Should I continue Augmentin (amoxicillin/clavulanate) for my sinus infection despite potential risks and benefits?

Management of Recurrent Sinus Infection with Augmentin

You should complete your current course of Augmentin for your sinus infection despite the gastrointestinal side effects, unless they become severe (bloody diarrhea or severe abdominal pain), as stopping antibiotics prematurely can lead to treatment failure and antibiotic resistance. 1, 2

Current Situation Assessment

Your case presents several important factors:

• History of deviated septum and recurrent sinus infections
• Multiple antibiotic courses in the past 7 months (Z-pack in early 2025, Augmentin in April 2025)
• Current symptoms including colored mucus, ear fullness, and sinus headaches
• ENT diagnosis of sinus infection with pending culture results
• GI symptoms after starting Augmentin (diarrhea, stomach cramp)

Recommendation for Current Treatment

Continue Augmentin Course

• The practice parameter guidelines recommend completing a full 10-14 day course of antibiotics for acute sinusitis 1
• Amoxicillin-clavulanate (Augmentin) is the preferred first-line therapy for sinus infections, especially for recurrent cases or when previous antibiotic treatment has been used 1
• Stopping antibiotics prematurely may:
  1. Decrease effectiveness of immediate treatment
  2. Increase likelihood of bacterial resistance development 2

Managing Side Effects

• Take Augmentin with food to reduce gastrointestinal upset 2
• Mild diarrhea is a common side effect that usually resolves after completing treatment
• Monitor for signs of C. difficile infection (severe or bloody diarrhea with fever) which would require immediate medical attention 2

Addressing Your Specific Questions

Should you continue medication?

Yes, unless you develop severe adverse effects. Gastrointestinal side effects are common with Augmentin but usually don't warrant discontinuation 2. The benefits of treating a bacterial sinus infection outweigh the risks of mild to moderate side effects.

What harm from taking the first three doses inconsistently?

• Inconsistent dosing reduces antibiotic effectiveness and increases risk of bacterial resistance 2
• Taking a dose after missing previous doses is not harmful but reduces treatment efficacy
• The irregular dosing pattern you described may have contributed to suboptimal antibiotic levels in your system

C. difficile risk assessment

Your risk for C. difficile is increased due to:

• Multiple antibiotic courses in the past several months
• Current gastrointestinal symptoms

However, most cases of antibiotic-associated diarrhea are not C. difficile. Monitor for:

• Watery or bloody diarrhea
• Severe abdominal pain or cramping
• Fever

If these symptoms develop, contact your physician immediately 2.

Next Steps Based on Culture Results

If Culture is Negative:

1. Complete the current antibiotic course as prescribed (7 days total)
2. Consider non-antibiotic management approaches:
   • Continue nasal corticosteroids (Dymista) which are beneficial for chronic sinusitis 1
   • Use saline nasal irrigation regularly (recommended as adjunctive therapy) 1
   • Consider evaluation for underlying allergic factors 1
   • Follow up with ENT to discuss structural issues (deviated septum) that may contribute to recurrent infections

If Culture is Positive:

1. Complete the current course if the organism is sensitive to Augmentin
2. If resistance is identified, your ENT may recommend an alternative antibiotic based on sensitivity results

Supportive Measures During Treatment

• Adequate hydration to thin mucus
• Saline nasal irrigation to clear secretions
• Sleep with head elevated
• Warm facial compresses for comfort 1
• Continue prescribed Dymista as it helps reduce mucosal inflammation

Long-Term Management Considerations

Given your history of recurrent infections, consider:

1. Evaluation of structural issues (deviated septum) that may require surgical correction
2. Assessment for underlying allergic factors
3. CT scan evaluation (which you've already had)
4. Possible immunological workup if infections continue despite appropriate management 1

Remember that stopping antibiotics prematurely can lead to treatment failure and contribute to antibiotic resistance. Unless you develop severe side effects, completing the prescribed course is the recommended approach.