Should amoxicillin (amoxicillin) be stopped in a child who develops a severe upset stomach while taking it?

Should Amoxicillin Be Stopped for Upset Stomach in Children?

No, amoxicillin should not be routinely stopped for mild to moderate gastrointestinal upset in children, as this is a common and expected side effect that does not indicate a serious adverse reaction. 1, 2

Understanding Gastrointestinal Side Effects

Gastrointestinal symptoms are the most common adverse events associated with amoxicillin therapy in children:

• Diarrhea occurs in approximately 15-25% of children taking amoxicillin or amoxicillin-clavulanate, with higher rates seen with the clavulanate combination 1
• Diaper dermatitis affects 35-51% of young children on amoxicillin therapy 1
• These symptoms are generally self-limited and do not require discontinuation of the antibiotic 1, 3

When to Continue Treatment

The antibiotic should be continued in most cases because:

• Mild gastrointestinal upset does not compromise treatment efficacy and resolves spontaneously 3
• Premature discontinuation occurs in approximately 64% of children with antibiotic-associated diarrhea, potentially leading to treatment failure 3
• Antibiotic-associated diarrhea typically begins around day 2-3 of therapy and lasts 2-3 days, often resolving even while continuing the medication 3

When to Consider Stopping

Discontinue amoxicillin immediately if the child develops:

• Severe, persistent vomiting with inability to retain oral medications 4
• Signs of drug-induced enterocolitis syndrome (vomiting, abdominal pain, and intense pallor occurring 2 hours after ingestion) 4
• Bloody diarrhea or signs of pseudomembranous colitis 2
• Severe allergic reactions (rash, angioedema, anaphylaxis) 2
• Signs of crystalluria or renal impairment (oliguria, flank pain) 2

Management Strategies Without Stopping

For mild to moderate upset stomach, implement supportive measures:

• Administer probiotics (lactobacilli) concurrently with amoxicillin to reduce gastrointestinal symptoms and stool frequency 5
• Give the medication with food to minimize gastric irritation (though this is not explicitly required for amoxicillin)
• Ensure adequate hydration to prevent dehydration from diarrhea 2
• Use antiemetics (ondansetron) if vomiting is severe and interfering with oral intake 4, 6

Critical Clinical Distinction

The key distinction is between common gastrointestinal side effects versus true drug-induced enterocolitis syndrome:

• Common side effects present as mild diarrhea or loose stools without systemic symptoms 3
• Drug-induced enterocolitis presents with acute vomiting, severe abdominal pain, and pallor 1-4 hours after ingestion, requiring immediate discontinuation and supportive care with ondansetron and fluid resuscitation (not epinephrine) 4

Important Caveats

Amoxicillin-clavulanate has a higher incidence of gastrointestinal side effects (16.7%) compared to amoxicillin alone (6.9%), though this difference was not statistically significant in pediatric studies 3. If gastrointestinal symptoms are particularly troublesome and the clavulanate component is not essential for the infection being treated, consider switching to amoxicillin monotherapy rather than stopping antibiotics entirely.

In case of overdosage presenting with severe gastrointestinal symptoms, discontinue amoxicillin, treat symptomatically, and maintain adequate fluid intake and diuresis to reduce the risk of crystalluria 2.