’s not the first choice for many infections anymore because of resistance and better alternatives.

Why You Might Need an Alternative

People switch from cephalexin for several real reasons:

  • You had nausea, diarrhea, or a rash on your last course
  • You’re allergic to penicillin (and cephalexin can cross-react in 5-10% of cases)
  • Your infection didn’t improve after 3-4 days
  • Your pharmacy ran out, or the cost went up
  • You’re pregnant, breastfeeding, or have kidney problems

None of these are minor. If you’re pregnant, you can’t just pick any antibiotic. If you’re on dialysis, dosing matters. And if your skin infection is getting worse, waiting for a refill could mean hospitalization.

Alternative #1: Amoxicillin (and Amoxicillin-Clavulanate)

Amoxicillin is the most common alternative. It’s a penicillin-type antibiotic, so if you’re allergic to penicillin, skip this one. But if you’re not, it’s often a better pick than cephalexin.

Here’s why: amoxicillin covers a wider range of bacteria, including some that cephalexin doesn’t touch-like the ones that cause sinus infections or ear infections in kids. The combination version, amoxicillin-clavulanate (Augmentin), adds a blocker that stops bacteria from resisting the drug. That makes it much more effective for stubborn infections like recurrent UTIs or deep skin infections.

Side effects? Similar to cephalexin: diarrhea, upset stomach. But studies show amoxicillin-clavulanate clears infections faster in 60% of cases where cephalexin failed.

Alternative #2: Doxycycline

Doxycycline is a tetracycline antibiotic. It’s not a direct replacement for cephalexin, but it’s often used when cephalexin doesn’t work-or when the infection looks different.

It’s great for acne, tick-borne illnesses like Lyme disease, and certain types of skin infections caused by MRSA (methicillin-resistant Staphylococcus aureus). Unlike cephalexin, doxycycline works well against intracellular bacteria-bugs that hide inside your cells.

But it has downsides. You can’t take it with dairy or antacids-they block absorption. It makes your skin super sensitive to the sun. And it’s not safe for kids under 8 or pregnant women. In Australia, it’s not on the PBS for most skin infections, so out-of-pocket cost can be $40-$60 for a 10-day course.

Alternative #3: Clindamycin

Clindamycin is the go-to when you’re allergic to penicillin and cephalexin won’t cut it. It’s especially strong against anaerobic bacteria and MRSA.

Doctors often reach for it for deep skin infections, abscesses, or when a patient has failed two other antibiotics. It’s available as pills or IV, and it’s sometimes used in combination with other drugs.

But here’s the big warning: clindamycin carries a risk of C. difficile infection-a severe, sometimes deadly diarrhea that can happen weeks after you stop taking it. In Australia, about 1 in 100 people who take clindamycin develop this. That’s why it’s not a first-line choice. It’s reserved for when you really need it.

Five antibiotic knights battle bacterial threats in a medieval-style illustrated battlefield.

Alternative #4: Azithromycin (Zithromax)

Azithromycin is a macrolide antibiotic. It’s not a direct substitute for cephalexin, but it’s often used for respiratory infections, sinusitis, or when you need a shorter course.

One big advantage? You only take it for 3-5 days. A typical course is one 500 mg pill on day one, then 250 mg daily for four more days. That’s easier to stick to than cephalexin’s four-times-a-day schedule.

It’s also safer for people with kidney problems. But it’s not great for skin infections. Studies show it’s less effective than cephalexin for cellulitis. And it can cause heart rhythm issues in people with existing conditions. The cost is higher too-around $30-$50 without PBS coverage.

Alternative #5: Nitrofurantoin (for UTIs only)

If your infection is a simple urinary tract infection (UTI), nitrofurantoin is often better than cephalexin. It’s concentrated in the urine, so it kills bugs right where they are. It’s also less likely to cause resistance or upset your gut flora.

But it’s useless for anything else. You can’t use it for skin infections, throat infections, or pneumonia. And it’s not safe if you have kidney disease (eGFR under 60). Also, you have to take it with food or milk to avoid stomach upset.

