Management of Augmentin-Associated Diarrhea and C. difficile Risk
You should contact your prescribing provider immediately to discuss switching antibiotics, as amoxicillin/clavulanate (Augmentin) causes diarrhea in approximately 23% of patients and the risk of C. difficile infection begins during antibiotic therapy and extends through the month following treatment. 1
Understanding Your Current Situation
Diarrhea from Augmentin is Common
- Amoxicillin/clavulanate has one of the highest rates of antibiotic-associated diarrhea among commonly prescribed antibiotics, affecting 18-23% of patients 1, 2
- In pediatric studies, diarrhea typically begins around 5 days after starting the antibiotic and lasts an average of 4 days 2
- The diarrhea you're experiencing is likely due to the clavulanate component disrupting your normal gut bacteria, not necessarily C. difficile infection yet 1, 2
C. difficile Risk Timeline
- The risk of C. difficile infection increases up to sixfold during antibiotic therapy and continues for the entire month after stopping the antibiotic 1
- Even short courses of antibiotics, including single-dose surgical prophylaxis, can increase C. difficile colonization or infection risk 1
- Amoxicillin/clavulanate is specifically listed among penicillins as posing significant C. difficile risk 1
What You Should Do Now
Immediate Action Required
- Contact your prescribing provider today to discuss switching to a different antibiotic 3, 4
- Do not simply stop the antibiotic without medical guidance, as this could lead to treatment failure of your primary infection 3
- If you cannot reach your provider and diarrhea is severe (>3 watery stools daily for 2+ days), seek urgent medical evaluation 2
Safer Alternative Antibiotics
Your provider should consider switching you to antibiotics with lower C. difficile risk, including: 3, 5, 4
- Macrolides (like azithromycin)
- Tetracyclines
- Sulfonamides (like trimethoprim-sulfamethoxazole)
- The specific choice depends on what infection is being treated
Antibiotics to Avoid
Your provider should NOT switch you to these high-risk alternatives: 1, 5, 4
- Clindamycin (highest risk)
- Fluoroquinolones (ciprofloxacin, levofloxacin, moxifloxacin)
- Third-generation cephalosporins
- These carry even higher C. difficile risks than amoxicillin/clavulanate
Warning Signs Requiring Immediate Medical Attention
When to Seek Emergency Care
Contact your provider immediately or go to urgent care if you develop: 3
- More than 10 watery bowel movements per day
- Severe abdominal pain or tenderness
- Fever above 101°F (38.3°C)
- Blood in your stool
- Signs of dehydration (dizziness, decreased urination, extreme thirst)
These Could Indicate C. difficile Infection
If you develop these symptoms, you need testing for C. difficile: 1, 3
- Persistent watery diarrhea (≥3 unformed stools in 24 hours)
- Abdominal cramping
- Fever
- Loss of appetite or nausea
Additional Protective Measures
Medication Review
- If you're taking proton pump inhibitors (omeprazole, pantoprazole, etc.), ask your provider if you can stop them, as they increase C. difficile risk 1, 5, 4
- PPIs are frequently overprescribed and discontinuing them when not essential reduces your infection risk 1
What NOT to Do
- Do not take probiotics to prevent C. difficile - there is insufficient evidence they help, and they can cause harm in certain patients 1, 5, 4
- Do not take anti-diarrheal medications (like loperamide) without discussing with your provider first, as these can worsen C. difficile infection if present 3
Key Clinical Context
Why This Matters
- Longer antibiotic duration increases C. difficile risk: a 10-day course carries 12% more risk than a 7-day course, and a 14-day course carries 27% more risk 6
- The combination of worsening diarrhea with each dose suggests progressive gut flora disruption, which is the primary mechanism leading to C. difficile overgrowth 1, 7
- Early antibiotic switching is safer than continuing a medication causing significant gastrointestinal distress 3, 4
Common Pitfall to Avoid
Many patients and providers wait too long to switch antibiotics, thinking diarrhea is "just a side effect" - but progressive worsening diarrhea increases your risk of developing true C. difficile infection and should prompt immediate antibiotic reassessment 1, 3