I finished a course of Augmentin (amoxicillin/clavulanate) 875 for sinusitis and now I'm experiencing burning pain around my right maxillary sinus, what should I do?

Management of Persistent Maxillary Sinus Pain After Augmentin Treatment

If you're experiencing burning pain around your right maxillary sinus after completing a course of Augmentin for sinusitis, you should seek medical evaluation as this may indicate treatment failure, a complication, or an alternative diagnosis such as dental infection.

Evaluation of Persistent Symptoms

When maxillary sinus pain persists after antibiotic treatment, several possibilities exist:

1. Treatment failure: The initial antibiotic therapy may have been inadequate to clear the infection completely 1.

2. Alternative diagnosis: The pain could be related to:

   • Dental infection (periodontitis or apical granulomas) 2
   • Temporomandibular joint (TMJ) pain-dysfunction syndrome 3
   • Other sinus pathology (polyps, tumors) 4

3. Complications: Development of more serious sinus infection or spread to adjacent structures 1

Recommended Next Steps

Immediate Actions:

• Comfort measures:
  • Adequate hydration
  • Warm facial packs
  • Analgesics for pain relief
  • Sleeping with head elevated 4

Medical Evaluation:

• Seek medical attention if:
  • Pain is severe or preventing sleep
  • You develop new symptoms like facial swelling, visual changes, or neurological symptoms 4

Treatment Options:

1. If treatment failure is suspected:

   • A different antibiotic may be needed. Options include:
     • Respiratory fluoroquinolones (levofloxacin, moxifloxacin)
     • Cephalosporins (cefuroxime-axetil, cefpodoxime-proxetil)
     • Clindamycin (if penicillin allergic) 1

2. Adjunctive therapies:

   • Intranasal corticosteroids to reduce inflammation
   • Saline nasal irrigation for symptom relief 1
   • Decongestants to improve sinus drainage 1

3. If dental origin is suspected:

   • Dental examination with radiographs is crucial as up to 47% of chronic maxillary sinusitis cases may be related to dental infections 2

Warning Signs Requiring Urgent Attention

Seek immediate medical care if you experience:

• Facial swelling or erythema over the sinus
• Visual changes or abnormal eye movements
• Periorbital inflammation or edema
• Severe headache or neurological symptoms 4

Follow-up Recommendations

• If started on a new antibiotic, evaluate response after 72 hours
• If symptoms persist or worsen after 72 hours of consistent therapy, further evaluation with CT scan or endoscopy may be warranted 1
• Consider evaluation for underlying risk factors such as allergies or structural abnormalities if sinusitis is recurrent 1

The burning sensation specifically around your right maxillary sinus could indicate either ongoing sinusitis or referred pain from a dental source, which is particularly common in the maxillary posterior teeth area 5. Given the completion of an Augmentin course without resolution, professional evaluation is necessary to determine the appropriate next steps.