Management of Recurrent Acute Rhinosinusitis with Pending Culture and Augmentin Side Effects
Based on your clinical presentation and current guidelines, you should discontinue Augmentin and wait for culture results before resuming antibiotic therapy, as the risk of antibiotic resistance from your partial course is low and your symptoms are currently improving. 1
Assessment of Your Current Situation
Your presentation shows several important features:
- Symptoms that started ~7 days ago with initial improvement
- Partial course of Augmentin (3 doses) discontinued due to GI side effects
- Currently experiencing new head pain that may be migraine-related
- History of recurrent rhinosinusitis with variable response to antibiotics
- Pending sinus culture from day 3
Clinical Decision Points
Current Symptom Pattern:
- Your initial symptoms (yellow/green mucus, facial pressure) have improved
- The new head pain coincides with a weather change and matches your migraine pattern
- The productive cough with colored phlegm started on day 5 (after antibiotics)
Antibiotic Resistance Concerns:
- Taking only 3 doses of Augmentin has a low likelihood of creating resistant bacteria
- Short, incomplete courses primarily pose resistance risk with longer-term infections
- The IDSA guidelines note that symptoms should improve within 3-5 days of appropriate therapy 1
Recommended Management Plan
Immediate Steps:
- Continue to wait for culture results before resuming antibiotics
- Manage symptoms with:
- Continue Dymista (azelastine/fluticasone) as prescribed
- Continue saline nasal irrigation (critical for symptom relief) 1
- Continue Allegra as prescribed
- Use pseudoephedrine as needed for congestion
When Culture Results Return:
If Culture Shows No Growth:
- This is consistent with your June 2025 findings
- Focus on non-antibiotic management:
- Intranasal corticosteroids (continue Dymista)
- Saline irrigation (fundamental therapy) 1
- Consider evaluation for structural issues (your deviated septum may be contributing)
If Culture Shows Bacterial Growth:
If Augmentin-sensitive bacteria:
If resistant bacteria:
- Follow culture-directed therapy as recommended by ENT
Addressing Your Specific Concerns
Regarding Antibiotic Resistance
Taking only 3 doses of Augmentin over 3 days is unlikely to have created significant resistance. The European Position Paper on Rhinosinusitis notes that resistance typically develops with prolonged subtherapeutic exposure 1.
Regarding Discontinuing Medication
Your decision to stop Augmentin due to significant side effects was reasonable. The IDSA guidelines recommend considering alternative management if side effects are significant 1. Diarrhea is the most common adverse event with Augmentin, reported in up to 32% of patients 2.
Regarding Future Antibiotic Options
If antibiotics are needed based on culture results:
- For Augmentin-sensitive bacteria, alternatives with better GI profiles include:
Important Considerations
- Pattern of recurrence: Your history suggests possible chronic rhinosinusitis with acute exacerbations
- CT findings: The mucosal thickening and deviated septum may contribute to recurrent infections
- Antibiotic history: Your multiple courses this year raise concerns about developing resistance
When to Seek Immediate Care
Return for evaluation if you develop:
- High fever
- Severe headache or visual changes
- Worsening facial pain/swelling
- Mental status changes
Remember that the majority of rhinosinusitis cases resolve without antibiotics, and waiting for culture results before restarting antibiotics is a reasonable approach given your improving symptoms and the side effects you experienced.