What is the best course of action for a patient with worsening symptoms of a sinus infection, currently being treated with Augmentin (amoxicillin/clavulanate), who has just been diagnosed with infectious mononucleosis (mono)?

Management of Worsening Sinus Infection in a Patient with Mono Who is on Augmentin

For a patient with worsening sinus infection symptoms who is currently on Augmentin (amoxicillin/clavulanate) and has just been diagnosed with infectious mononucleosis (mono), discontinue the antibiotic and focus on supportive care for mono.

Rationale for Discontinuing Antibiotics

• Worsening symptoms despite appropriate antibiotic therapy with Augmentin suggests that the patient's symptoms are likely due to infectious mononucleosis rather than bacterial sinusitis 1, 2
• Infectious mononucleosis is caused by Epstein-Barr virus (EBV), which does not respond to antibiotics 2, 3
• Continuing antibiotics when they are not needed increases the risk of antibiotic resistance and potential side effects without providing benefit 1, 4

Supportive Care for Infectious Mononucleosis

• Treatment for infectious mononucleosis is primarily supportive 2, 3:

  • Adequate rest and hydration 1, 5
  • Over-the-counter analgesics for pain and fever control 1, 3
  • Warm facial packs and steamy showers for symptomatic relief 1
  • Sleeping with the head of the bed elevated 1

• Activity recommendations:

  • Allow the patient to be out of bed as soon as they feel able, as this has been shown to promote quicker recovery compared to imposed bed rest 5
  • Avoid contact sports or strenuous exercise for at least 3-8 weeks due to risk of splenic rupture 2, 3

Monitoring and Follow-up

• Reassess the patient in 72 hours to evaluate response to supportive care 1

• Monitor for potential complications of infectious mononucleosis:

  • Splenic rupture (occurs in 0.1-0.5% of cases) 3
  • Severe fatigue syndrome 3, 5
  • Hepatic involvement (monitor for jaundice and elevated liver enzymes) 2, 3

• Warning signs requiring immediate attention:

  • Left upper quadrant pain (potential splenic involvement) 3
  • Severe throat swelling affecting breathing 2
  • Significant dehydration 1
  • High persistent fever 1, 6

Special Considerations

• Avoid prescribing additional antibiotics unless there is clear evidence of a secondary bacterial infection 1
• If the patient's condition deteriorates rapidly with high fever and severe symptoms, consider:
  • Hospitalization for supportive care 3
  • In rare cases of fulminant infectious mononucleosis, corticosteroids may be considered (though this is uncommon in immunocompetent patients) 6

Patient Education

• Explain that infectious mononucleosis is viral and antibiotics will not help 4, 2
• Inform the patient that symptoms typically resolve within 2-4 weeks, though fatigue may persist for several months 2, 3
• Advise about transmission through saliva and close contact 2, 3
• Instruct to return if symptoms worsen or if new symptoms develop 1