From the Guidelines
The change from yellowish to whitish discharge after antibiotic treatment typically indicates improvement in the infection, suggesting that the bacterial infection is being effectively managed by the antibiotics. When a patient presents with an initial yellowish discharge that turns whitish after antibiotic treatment, it is essential to consider the guidelines for acute bacterial rhinosinusitis (ABRS) and acute rhinosinusitis (ARS) 1. The yellowish discharge often suggests a bacterial infection, and the change to whitish discharge after antibiotic treatment may indicate a reduction in the bacterial load and a decrease in inflammatory cells. According to the clinical practice guideline for adult sinusitis 1, clinicians should distinguish presumed ABRS from ARS caused by viral upper respiratory infections and noninfectious conditions, and diagnose ABRS when symptoms or signs of ARS persist without evidence of improvement for at least 10 days beyond the onset of upper respiratory symptoms. Key points to consider in the management of ABRS include:
- Clinicians should either offer watchful waiting or prescribe initial antibiotic therapy for adults with uncomplicated ABRS 1.
- If a decision is made to treat ABRS with an antibiotic agent, the clinician should prescribe amoxicillin with or without clavulanate as first-line therapy for 5 to 10 days for most adults 1.
- If the patient worsens or fails to improve with the initial management option by 7 days after diagnosis, the clinician should reassess the patient to confirm ABRS, exclude other causes of illness, and detect complications 1. It is crucial to complete the full antibiotic course, even if symptoms improve, to ensure that the infection is fully cleared and to reduce the risk of antibiotic resistance. If the discharge persists or changes character, it is essential to follow up with a healthcare provider to assess for treatment failure or reinfection.
From the FDA Drug Label
Onset of pseudomembranous colitis symptoms may occur during or after antibiotic treatment.
The cause of an initial yellowish discharge that turns whitish after antibiotic treatment may be related to pseudomembranous colitis, which can occur during or after antibiotic treatment.
- Pseudomembranous colitis is a potential side effect of amoxicillin-clavulanate treatment.
- The discharge may be a symptom of this condition, but the exact cause of the color change is not explicitly stated in the drug label 2.
From the Research
Cause of Initial Yellowish Discharge
- The initial yellowish discharge may be caused by a bacterial infection, such as those caused by Staphylococcus aureus or Streptococcus pyogenes 3.
- The discharge may also be a result of other infections, such as Actinomyces, which can cause abscesses and sinus tracts 4.
Effect of Antibiotic Treatment on Discharge
- Antibiotic treatment, such as amoxicillin-clavulanate, can effectively treat bacterial infections and reduce the discharge 5, 6, 7, 4.
- The change in color of the discharge from yellowish to whitish after antibiotic treatment may indicate a reduction in the bacterial load and inflammation 5, 6, 7, 4.