Should I resume Augmentin (amoxicillin/clavulanate) for sinus infection after discontinuing due to gastrointestinal side effects or wait for culture results?

Management of Augmentin for Sinus Infection After GI Side Effects

You should resume the Augmentin course despite the gastrointestinal side effects, as completing the full antibiotic course is necessary to effectively treat your sinus infection and prevent bacterial resistance. 1

Assessment of Your Current Situation

Your clinical presentation strongly suggests acute bacterial sinusitis with:

• Colored mucus (yellow/green)
• Facial pain
• Sinus headaches
• Ear fullness with autophony
• Positive nasal endoscopy findings from ENT

Understanding the Need for Antibiotics

The Infectious Diseases Society of America recommends amoxicillin-clavulanate (Augmentin) as first-line therapy for acute bacterial sinusitis due to its effectiveness against common pathogens including H. influenzae 2. Your recent history of multiple URIs and previous antibiotic treatments suggests you may have resistant organisms, making Augmentin an appropriate choice.

Managing the Gastrointestinal Side Effects

Your GI symptoms (diarrhea, abdominal discomfort) are common side effects of Augmentin. Here's how to manage them:

1. Take with food - Always take Augmentin with meals or snacks to reduce gastrointestinal upset 1
2. Consider probiotics - Though not in the guidelines, these may help with antibiotic-associated diarrhea
3. Stay hydrated - Especially important with diarrhea
4. Timing adjustment - Space doses evenly throughout the day (every 8 hours for a 3x/day regimen)

Recommended Course of Action

1. Resume the full 7-day course of Augmentin - Skipping doses or not completing the full course decreases effectiveness and increases the likelihood of bacterial resistance 1
2. Complete the remaining days - Start where you left off and finish the full 7-day course
3. Wait for culture results - Continue the medication while awaiting culture results; adjustments can be made if the culture shows resistance

Rationale for Continuing Treatment

1. Preventing resistance - Incomplete antibiotic courses promote bacterial resistance 1
2. Clinical guidelines support - The American Academy of Pediatrics recommends continuing antibiotics until the patient is asymptomatic for 7 days in sinusitis 2
3. Symptom progression - Your worsening symptoms (productive cough with green mucus) suggest active infection requiring treatment

Monitoring and Follow-up

• If diarrhea becomes severe (watery or bloody) or persists more than 2-3 days, contact your physician 1
• If symptoms worsen significantly within 72 hours of resuming treatment, reassessment is recommended 2
• Continue your adjunctive treatments (Dymista, Allegra, saline sprays) as they complement antibiotic therapy

Important Considerations

• Duration of therapy: Guidelines recommend 10-14 days of appropriate antibiotic therapy for most bacterial sinusitis 2
• Treatment assessment: Evaluate response after 72 hours; improvement should be noticeable by then 2
• Culture results: If cultures show a different sensitivity pattern, your antibiotic may need to be changed

Common Pitfalls to Avoid

1. Stopping antibiotics early when feeling better - This is a common mistake that promotes antibiotic resistance
2. Taking antibiotics without food - This increases the risk of GI side effects
3. Missing doses - Irregular dosing reduces antibiotic effectiveness
4. Ignoring severe diarrhea - Could indicate C. difficile infection requiring medical attention

Remember that while GI side effects are uncomfortable, they are generally manageable and typically resolve after completing the antibiotic course. The risks of untreated or inadequately treated sinus infection (including potential complications like orbital or intracranial spread) outweigh the temporary discomfort of antibiotic side effects.