Comparison Table: Cephalexin vs Top Alternatives

Comparison of Cephalexin and Common Antibiotic Alternatives
Antibiotic Best For Dosing Frequency Common Side Effects Cost (AUD, PBS-subsidised) Contraindications
Cephalexin (Keftab) Skin, bone, urinary tract infections 2-4 times daily Diarrhea, nausea, rash $5-$7 Penicillin allergy (risk), kidney impairment
Amoxicillin Ear, sinus, throat, some UTIs 2-3 times daily Diarrhea, vomiting, rash $5-$7 Penicillin allergy
Amoxicillin-Clavulanate Stubborn skin, sinus, UTIs 2-3 times daily Diarrhea (higher risk), liver issues $10-$15 Penicillin allergy, liver disease
Doxycycline Acne, Lyme, MRSA, tick bites Once or twice daily Sun sensitivity, nausea, tooth staining $40-$60 Under 8 years, pregnancy, dairy/antacids
Clindamycin MRSA, deep abscesses, penicillin allergy 3-4 times daily Severe diarrhea (C. diff), stomach pain $20-$30 History of C. diff, colitis
Azithromycin Respiratory, short-course needs Once daily for 5 days Nausea, heart rhythm issues $30-$50 Heart conditions, QT prolongation
Nitrofurantoin Simple UTIs only 2-4 times daily Stomach upset, dark urine $7-$10 Kidney disease (eGFR < 60), pregnancy (near term)

What to Do If Cephalexin Doesn’t Work

If you’ve taken cephalexin for 3-4 days and your fever hasn’t dropped, the redness is spreading, or you’re feeling worse, don’t wait. Go back to your doctor.

They’ll likely check for:

  • MRSA (a swab test takes 24-48 hours)
  • Drug resistance (if you’ve taken antibiotics often)
  • Non-bacterial causes (like fungal infections or autoimmune issues)

Don’t try to self-switch antibiotics. Taking the wrong one can make things worse. It can also make future infections harder to treat.

A pharmacist guides a mother through antibiotic choices in a warm, sunlit pharmacy scene.

What About Natural Remedies or OTC Options?

There’s no over-the-counter antibiotic in Australia. Honey, garlic, or tea tree oil won’t kill a bacterial infection like cellulitis or a UTI. They might help soothe symptoms, but they won’t stop the infection from spreading.

One exception: for minor cuts or scrapes, a topical antibiotic like mupirocin (Bactroban) can help prevent infection. But if you already have redness, swelling, or pus, you need an oral antibiotic.

When to Choose Cephalexin

Still, cephalexin has its place. It’s ideal if:

  • You have a mild skin infection like impetigo or a small abscess
  • You’re not allergic to penicillin
  • You have normal kidney function
  • You need something affordable and well-tested

It’s not the newest, but it’s still reliable for the right cases.

Bottom Line: It’s Not One-Size-Fits-All

There’s no single "best" antibiotic. What works for your neighbor’s ear infection might not work for your leg rash. The right choice depends on:

  • What infection you have (and where)
  • Your allergies and medical history
  • Your kidney and liver function
  • Whether you’re pregnant or breastfeeding
  • Cost and availability

Always talk to your doctor or pharmacist before switching. They know your history. They know what’s covered by PBS. And they know what bugs are common in your area right now.

Antibiotics aren’t candy. Take them exactly as prescribed. Finish the whole course-even if you feel better. And never share them. Your infection might be different. Your body might react differently. And you could be helping create the next superbug.

Is Keftab the same as cephalexin?

Yes. Keftab is the brand name for cephalexin. They contain the same active ingredient and work the same way. Generic cephalexin is just as effective and usually cheaper.

Can I take cephalexin if I’m allergic to penicillin?

Maybe-but not without caution. About 5-10% of people with penicillin allergies also react to cephalexin because they’re in the same drug family. If you’ve had a serious reaction to penicillin (like anaphylaxis or swelling), avoid cephalexin. For mild rashes, your doctor might still prescribe it after testing.

Which is better for a skin infection: cephalexin or amoxicillin?

For simple skin infections like cellulitis, cephalexin is often preferred because it’s more effective against Staph bacteria. But if the infection is stubborn or you’ve had it before, amoxicillin-clavulanate is usually more powerful because it fights resistant strains.

Does cephalexin cause yeast infections?

