Should I continue Augmentin (amoxicillin/clavulanate) for sinus infection despite gastrointestinal side effects, or wait for culture results to determine alternative treatments?

Discontinue Augmentin and Wait for Culture Results Before Deciding Next Steps

You should discontinue the Augmentin due to your gastrointestinal side effects and wait for the culture results before determining next treatment steps. 1

Assessment of Current Situation

Your case presents several important considerations:

1. Multiple recent antibiotic courses: You've had two courses of antibiotics already in 2025 (Z-pack in early 2025, Augmentin in April 2025)
2. Negative culture in May: Previous culture showed no bacterial growth
3. Current symptoms: Ear fullness, sinus headaches, and nasal congestion with colored mucus
4. Current treatment issues: Gastrointestinal side effects including diarrhea and abdominal cramps after starting Augmentin

Recommendation Algorithm

Step 1: Discontinue Current Antibiotic

• Stop taking Augmentin immediately due to significant gastrointestinal side effects 2
• The diarrhea and abdominal cramps you're experiencing are common side effects of Augmentin that warrant discontinuation, especially since you've only taken 3 doses
• Taking antibiotics with significant side effects reduces compliance and may not allow for completion of the full course 1

Step 2: Wait for Culture Results

• Since the ENT has already taken a culture (results expected July 22-23), wait for these results before deciding on further antibiotic therapy 1
• The culture will provide crucial information about:
  • Whether you actually have a bacterial infection
  • Which bacteria might be present
  • What antibiotics would be most effective

Step 3: Next Steps Based on Culture Results

If Culture is Negative:

• Focus on non-antibiotic treatments:
  • Continue Dymista (corticosteroid + antihistamine combination)
  • Use saline nasal irrigation regularly
  • Consider short course of oral decongestants if ear fullness persists
  • Follow up with ENT to discuss your deviated septum and whether it requires surgical intervention 1

If Culture is Positive:

• Request an antibiotic with:
  • Different side effect profile than Augmentin
  • Coverage appropriate for the identified bacteria
  • Options might include cefdinir, cefpodoxime, or cefuroxime which have good sinus penetration with potentially fewer GI side effects 1

Addressing Your Specific Concerns

Harm from Taking Partial Course

• Taking only 3 doses of Augmentin likely did not cause significant harm in terms of antimicrobial resistance 2
• The primary concern with partial courses is selecting for resistant organisms, but this risk is relatively low with just 3 doses
• The irregular dosing (missing a day) is not ideal but less concerning than continuing a medication causing significant side effects

C. difficile Risk

• Your risk for C. difficile is elevated due to:
  • Multiple antibiotic courses in the past 6 months
  • Current diarrhea while on antibiotics
• However, the risk remains relatively low with short-term outpatient use
• Monitor for severe or bloody diarrhea, fever, or abdominal pain that persists after stopping Augmentin 2
• If these symptoms occur, contact your doctor immediately for C. difficile testing

Important Considerations

• Recurrent URIs with colored mucus do not always indicate bacterial infection; viral infections can also cause colored discharge
• Your May culture was negative despite symptoms, suggesting possible non-bacterial causes
• The European Position Paper on Rhinosinusitis (EPOS) guidelines indicate that antibiotics may not significantly improve outcomes in many cases of rhinosinusitis compared to symptomatic treatment 1
• Your history of multiple URIs suggests a need to address underlying factors like the deviated septum or possible allergic components

Remember to stay hydrated while experiencing diarrhea, and contact your physician if symptoms worsen or if you develop fever, severe abdominal pain, or bloody stools after stopping the antibiotic.