Alternatives to Metronidazole Cream: Practical Options You Can Talk About

Metronidazole cream is commonly used for rosacea and some infections, but it doesn’t work for everyone or every condition. If you’re not seeing results, have side effects, or need something safe for pregnancy, there are real alternatives. Below I list common options, what they do, and quick tips for choosing one.

Top topical alternatives

Azelaic acid (15% gel or cream) — A proven choice for rosacea and mild acne. It reduces redness and bumps and is a good option if metronidazole irritates your skin. You’ll usually apply it twice daily. Expect slower improvement than antibiotics, but fewer long-term side effects.

Ivermectin 1% cream — Targets inflammation and Demodex mites, which can drive rosacea in many people. Lots of patients see clearer skin and reduced bumps after a few weeks. Use once daily as prescribed.

Topical clindamycin — Often used for bacterial skin infections and acne. Clindamycin works differently from metronidazole and can be helpful for mixed infections. It’s not ideal long term because of resistance risk, so follow a doctor’s plan.

Sulfur and sodium sulfacetamide products — These are old-school but still useful for inflammatory skin conditions. Sulfur-based washes or creams can calm redness and reduce oil. They’re an option if you prefer gentler, non-antibiotic formulas.

Benzoyl peroxide — Not a direct replacement for metronidazole, but useful if acne-like lesions are present. It’s antibacterial and dries out lesions, but can bleach fabrics and irritate sensitive skin.

Alternatives for vaginal infections and other options

For bacterial vaginosis (BV), topical clindamycin 2% cream is a common substitute for metronidazole gel. Oral options like tinidazole or different dosing of metronidazole may also be used. Always confirm with a healthcare provider — treatment depends on pregnancy status and allergy history.

Oral low-dose doxycycline — For rosacea with widespread inflammation, doctors sometimes prescribe sub-antibiotic doxycycline. It controls inflammation without the same risk of bacterial resistance seen with higher antibiotic doses.

Probiotics and hygiene changes — For recurrent BV, adding proven lifestyle steps (avoid douching, use condoms, consider specific probiotics) can reduce recurrence alongside medical treatment.

Quick safety tips: patch-test new topicals, avoid mixing strong actives unless a clinician says it’s ok, and tell your provider if you’re pregnant or breastfeeding. If a product causes severe irritation, stop and call your clinician.

Not sure which option fits you? Bring pictures and a short history to your appointment. That makes it easier for your clinician to recommend a specific alternative and a clear plan that actually works for your skin or infection.