Should I resume Augmentin (amoxicillin/clavulanate) despite gastrointestinal side effects or wait for culture results to guide treatment for my sinus infection?

Managing Recurrent Sinusitis with Augmentin Side Effects

You should wait for culture results before resuming Augmentin, as the gastrointestinal side effects you're experiencing are significant, and your recent negative culture (May 28) suggests potential viral etiology rather than bacterial infection requiring antibiotics.

Assessment of Your Current Situation

Your case presents several important considerations:

1. Recurrent URI pattern: Multiple episodes since December 2024 with only two requiring antibiotics
2. Recent negative culture: Your May 28 culture showed no bacterial growth
3. Current symptoms: Colored mucus, ear fullness, sinus headaches
4. Medication response: Significant GI side effects from Augmentin (diarrhea, abdominal cramps)
5. Diagnostic findings: CT showing mucosal thickening and positive nasal endoscopy

Recommendation Based on Guidelines

The decision to continue antibiotics should be based on:

1. Likelihood of Bacterial vs. Viral Infection

• Your recent negative culture (May 28) suggests possible viral etiology 1
• The pattern of illness with periods of improvement suggests recurrent viral infections rather than persistent bacterial sinusitis 1
• Green mucus alone is not a reliable indicator of bacterial infection 1

2. Antibiotic Side Effects

• You're experiencing significant GI side effects (diarrhea, abdominal cramps) which are common with Augmentin 2
• These side effects occur in approximately 9% of patients taking Augmentin 2
• Diarrhea that is severe or lasts more than 2-3 days warrants discontinuation and physician consultation 2

3. Antibiotic Efficacy vs. Harm

• For acute bacterial rhinosinusitis, antibiotics provide only modest benefit (91% vs 86% improvement compared to placebo) 1
• The number needed to treat is 11-15 patients for one to benefit 1
• Adverse events are more common with antibiotics (number needed to harm: 8.1) 1

Action Plan

1. Wait for culture results before resuming antibiotics

   • Culture results will guide appropriate therapy if bacterial infection is present
   • If culture is negative, antibiotics may be unnecessary

2. Continue supportive measures while waiting:

   • Continue Dymista nasal spray as prescribed
   • Continue Allegra as prescribed
   • Use saline nasal irrigation (recommended as adjunctive treatment) 1
   • Consider intranasal corticosteroids (you're already on Dymista which contains fluticasone) 1

3. When to resume antibiotics:

   • If culture shows bacterial growth with sensitivity to Augmentin
   • If symptoms significantly worsen (high fever, severe pain, orbital complications)
   • Consider alternative antibiotics if culture shows resistance or if Augmentin side effects are intolerable

Important Caveats

• Watchful waiting is appropriate for many cases of suspected sinusitis, especially with recent negative cultures 1
• Completing the full course is important if you do restart antibiotics, but severe GI side effects are a valid reason to discontinue 2
• Alternative antibiotics may be considered if culture shows bacterial infection but Augmentin side effects are intolerable 1
• Deviated septum may contribute to recurrent infections and might warrant surgical evaluation if infections continue despite appropriate medical management 1

If culture results show bacterial infection and you need to resume antibiotics but cannot tolerate Augmentin, discuss alternative options with your ENT such as doxycycline or a respiratory fluoroquinolone if appropriate based on culture sensitivities 1.