Should I continue Augmentin (amoxicillin/clavulanate) for a diagnosed sinus infection despite gastrointestinal side effects while awaiting culture results?

Managing Sinus Infection Treatment with Augmentin 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 Current Situation

Your case presents several important considerations:

1. Current symptoms and treatment:

   • Diagnosed sinus infection with nasal endoscopy
   • Started 7-day Augmentin course but experiencing:
     • Loose bowel movements/diarrhea
     • Severe upper stomach cramp
     • General abdominal discomfort

2. Recent antibiotic history:

   • Z-pack in early 2025
   • Augmentin course completed April 7,2025
   • Current Augmentin started July 19,2025 (3 doses taken irregularly)

Recommendation for Immediate Management

Step 1: Discontinue Augmentin

The gastrointestinal side effects you're experiencing (diarrhea, abdominal cramps) are significant adverse events that warrant discontinuation of the medication. The FDA drug information specifically states: "If diarrhea is severe or lasts more than 2 or 3 days, patients should contact their physician." 2

Step 2: Wait for Culture Results

Since you've had a culture taken that will be available in 1-2 days, the most prudent approach is to wait for these results before deciding on further antibiotic therapy. 1

Next Steps Based on Culture Results

If Culture is Negative:

1. Focus on non-antibiotic treatments:
   • Continue intranasal corticosteroids (Dymista) 1
   • Use saline nasal irrigation (recommended as adjunctive therapy) 1
   • Consider the possibility that your symptoms may be related to your deviated septum or non-bacterial causes

If Culture is Positive:

1. If sensitive to Augmentin but you can't tolerate it:

   • Request an alternative antibiotic based on sensitivity results
   • Options may include respiratory fluoroquinolones (e.g., levofloxacin) for adults with moderate disease 1

2. If resistant to Augmentin:

   • Your physician should select an appropriate antibiotic based on the sensitivity pattern

Potential Harms from Partial Antibiotic Course

Taking only three doses of Augmentin may have caused:

1. Incomplete treatment of infection: The partial course likely did not fully treat the infection if bacterial 1

2. Potential for resistance development: Incomplete antibiotic courses can increase the likelihood that bacteria will develop resistance 2

3. Gastrointestinal microbiome disruption: Even short courses of antibiotics can disrupt your gut microbiome 1

C. difficile Risk Assessment

Your concern about C. difficile is valid given:

• Multiple recent antibiotic exposures (Z-pack, two courses of Augmentin)
• Current diarrhea symptoms

The risk of C. difficile colitis is increased with antibiotic exposure, and recent antibiotic use is an important risk factor 1. Monitor for:

• Watery, bloody diarrhea
• Fever
• Abdominal pain that worsens

If these symptoms develop, contact your physician immediately for C. difficile testing.

Important Considerations

1. Antibiotic overuse concerns: Your history shows multiple antibiotic courses in a short period, which increases risks of adverse effects and resistance 1

2. Underlying issues: The recurrent nature of your infections suggests potential underlying factors that may need addressing:

   • Deviated septum evaluation
   • Comprehensive allergy assessment
   • Evaluation for chronic rhinosinusitis

3. Non-antibiotic approaches: Given your history, emphasizing non-antibiotic approaches (nasal irrigation, intranasal corticosteroids) may be beneficial for long-term management 1

Remember that antibiotics should only be used when there is clear evidence of bacterial infection, as they do not treat viral infections and carry risks of adverse effects 2.