Should You Continue Augmentin Despite Gastrointestinal Side Effects?
You should discontinue the Augmentin and wait for your culture results before deciding on further antibiotic treatment, as your gastrointestinal symptoms indicate an adverse reaction and your recent negative culture (May 28) suggests a possible non-bacterial cause of your symptoms.
Understanding Your Current Situation
Your case presents several important considerations:
Recent History of Antibiotics:
- Z-pack in early 2025
- Augmentin course completed April 7,2025
- Current partial course of Augmentin (3 doses)
Current Symptoms:
- Gastrointestinal side effects (diarrhea, severe stomach cramp)
- Ear fullness (autophony) that isn't responding to the antibiotic
- Sinus-type headaches
- Colored mucus
Recent Diagnostic Information:
- Negative bacterial culture on May 28,2025
- Pending culture results from July 18,2025
- CT showing mucosal thickening
Recommendation Based on Evidence
1. Discontinue Augmentin
The gastrointestinal symptoms you're experiencing are well-documented side effects of Augmentin. According to the FDA label, diarrhea is the most common adverse reaction (9% of patients) 1. These side effects can be significant enough to warrant discontinuation - in clinical trials, up to 3% of patients discontinued therapy due to drug-related adverse reactions 1.
2. Wait for Culture Results
The European Position Paper on Rhinosinusitis (EPOS) guidelines emphasize the importance of culture-directed antibiotic therapy, especially in cases of recurrent sinusitis 2. Your May 28 culture was negative for bacterial growth, which raises questions about whether your current symptoms are bacterial in nature.
3. Consider Alternative Management While Waiting
While waiting for culture results:
- Continue saline nasal sprays (but discontinue Afrin after 3 days as prescribed)
- Consider intranasal corticosteroids, which are recommended as first-line therapy for both mild and moderate/severe CRS 2
Why This Approach Is Best
Avoiding Antibiotic Resistance: Multiple courses of antibiotics in a short period increase the risk of developing resistant bacteria. The EPOS guidelines note that empiric use of antibiotics without knowledge of the causative organisms can create more severe infections 2.
Addressing Quality of Life: Your gastrointestinal symptoms are affecting your quality of life and may worsen with continued Augmentin use.
Evidence-Based Approach: The Antimicrobial Treatment Guidelines for Acute Bacterial Rhinosinusitis state that "patients who have received effective antibiotic therapy and continue to be symptomatic need further evaluation" 2. Your symptoms persisting despite multiple antibiotic courses suggest this may not be a simple bacterial infection.
Addressing Your Specific Questions
Should you continue the medication?
No, the gastrointestinal side effects indicate you should stop the Augmentin.
What should your next steps be?
Wait for the culture results from your July 18 ENT visit. These will guide whether you need antibiotics and, if so, which type would be most effective.
What harm did taking the first three doses cause?
The intermittent dosing (two doses, missed day, one dose) likely caused minimal harm but:
- May have contributed to your gastrointestinal symptoms
- Is not ideal for bacterial eradication (inconsistent dosing can promote resistance)
- Taking the third dose a day late after deciding to stop was not beneficial and likely contributed to your GI symptoms
Important Considerations
Potential for Non-Bacterial Causes: Your recurrent symptoms despite antibiotics, along with the negative May culture, suggest possible non-bacterial causes such as:
- Allergic component
- Viral infections
- Structural issues related to your deviated septum
Antibiotic Side Effect Profile: Ciprofloxacin has been shown to have fewer gastrointestinal side effects than amoxicillin/clavulanate (12.4% vs 25%) 2, which may be relevant if future antibiotics are needed.
Follow-up Plan: If culture results are positive, discuss with your ENT about alternative antibiotics with fewer GI side effects. If negative, further evaluation of underlying causes (allergies, structural issues) may be warranted.
Remember that discontinuing antibiotics is appropriate when side effects are significant, especially when pending culture results will soon provide more definitive guidance for treatment.