Yes. Like most antibiotics, cephalexin can kill good bacteria in your gut and vagina, which lets yeast overgrow. Vaginal itching or white discharge after a course is common. Over-the-counter antifungals like clotrimazole can help. Talk to your pharmacist if it’s persistent.

Can I drink alcohol while taking cephalexin?

Yes, alcohol doesn’t interact with cephalexin the way it does with metronidazole or some other antibiotics. But drinking can weaken your immune system and make recovery slower. It’s best to avoid it while you’re sick.

How long does cephalexin stay in your system?

Cephalexin has a half-life of about 1 hour in people with normal kidney function. That means it’s mostly cleared from your blood within 6-8 hours. But you still need to take it multiple times a day to keep enough in your system to kill the bacteria.

Next Steps

If you’re on cephalexin and it’s working, finish the course. If it’s not working, make an appointment with your GP or pharmacist. Bring your list of symptoms and any side effects you’ve had. Ask: "Is there a better option for me?"

If you’re looking for alternatives, don’t guess. Use your pharmacist. They can check your history, your PBS status, and what’s in stock. They’re the ones who see what works-and what doesn’t-for real people every day.

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16 Comments

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    Sherri Naslund

    November 19, 2025 AT 17:39
    so like... i took cephalexin last year for a rash and ended up in the ER because my face swelled up? but my doctor swore it was fine 'cause i only had a 'mild' penicillin rash? yeah right. turns out i'm allergic to ALL cephalosporins. now i just carry an epipen and laugh when people say 'it's just an antibiotic'. đŸ€Ą
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    Ashley Miller

    November 21, 2025 AT 08:04
    funny how they never mention that Big Pharma paid the FDA to keep cephalexin on the PBS while pushing pricier alternatives. i bet if you dig into the clinical trials, 80% of the 'superior efficacy' studies were funded by Augmentin's parent company. also... why is doxycycline so expensive? because it's a 1950s drug that no one can patent anymore. they want you to buy the $50 zithromax instead. đŸ€”
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    Martin Rodrigue

    November 23, 2025 AT 01:50
    The pharmacokinetic profile of cephalexin is well-documented in the literature, with a serum half-life of approximately 60–80 minutes in individuals with normal renal function. Its primary excretion route is via glomerular filtration and tubular secretion. While amoxicillin-clavulanate demonstrates broader spectrum coverage, particularly against beta-lactamase-producing organisms, it is not universally superior. Clinical outcomes are context-dependent, and empirical prescribing without culture data remains a significant contributor to antimicrobial resistance. One must also consider the ecological impact of antibiotic use on the gut microbiome.
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    Greg Knight

    November 24, 2025 AT 06:40
    Hey, I just want to say-this post is SO helpful. I was terrified after my last UTI when cephalexin didn’t touch it. My doc switched me to nitrofurantoin and it was like magic. I didn’t even know that was a thing! Also, I had no idea clindamycin could cause C. diff-I thought it was just ‘bad stomach cramps’. I’m telling all my friends about this. You’re basically a superhero for writing this. Keep being awesome. đŸ’Ș
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    Bette Rivas

    November 25, 2025 AT 13:12
    The table provided is accurate and clinically sound, but it's worth noting that regional resistance patterns significantly influence antibiotic efficacy. For example, in parts of the U.S. Southwest, community-acquired MRSA prevalence exceeds 40%, making clindamycin or doxycycline preferable even for uncomplicated skin infections. Additionally, while cephalexin is cost-effective, its dosing frequency (Q6H or Q8H) reduces adherence compared to once-daily agents like azithromycin. However, azithromycin's limited activity against gram-positive cocci makes it inappropriate for cellulitis. Always correlate clinical presentation with local antibiograms.
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    prasad gali

    November 27, 2025 AT 06:41
    Cephalexin is a first-gen cephalosporin with narrow gram-positive coverage and negligible anaerobic activity. Its utility is largely confined to uncomplicated skin and soft tissue infections (SSTIs) caused by MSSA and streptococci. For any suspected MRSA, beta-lactams are suboptimal. Doxycycline and clindamycin exhibit better tissue penetration and intracellular activity. Nitrofurantoin’s renal concentration mechanism renders it ideal for cystitis but useless for pyelonephritis. The real issue is antibiotic stewardship-prescribing cephalexin for sinusitis is a classic example of empirical overuse.
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    Paige Basford

