Is 11 doses of Augmentin (Amoxicillin/Clavulanate) 875 sufficient to eradicate bacteria in a mild sinus infection?

Management of Augmentin-Associated Diarrhea in a Patient with Mild Sinus Infection

The patient should discontinue Augmentin due to severe diarrhea and abdominal cramping, as the 11 doses taken are likely insufficient for complete bacterial eradication of K. oxytoca. 1

Assessment of Current Treatment

The patient has taken 11 doses of Augmentin 875 mg for a mild sinus infection with confirmed K. oxytoca, but with an inconsistent dosing schedule and now experiencing severe diarrhea with abdominal cramping for 1.5 days.

• Current treatment status:
  • 11 doses of Augmentin 875 mg taken over 9 days
  • Inconsistent dosing with gaps (missed doses on 7/20,7/21 evening, 7/22,7/23 morning)
  • Experiencing severe diarrhea and abdominal cramping

Recommended Approach

1. Discontinue Current Treatment

• The severe diarrhea and abdominal cramping indicate significant gastrointestinal adverse effects that warrant discontinuation of Augmentin
• While diarrhea is a common side effect of Augmentin, severe symptoms should prompt discontinuation 1

2. Evaluate Treatment Adequacy

• The Infectious Diseases Society of America (IDSA) recommends a complete 5-7 day course of twice-daily dosing without interruptions for bacterial sinusitis 1
• The patient's treatment has been inconsistent with significant gaps between doses
• For gram-negative organisms like K. oxytoca, consistent antibiotic levels are particularly important for eradication 1
• The 11 doses taken over 9 days with inconsistent timing is likely insufficient for complete bacterial eradication

3. Alternative Treatment Options

Since the current treatment needs to be discontinued due to severe side effects, consider:

• For non-penicillin allergic patients with continued symptoms:

  • Respiratory fluoroquinolone (gatifloxacin, levofloxacin, moxifloxacin) 2
  • Ceftriaxone (1-2 g/day for 5 days) 2

• For penicillin-allergic patients:

  • Clindamycin (300-450 mg orally 3 times daily for 7 days) 1
  • Macrolides (azithromycin, clarithromycin) - though these have limited effectiveness against major pathogens of ABRS 2

4. Monitoring and Follow-up

• Evaluate response to new treatment after 72 hours 1
• If symptoms persist or worsen after 72 hours of consistent therapy, reevaluation is necessary 2
• Consider CT scan, fiberoptic endoscopy, or sinus aspiration for culture if symptoms persist despite appropriate antibiotic therapy 2

Important Considerations

• Incomplete antibiotic courses increase risk of treatment failure and bacterial resistance 1
• The European Position Paper on Rhinosinusitis and IDSA emphasize that inconsistent antibiotic levels can compromise efficacy 1
• Research shows that even with consistent dosing, amoxicillin-clavulanate provides minimal benefit in some cases of acute bacterial sinusitis 3
• For mild sinus infections, a minimum effective duration of 5 days with consistent twice-daily dosing is recommended 1

Adjunctive Measures

While transitioning to alternative antibiotic therapy:

• Intranasal corticosteroids to reduce inflammation 1
• Saline nasal irrigation for symptom relief 1
• Probiotics may help manage antibiotic-associated diarrhea 1
• Analgesics for pain management 1

The key issue here is that the patient has not completed a consistent course of appropriate antibiotic therapy, and the severe gastrointestinal side effects necessitate discontinuation of the current regimen and consideration of alternative treatment options.