What should I do about the diarrhea and sharp cramps after taking Augmentin (amoxicillin/clavulanate) for a sinus infection?

Managing Diarrhea and Cramps from Augmentin During Sinus Infection Treatment

You should discontinue Augmentin and contact your doctor immediately for an alternative antibiotic due to the significant gastrointestinal side effects you're experiencing. 1

Understanding Your Situation

You have a confirmed sinus infection (via nasal endoscopy) with recurring sinus infections over the past several months. You've taken two doses of Augmentin 875mg on Saturday, missed doses on Sunday, and took one dose Monday morning. Now you're experiencing diarrhea and sharp abdominal cramps, which are recognized adverse effects of amoxicillin/clavulanate.

Recommended Action Plan

1. Stop taking Augmentin immediately

   • Diarrhea with sharp cramps suggests significant gastrointestinal intolerance
   • According to the FDA label, "If diarrhea is severe or lasts more than 2 or 3 days, patients should contact their physician" 1

2. Contact your doctor within 24 hours for an alternative antibiotic

   • For patients allergic to or intolerant of amoxicillin/clavulanate, guidelines recommend:
     • Cephalosporins (cefpodoxime, cefuroxime, cefdinir) 2
     • Macrolides (azithromycin, clarithromycin) 2
     • Respiratory fluoroquinolones (for adults only) 2

3. Monitor for warning signs of C. difficile infection

   • Watch for watery or bloody stools with fever and abdominal cramps
   • This can occur even up to 2 months after antibiotic use 1

Why This Approach Is Best

Augmentin (amoxicillin/clavulanate) is considered a first-line treatment for sinus infections, especially when there's concern about resistant bacteria 2. However, gastrointestinal side effects are common and can be significant enough to warrant discontinuation.

The practice parameter update for sinusitis specifically notes: "Although clindamycin is generally well tolerated, patients should be alerted to the possibility of pseudomembranous enterocolitis and told to contact their physician for any sign of diarrhea or bloody stools" 2. This caution applies to all antibiotics, including Augmentin.

Alternative Treatment Options

Based on your history of recurrent infections and current symptoms, your doctor may consider:

1. For immediate replacement therapy:

   • Cefpodoxime, cefuroxime, or cefdinir (these have good efficacy against common sinus pathogens) 2
   • A respiratory fluoroquinolone if you have moderate disease or recent antibiotic use 2

2. Supportive measures during treatment:

   • Adequate hydration to replace fluid loss from diarrhea
   • Nasal saline irrigation
   • Intranasal corticosteroids to reduce inflammation 2
   • Rest, analgesics as needed, warm facial packs 2

Important Considerations

• Do not attempt to push through the side effects - gastrointestinal symptoms can worsen and lead to more serious complications
• Complete the full course of your new antibiotic once prescribed to prevent antibiotic resistance
• Your recurring sinus infections may warrant evaluation for underlying causes such as allergies, anatomical abnormalities, or immunodeficiency 2

Remember that diarrhea is a common side effect of antibiotics, but severe cramping pain suggests a need for prompt intervention and medication change rather than continuing the current treatment.