    November 28, 2025 AT 00:07
    I had this weird reaction to cephalexin where my tongue felt like sandpaper? My pharmacist said it’s not super common but it happens. She gave me this probiotic chewable thing and it helped so much. Also, I used to take it with yogurt thinking it’d help my stomach, but now I know that’s bad for doxycycline! Soooo
 maybe don’t mix them? Anyway, thanks for the table. I printed it and stuck it on my fridge. đŸ€“
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    Ankita Sinha

    November 29, 2025 AT 21:43
    OMG I just finished a 10-day course of clindamycin for a bad abscess and I’m still terrified of getting C. diff. I’ve been drinking kefir daily and eating fermented veggies like crazy. My gut feels okay so far but I’m checking my poop every hour 😅 I didn’t even know antibiotics could mess you up like this. This post saved me from blindly trusting my doctor’s script. Also-why isn’t this on every pharmacy poster??
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    Kenneth Meyer

    December 1, 2025 AT 12:51
    There’s something deeply ironic about how we treat antibiotics like tools-pick one, use it, move on. But bacteria don’t care about our convenience. They evolve. They adapt. They outlive us. Cephalexin was a miracle in 1965. Now it’s a relic. And yet we still cling to it because it’s cheap and familiar. But medicine isn’t about nostalgia. It’s about humility. The real question isn’t ‘what’s the best antibiotic?’ It’s ‘what’s the least destructive path forward?’
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    Donald Sanchez

    December 1, 2025 AT 20:31
    ok so i just took doxycycline and now i look like a lobster and my skin is peeling off like a sunburn 😭 why is this not on the warning label? also i drank milk with it and now i feel like a ghost. also i think my cat is judging me. đŸ±đŸ’€
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    Abdula'aziz Muhammad Nasir

    December 1, 2025 AT 21:38
    In Nigeria, cephalexin is widely available and affordable, often sold over the counter. However, this accessibility leads to misuse-patients stop taking it after 3 days when they feel better. This contributes to resistance. We need community education, not just better prescriptions. A pharmacist in Lagos once told me: 'If you don’t finish the course, you’re not curing the infection-you’re breeding monsters.' Wise words.
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    Tara Stelluti

    December 3, 2025 AT 11:13
    i swear my doctor gave me cephalexin just to get me out of his office. i went back 3 days later with a fever and he said 'maybe it's viral?' like i didn't already know that. then i paid $200 for a lab test that said 'it's MRSA'. i feel like i got played. and now my ex is texting me 'u okay?' like he cares. i don't even want to talk about it. 💔
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    Lauren Hale

    December 4, 2025 AT 16:55
    I’m so glad someone finally broke this down without jargon. My mom’s on dialysis and her last antibiotic made her sick-she was terrified to take anything new. I printed this out and read it to her. She cried. Not from sadness-from relief. She said, 'I didn’t know I could ask for alternatives.' Thank you for reminding us that patients deserve to understand, not just obey.
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    Hannah Machiorlete

    December 5, 2025 AT 17:28
    i took azithromycin for a throat thing and then my heart started doing backflips. like literally. i thought i was having a heart attack. turned out it was QT prolongation. now i have a card in my wallet that says 'NO MACROLIDES'. also i hate that i have to carry it. why does medicine have to be so dramatic??
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    Danielle Mazur

    December 6, 2025 AT 14:28
    Did you know the FDA approved cephalexin in 1968 without any long-term microbiome studies? And now we’re seeing a 300% spike in C. diff cases since 2010? Coincidence? I think not. They’re hiding the truth. Big Pharma doesn’t want you to know antibiotics destroy your gut for life. The real cure? Raw milk and fasting. But they’ll never tell you that.
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    Greg Knight

    December 7, 2025 AT 07:04
    I just wanted to reply to @LaurenHale-your comment about your mom made me tear up. My grandma had the same thing. She was on dialysis and they kept giving her cephalexin until she got septic. We didn’t know kidney dose adjustments existed. I’m so glad this post exists. You’re not alone in this. We’re all just trying not to die from a $7 pill.

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