What is the best treatment for diarrhea and vomiting caused by Augmentin (amoxicillin/clavulanate)?

Management of Diarrhea and Vomiting from Augmentin

For diarrhea and vomiting caused by Augmentin (amoxicillin/clavulanate), loperamide is the most effective treatment for adults, while oral rehydration therapy is the primary intervention for all patients, especially children. 1

Initial Management

• Ensure adequate hydration through oral rehydration solution (ORS) as the first step in managing antibiotic-associated diarrhea 1
• Monitor for signs of dehydration including decreased urine output, dry mouth, dizziness upon standing, and altered mental status 1, 2
• Continue the antibiotic course unless symptoms are severe or there are signs of C. difficile infection (bloody stools, severe abdominal pain, high fever) 3
• Take Augmentin with food to reduce gastrointestinal upset 3

Pharmacological Management

For Adults:

• Loperamide is recommended for adults with watery diarrhea at an initial dose of 4 mg followed by 2 mg after each loose stool (maximum 16 mg daily) 1
• Continue loperamide until 12 hours after diarrhea resolves 2
• For persistent symptoms, increase loperamide dosing to every 2 hours within the maximum daily limit 2
• Avoid loperamide if there is fever or bloody diarrhea as this may indicate inflammatory diarrhea or C. difficile infection 1, 3

For Children:

• Antimotility drugs like loperamide should NOT be given to children under 18 years of age with acute diarrhea 1
• Ondansetron may be given to children over 4 years of age to control vomiting and facilitate oral rehydration 1
• Focus on oral rehydration therapy with appropriate pediatric electrolyte solutions 1

Dietary Recommendations

• Implement dietary modifications by eliminating lactose-containing products, alcohol, and high-osmolar supplements 2
• Encourage consumption of 8-10 large glasses of clear liquids daily 2
• Resume normal diet as soon as tolerated; the BRAT diet (bananas, rice, applesauce, toast) has limited supporting evidence but may be helpful 1
• Avoid spicy foods, coffee, and foods high in insoluble fiber 1, 2

When to Seek Further Medical Attention

• If diarrhea is severe or lasts more than 2-3 days despite treatment 3
• If there are signs of dehydration (decreased urination, excessive thirst, dizziness) 1
• If bloody stools develop, which may indicate C. difficile infection 3
• If fever develops or persists 1, 3

Special Considerations

• Consider C. difficile infection if symptoms are severe or persistent, as this is a potential complication of antibiotic use 3
• For severe cases with dehydration, intravenous fluids may be necessary 1
• If symptoms persist beyond 7 days, further diagnostic investigation is warranted 1

Important Precautions

• Antibiotic-associated diarrhea typically resolves when the antibiotic is discontinued 3
• Probiotics may be considered to reduce symptom severity and duration, though evidence is moderate 1
• Bismuth subsalicylate has mild effectiveness for diarrhea but should be used cautiously with antibiotics 1