Should I resume Augmentin (amoxicillin/clavulanate) for my sinus infection despite previous gastrointestinal side effects and incomplete initial course?

Management of Recurrent Sinus Infection with Augmentin

You should resume the Augmentin course despite the gastrointestinal side effects, as completing the full antibiotic treatment is essential to prevent bacterial resistance and ensure complete eradication of your sinus infection. 1, 2

Assessment of Your Current Situation

Your case presents as recurrent acute bacterial rhinosinusitis (ABRS) with:

• History of deviated septum (structural predisposition)
• Multiple episodes of upper respiratory infections since December 2024
• Current symptoms including colored mucus, facial pain, ear fullness, and sinus headaches
• ENT diagnosis of sinus infection via nasal endoscopy
• Previous CT showing mucosal thickening
• Incomplete course of Augmentin with GI side effects

Recommendation for Antibiotic Management

Primary Recommendation:

1. Resume the Augmentin course - Clinical guidelines strongly recommend completing the prescribed antibiotic course to prevent bacterial resistance 1, 2
2. Take with food - Always take Augmentin with meals or snacks to reduce gastrointestinal upset 2
3. Complete the full 7-day course - Guidelines recommend 5-10 days of therapy for ABRS in adults 1

Managing Side Effects:

• Take probiotics (2 hours apart from antibiotics)
• Stay well hydrated
• Consider over-the-counter antidiarrheals if needed
• If severe diarrhea with blood or severe abdominal pain develops, contact your physician immediately 2

Rationale for Continuing Antibiotics

1. Preventing bacterial resistance: Incomplete antibiotic courses increase the likelihood of bacteria developing resistance 2
2. Clinical guidelines support: Amoxicillin-clavulanate is the recommended first-line therapy for ABRS, especially with your history of recurrent infections 1
3. Risk of worsening infection: Your symptoms (green mucus, worsening condition) suggest active bacterial infection that requires complete treatment 1

Additional Supportive Measures

While continuing antibiotics, implement these evidence-based supportive measures:

• Saline nasal irrigation - Recommended as an adjunctive treatment to help clear mucus and reduce symptoms 1
• Continue intranasal corticosteroids (Dymista) - Helps reduce inflammation and improve sinus drainage 1
• Adequate hydration - Helps thin mucus secretions
• Warm facial packs - Can provide symptomatic relief 1
• Sleep with head elevated - Improves sinus drainage 1

Follow-up Recommendations

1. Wait for culture results - This will confirm if Augmentin is appropriate, but don't delay continuing treatment
2. If symptoms worsen within 48-72 hours or fail to improve after 3-5 days of resumed antibiotics, contact your physician for reassessment 1
3. Consider specialist follow-up for your recurrent sinusitis and deviated septum, as you may need evaluation for:
   • Surgical intervention for the deviated septum
   • Allergy testing
   • Immunological evaluation 1

Common Pitfalls to Avoid

• Stopping antibiotics early when feeling better - This is a common mistake that can lead to recurrence and antibiotic resistance 2
• Not taking medication with food - Augmentin should always be taken with meals to minimize GI side effects 2
• Ignoring severe side effects - While mild GI upset is common, severe or bloody diarrhea requires immediate medical attention 2
• Relying solely on antibiotics - Adjunctive therapies like saline irrigation and intranasal steroids are important components of treatment 1

Your history of recurrent infections with a deviated septum suggests you may benefit from comprehensive ENT evaluation after this acute episode resolves to address the underlying anatomical factors contributing to your recurrent infections.