Should I continue Augmentin (amoxicillin/clavulanate) for sinus infection despite gastrointestinal side effects and history of antibiotic use?

Managing Augmentin for Sinus Infection with GI Side Effects

You should discontinue the Augmentin due to significant gastrointestinal side effects and wait for culture results before deciding on next steps. 1, 2

Assessment of Your Current Situation

Your case presents several important considerations:

1. History of recurrent URIs and sinus issues:

   • Multiple URIs since December 2024
   • Previous antibiotic courses (Z-pack in early 2025, Augmentin in April 2025)
   • CT showing mucosal thickening
   • Current symptoms suggesting another sinus infection

2. Current treatment issues:

   • Started Augmentin but experiencing diarrhea and severe stomach cramps
   • Inconsistent dosing (missed doses on July 20)
   • Culture results pending

Recommendation for Augmentin

The gastrointestinal symptoms you're experiencing (diarrhea and severe stomach cramps) are known adverse effects of amoxicillin-clavulanate (Augmentin) 2. According to the FDA label, these side effects are common, occurring in up to 9% of patients taking the medication 2.

Given your symptoms and the inconsistent dosing:

• Discontinue Augmentin until you discuss with your ENT
• Wait for culture results (expected in 1-2 days) before deciding next steps
• Contact your physician about the diarrhea, especially if it's severe or persists 2

Next Steps Based on Culture Results

If Culture is Positive:

1. Alternative antibiotic options to discuss with your ENT:

   • Cephalosporins (cefpodoxime, cefuroxime, cefdinir) 1
   • Respiratory fluoroquinolones (for adults only) 1
   • Doxycycline 1
   • Clindamycin plus a third-generation cephalosporin 1

2. Duration of therapy:

   • Generally 10-14 days for acute sinusitis 1
   • Continue until symptoms improve plus 7 additional days 1

If Culture is Negative:

1. Consider non-antibiotic approaches:

   • Continue Dymista (intranasal corticosteroid) 1
   • Saline nasal irrigation 1
   • Adequate hydration, rest, warm facial packs 1
   • Analgesics for pain if needed 1

2. Reevaluate diagnosis:

   • Your symptoms might be due to:
     • Allergic rhinitis (which you're treating with Dymista)
     • Viral upper respiratory infection
     • Structural issues related to your deviated septum 1

Concerns About Antibiotic Use

Harm from Partial Course

Taking only three doses of Augmentin:

• Minimal risk of developing resistance since the exposure was brief
• Disruption of normal gut flora has already begun, which explains your GI symptoms 1
• Incomplete treatment of any bacterial infection that might be present 2

C. difficile Risk

Your C. difficile risk is elevated due to:

• Recent antibiotic exposure (Z-pack in early 2025, Augmentin in April 2025) 1
• Current GI symptoms while on Augmentin
• Multiple courses of antibiotics within a short timeframe 1

Monitor for symptoms of C. difficile infection, including:

• Watery diarrhea (often with blood)
• Fever
• Abdominal pain or cramping
• Persistent diarrhea even after stopping antibiotics 2

Long-term Management Considerations

Given your history of recurrent sinus issues and deviated septum:

1. Consider ENT follow-up for evaluation of underlying structural issues
2. Continue appropriate use of Dymista for anti-inflammatory effects
3. Evaluate for allergic triggers that may contribute to recurrent symptoms
4. Consider imaging if symptoms persist despite appropriate therapy

Common Pitfalls to Avoid

1. Continuing antibiotics despite significant side effects
2. Starting new antibiotics before culture results when not critically ill
3. Overuse of antibiotics for possibly viral infections
4. Ignoring underlying structural or allergic factors contributing to recurrent infections