Are 11 irregular doses of Augmentin (amoxicillin/clavulanate) sufficient to eradicate Klebsiella oxytoca in a patient with a bacterial sinus infection?

Irregular Augmentin Dosing for Bacterial Sinus Infection

The 11 irregular doses of Augmentin taken over 9 days are insufficient to eradicate Klebsiella oxytoca in a bacterial sinus infection, as guidelines recommend a complete 5-7 day course of twice-daily dosing without interruptions. 1, 2

Recommended Treatment Duration and Regimen

According to current guidelines, proper treatment for bacterial sinusitis requires:

• For adults: 5-7 days of continuous therapy 1
• Amoxicillin-clavulanate (Augmentin) is the recommended first-line treatment for bacterial sinusitis 1, 2
• Proper dosing is 875/125 mg twice daily 1, 2
• Treatment should be taken consistently without interruptions 2

Analysis of Current Treatment

The patient has taken 11 doses over 9 days (7/19 to 7/27) with significant gaps:

• 2 doses on 7/19
• 1 dose on 7/21
• 1 dose on 7/23
• 6 doses on 7/24-7/27 (consistent dosing only in this period)

Problems with this regimen:

1. Inconsistent dosing: Multiple days were skipped entirely (7/20,7/22) and several days had only one dose instead of the recommended twice-daily dosing 1, 2

2. Inadequate continuous therapy: Only the last 3-4 days show consistent twice-daily dosing 2

3. Risk of resistance development: Irregular antibiotic dosing is a major factor in developing antimicrobial resistance 2

Impact of Diarrhea

The patient's diarrhea (Bristol stool 6-7 for 1.5 days) is a common side effect of Augmentin 1, 2. However:

• Diarrhea is an expected side effect and not necessarily a reason to discontinue therapy unless severe 1
• Taking Augmentin with food can minimize GI side effects 2
• The presence of diarrhea may affect absorption but does not eliminate the need for a complete course

Recommendation for This Patient

Given the confirmed bacterial infection with K. oxytoca and known susceptibility to Augmentin:

1. Complete a proper course: The patient should restart a full 5-7 day course of Augmentin 875/125 mg twice daily without interruptions 1, 2

2. Evaluate response: Assess clinical response after 72 hours of consistent therapy 2

3. Manage side effects: Take medication with food to minimize GI side effects; consider probiotics for diarrhea management 2

Key Considerations

• Incomplete antibiotic courses increase the risk of treatment failure and bacterial resistance 2
• K. oxytoca requires adequate and consistent antibiotic levels for eradication 1
• The European Position Paper on Rhinosinusitis (EPOS 2020) emphasizes the importance of complete antibiotic courses for bacterial eradication 1

Irregular dosing with multiple missed doses is unlikely to achieve the sustained antibiotic levels needed for bacterial eradication, particularly for gram-negative organisms like K. oxytoca.