What is the cause of persistent ear and throat pain in a 49-year-old male after completing a 10-day course of Augmentin (amoxicillin-clavulanate) 875-125, started on April 8, 2025?

From the Guidelines

The patient should be evaluated for persistent symptoms despite completing a course of Augmentin, and I recommend scheduling an in-person assessment to determine the underlying cause of the ongoing ear and throat pain. Given the patient's symptoms have persisted despite a 10-day course of Augmentin, it's crucial to reassess the diagnosis and consider alternative causes or the possibility of treatment failure. The patient may need additional diagnostic tests like a throat culture or tympanometry to guide further treatment. Options may include switching to a different antibiotic, such as Cefdinir 300mg twice daily for 10 days or Levofloxacin 750mg daily for 5-7 days, depending on examination findings and the results of any diagnostic tests 1. Pain management with acetaminophen or ibuprofen can be continued while addressing the underlying cause, as these medications can help alleviate symptoms without contributing to antibiotic resistance 1. If symptoms are severe or include new findings like difficulty swallowing, breathing issues, or spreading redness, urgent evaluation is warranted to rule out complications such as abscess formation or other serious conditions 1. It's also important to consider the possibility of a viral etiology, in which case antibiotics would not be effective, and supportive care would be the mainstay of treatment 1. Given the complexity of the case and the potential for various underlying causes, a thorough evaluation and potentially a consultation with a specialist may be necessary to determine the best course of action 1.

From the FDA Drug Label

1. Adverse Reactions The most frequently reported adverse reactions were diarrhea/loose stools (9%), nausea (3%), skin rashes and urticaria (3%), vomiting (1%) and vaginitis (1%). Other less frequently reported adverse reactions (<1%) include: Abdominal discomfort, flatulence, and headache.

The patient's complaints of ear and throat pain are not directly addressed in the adverse reactions section of the drug label for amoxicillin-clavulanate. Key points:

• The drug label does not provide information on the effectiveness of the treatment for ear and throat pain.
• The patient has completed the 10-day course of Augmentin 875-125, and the persistence of symptoms may indicate a need for further evaluation or alternative treatment. 2

From the Research

Patient's Condition

The patient, a 49-year-old male, started taking Augmentin 875-125 on 4.8.2025 for 10 days but is still complaining of ear and throat pain.

Relevant Studies

• The study 3 discusses infections of the ear, including diagnostic and treatment options, but does not provide specific information on the effectiveness of Augmentin for ear and throat pain.
• The study 4 compares the effectiveness of amoxicillin/clavulanate (Augmentin) and azithromycin for the treatment of bacterial acute otitis media in children, finding that amoxicillin/clavulanate is more effective in eradicating pathogens.
• The study 5 compares the efficacy and safety of azithromycin and amoxicillin/clavulanate for the treatment of otitis media in children, finding that azithromycin is comparable to amoxicillin/clavulanate and has fewer adverse events.
• The study 6 compares the effectiveness of azithromycin extended release and amoxicillin/clavulanate for the treatment of acute sinusitis, finding that more patients experienced symptom resolution at day 5 with azithromycin extended release.
• The study 7 discusses the properties, indications, and usage of oral amoxicillin and amoxicillin-clavulanic acid, providing guidance on their use and emphasizing the preferred use of amoxicillin alone.

Possible Causes of Persistent Symptoms

• The patient's persistent ear and throat pain may be due to various factors, including:
  • Inadequate treatment of the underlying infection
  • Resistance to the antibiotic
  • Presence of a viral infection that is not responsive to antibiotics
  • Other underlying conditions that need to be addressed

Next Steps

• Further evaluation and assessment are needed to determine the cause of the patient's persistent symptoms and to guide further treatment.
• The patient's treatment plan may need to be adjusted based on the results of further evaluation and assessment.