What to Do When You Can't Find Macrobid

You have a UTI. Your doctor prescribed Macrobid (Nitrofurantoin). But the pharmacy says it's out of stock — and so does the next one you call. With ongoing supply issues affecting Macrobid in 2026, this is a situation many patients are facing.

The most important thing to know: you have options. Several other antibiotics can treat uncomplicated UTIs effectively. Here's what to discuss with your doctor.

Important: Don't Switch Antibiotics on Your Own

Before we go through the alternatives, a quick reminder: only your doctor can decide which antibiotic is right for you. The best choice depends on your medical history, allergies, other medications you take, and the type of bacteria causing your infection. Always talk to your doctor before switching medications.

The Best Alternatives to Macrobid for UTIs

1. Trimethoprim-Sulfamethoxazole (Bactrim, Septra)

What it is: A combination antibiotic that's been used for UTIs for decades. Like Macrobid, it's considered a first-line treatment for uncomplicated UTIs.

How it's taken: One tablet (160/800 mg) twice daily for 3 days.

Pros:

• Very effective against common UTI bacteria
• Short treatment course (3 days vs. 7 for Macrobid)
• Widely available and inexpensive
• Generic versions cost as little as $4-$10

Cons:

• Sulfa allergy is common — if you're allergic to sulfa drugs, this isn't an option
• Resistance rates are higher in some regions (10-20% in parts of the US)
• More drug interactions than Macrobid
• Not safe in late pregnancy

2. Fosfomycin (Monurol)

What it is: A unique antibiotic given as a single dose for uncomplicated UTIs. It's also considered a first-line option by infectious disease guidelines.

How it's taken: One packet (3 grams) dissolved in water, taken once.

Pros:

• Single-dose treatment — you only take it once
• Good activity against resistant bacteria, including some ESBL-producing organisms
• Safe in pregnancy (Category B)
• Few drug interactions

Cons:

• Can be expensive — brand-name Monurol may cost $50-$100 without insurance
• Slightly less effective than Macrobid or Bactrim for some infections
• May also be in short supply at some pharmacies
• Only approved for uncomplicated UTIs in women

3. Cephalexin (Keflex)

What it is: A first-generation cephalosporin antibiotic. It's not a first-line UTI treatment but is a solid second-line option.

How it's taken: 250-500 mg four times daily for 7 days (or 500 mg twice daily in some regimens).

Pros:

• Very widely available
• Effective against most common UTI-causing bacteria
• Safe in pregnancy
• Inexpensive generic versions available ($4-$15)

Cons:

• Longer treatment course with more frequent dosing
• Not appropriate for patients with severe penicillin allergies (cross-reactivity risk)
• Broader-spectrum, which means it may affect gut bacteria more than Macrobid

4. Amoxicillin-Clavulanate (Augmentin)

What it is: A broad-spectrum antibiotic combining amoxicillin with a beta-lactamase inhibitor. Used as a second-line option for UTIs.

How it's taken: 500/125 mg twice daily or 875/125 mg twice daily for 5-7 days.

Pros:

• Effective against a wide range of bacteria
• Widely available at most pharmacies
• Safe in pregnancy

Cons:

• Higher risk of diarrhea and GI side effects
• Not a first-line UTI drug — your doctor may prefer other options
• Not suitable for penicillin-allergic patients

5. Ciprofloxacin (Cipro) — Use With Caution

What it is: A fluoroquinolone antibiotic. Very effective for UTIs, but the FDA has issued warnings about serious side effects.

How it's taken: 250 mg twice daily for 3 days.

Pros:

• Highly effective against most UTI bacteria
• Short treatment course
• Widely available

Cons:

• FDA black box warning for tendon rupture, nerve damage, and other serious side effects
• Should be reserved for infections where other options don't work
• Not recommended as first-line for simple UTIs
• Growing antibiotic resistance

Note: Most doctors will try other alternatives before prescribing a fluoroquinolone for a simple UTI. This option is typically reserved for complicated infections or when other antibiotics can't be used.

How to Talk to Your Doctor About Alternatives

If you can't find Macrobid, here's how to approach the conversation with your doctor:

1. Call the office and explain the situation. You don't always need an appointment — many offices can change a prescription over the phone.
2. Mention your allergies. This is especially important with sulfa drugs (Bactrim) and penicillin-type drugs (Cephalexin, Augmentin).
3. Ask about a urine culture. If you've had recurring UTIs or recent antibiotic use, a culture can help your doctor choose the most effective antibiotic.
4. Ask about cost. Some alternatives are cheaper than Macrobid, especially generics like Bactrim and Cephalexin.

Can You Wait to Start Treatment?

In most cases, no — you should not wait. UTIs can get worse quickly and may spread to the kidneys if left untreated. A kidney infection (pyelonephritis) can require hospitalization and IV antibiotics.

If you have UTI symptoms — burning during urination, frequent urge to urinate, lower abdominal pain, cloudy or bloody urine — get treated as soon as possible. If you can't find Macrobid today, ask your doctor for an alternative today.

Still Want to Try Finding Macrobid?

If you prefer to stick with Macrobid, use MedFinder to search for pharmacies that have it in stock. You might also try independent pharmacies or mail-order options, though mail-order may take several days.

Key Takeaways

• Several effective alternatives to Macrobid exist for treating UTIs.
• Bactrim, Fosfomycin, and Cephalexin are the most commonly prescribed alternatives.
• Only your doctor can determine which alternative is right for you.
• Don't delay UTI treatment — if you can't find Macrobid, get an alternative prescription right away.
• Use MedFinder to check if Macrobid is available near you before switching.