Should I resume Augmentin (amoxicillin/clavulanate) after missing doses and experiencing gastrointestinal side effects, given the culture results show susceptibility to Augmentin?

Management of Sinus Infection with Klebsiella oxytoca

You should resume taking Augmentin to complete your full 7-day course as originally prescribed, since the culture shows the infection is susceptible to this antibiotic and missing doses increases the risk of treatment failure and antibiotic resistance. 1, 2

Current Situation Assessment

Your case presents several important clinical factors:

• Day 8 of sinus infection with culture confirming Klebsiella oxytoca (susceptible to Augmentin)
• Partial treatment with Augmentin 875mg (3 doses taken, 4 doses missed)
• Symptoms initially improved but now have:
  • Sticky clear mucus
  • Productive cough with yellow/green phlegm (started day 5)
  • GI side effects that led to discontinuation

Treatment Recommendation

Primary Recommendation

• Resume Augmentin 875mg to complete the full 7-day course as originally prescribed 3
• The 3 doses you've already taken are unlikely to have conferred resistance since the organism was confirmed susceptible on culture 1

Managing GI Side Effects

• Take Augmentin with food to reduce gastrointestinal upset 2
• Consider probiotics (though not specifically mentioned in guidelines)
• Ensure adequate hydration 1

Rationale for Resuming Augmentin

1. Culture-confirmed susceptibility: The culture shows Klebsiella oxytoca is susceptible to Augmentin, making it the appropriate targeted therapy 3

2. Risk of incomplete treatment: Skipping doses or not completing the full course may:

   • Decrease effectiveness of immediate treatment
   • Increase likelihood of bacterial resistance development 2

3. Low risk of resistance from partial treatment: Since only 3 doses were taken and the organism was confirmed susceptible, the risk of resistance development is low 1

4. Symptom pattern: Your symptoms initially improved but haven't fully resolved, suggesting the antibiotic was working but needs to be completed 1

Monitoring and Follow-up

• Monitor for 72 hours after resuming antibiotics for:

  • Improvement in symptoms
  • Any worsening of symptoms
  • Development of severe side effects 1

• Seek immediate medical attention if:

  • Symptoms worsen significantly
  • High fever develops
  • Severe headache or visual changes occur
  • Bloody diarrhea develops 1, 2

Important Considerations

• Antibiotic resistance risk: Not completing the full course increases the risk of bacterial resistance 2
• GI side effects management: Taking with food can reduce GI upset; if severe diarrhea persists for more than 2-3 days, contact your physician 2
• Supportive care: Continue supportive measures like adequate hydration, saline nasal irrigation, and rest 1

If symptoms persist beyond completion of the full 7-day course, further evaluation would be warranted to determine if a different antibiotic or longer duration of therapy is needed 3.