Can I resume Augmentin (amoxicillin/clavulanate) for a sinus infection if the culture shows sensitivity, after previously taking 3 doses and stopping due to gastrointestinal side effects?

Management of Recurrent Sinus Infection After Interrupted Augmentin Course

You should resume the Augmentin course for your sinus infection, but start a new 7-day course rather than continuing from where you left off, and take measures to reduce gastrointestinal side effects.

Understanding Your Situation

You have a history of recurrent sinus infections with a deviated septum, which increases your risk for persistent or recurrent infections. Your current symptoms (colored mucus, ear fullness, sinus headaches) are consistent with bacterial sinusitis, and your ENT has prescribed Augmentin based on clinical examination.

Recommendation for Antibiotic Management

Resuming Antibiotic Therapy

• Given your symptoms of colored mucus, ear fullness, and sinus headaches that are worsening after stopping antibiotics, resuming antibiotic therapy is appropriate 1
• Since you've only taken 3 doses of the prescribed 7-day course, and symptoms are worsening, you should restart a full 7-day course rather than continuing from where you left off 1
• Taking an incomplete course may decrease treatment effectiveness and potentially increase bacterial resistance 2

Managing Gastrointestinal Side Effects

• Take each dose with food to reduce gastrointestinal upset 2
• Consider probiotics (though not within 2 hours of antibiotic doses)
• Ensure adequate hydration
• If diarrhea is severe or persists more than 2-3 days, contact your physician 2

Importance of Culture Results

• Wait for culture results if you can tolerate your symptoms for another day or two
• If the culture shows sensitivity to Augmentin, this confirms it's the appropriate choice
• If the culture shows resistance, your ENT may prescribe an alternative antibiotic

Treatment Algorithm Based on Culture Results

1. If culture is negative but symptoms persist:

   • Continue Augmentin as prescribed (full 7-day course)
   • Your symptoms may still be bacterial despite negative culture 1

2. If culture shows bacteria sensitive to Augmentin:

   • Complete the full 7-day course of Augmentin
   • Take measures to reduce GI side effects

3. If culture shows resistant bacteria:

   • Switch to an alternative antibiotic based on sensitivity results
   • Options may include respiratory fluoroquinolones or other antibiotics 1

Additional Supportive Measures

• Continue Dymista and Allegra as prescribed
• Add saline nasal irrigation 2-3 times daily 1
• Consider warm facial packs and sleeping with head elevated 1
• Adequate hydration and rest 1

When to Seek Further Care

• If symptoms worsen despite restarting antibiotics after 3-5 days 1
• If you develop severe headache, visual changes, facial swelling, or mental status changes (signs of complications) 1
• If gastrointestinal side effects become severe or intolerable 2

Common Pitfalls to Avoid

• Stopping antibiotics early: This is a common mistake that can lead to treatment failure and bacterial resistance 2
• Not taking with food: Augmentin should be taken with meals to minimize GI side effects 2
• Ignoring worsening symptoms: Progressive symptoms despite treatment may indicate complications or resistant bacteria 1
• Overuse of antibiotics: While you need to complete this course, frequent antibiotic use can lead to resistance; addressing underlying issues like your deviated septum may be beneficial long-term

Your history of multiple URIs and sinus infections this year suggests you may benefit from ENT follow-up to address the underlying deviated septum, which is likely contributing to your recurrent infections.