Should I continue taking Augmentin (amoxicillin/clavulanate) despite side effects?

Management of Sinus Infection with Klebsiella Oxytoca and Augmentin Side Effects

You should discontinue Augmentin due to significant side effects and consider alternative antibiotics that target your confirmed Klebsiella oxytoca infection.

Assessment of Current Situation

Your current clinical presentation shows:

• Day 9 of sinus infection with mostly resolved symptoms
• Culture showing heavy growth of Klebsiella oxytoca susceptible to Augmentin
• Significant side effects from Augmentin (GI effects, cramping, arm pain, tingling fingers)
• Inconsistent dosing of the prescribed 5-day course

Decision Algorithm for Antibiotic Management

1. Evaluate Need for Continued Antibiotics

• Your symptoms are "mostly resolved" with only sticky clear mucus and occasional productive cough
• The European Position Paper on Rhinosinusitis (EPOS) 2020 indicates that many sinus infections resolve without antibiotics 1
• The culture confirms bacterial infection (Klebsiella oxytoca), which typically warrants targeted treatment

2. Assess Severity of Side Effects

Your current side effects include:

• Gastrointestinal effects (common with Augmentin)
• Cramping and sharp pains in arm
• Tingling fingers (potential neurological side effect)

These side effects are significant and potentially concerning, particularly the neurological symptoms.

3. Recommended Action Plan

Immediate Steps:

1. Contact your ENT physician immediately to report these side effects and discuss alternative antibiotics
2. Discontinue Augmentin due to significant side effects that outweigh benefits in your mostly resolved infection 2
3. Request an alternative antibiotic based on your culture sensitivity results

Alternative Antibiotic Options:

Based on your culture showing Klebsiella oxytoca susceptible to multiple antibiotics:

• Ciprofloxacin may be considered as it has shown similar efficacy to Augmentin with fewer GI side effects (12.4% vs 25%) 1
• Clarithromycin could be an alternative with different side effect profile 1

Important Considerations

Risks of Discontinuing Antibiotics

• Taking only partial courses of antibiotics can promote antibiotic resistance 3
• However, severe side effects necessitate discontinuation and switching to alternative therapy

Monitoring for Complications

Watch for these warning signs requiring immediate medical attention:

• Fever development or worsening
• Severe headache or facial pain
• Visual changes
• Mental status changes

Supportive Measures While Awaiting New Prescription

• Saline nasal irrigation to help clear mucus
• Adequate hydration
• Over-the-counter analgesics for pain if needed

Common Pitfalls to Avoid

1. Don't restart Augmentin despite culture results - The side effects you're experiencing (particularly neurological symptoms) outweigh the benefits, especially since your infection is mostly resolved 2

2. Don't leave the infection untreated - While symptoms are improving, Klebsiella is a significant pathogen that should be properly treated based on culture sensitivity

3. Don't delay contacting your physician - Neurological symptoms like arm pain and tingling fingers warrant prompt medical evaluation

4. Don't assume all antibiotics will cause the same side effects - Different antibiotic classes have different side effect profiles, and an alternative may be better tolerated 1

The American Academy of Otolaryngology guidelines recommend reevaluating the treatment plan if no improvement is seen after 72 hours or if side effects develop 3. Your side effects are significant enough to warrant discontinuation and switching to an alternative antibiotic that targets your confirmed pathogen.