I have a worsening illness with fever 104 °F, vomiting, diarrhea, pleuritic chest pain on cough, ear pain, and non‑tender abdominal discomfort after starting amoxicillin for otitis media; should I seek emergency care?

You need to seek emergency or urgent medical care immediately.

Given your high fever (104°F), persistent vomiting and diarrhea, severe pain with coughing, and worsening symptoms despite starting amoxicillin, you should go to the emergency department or urgent care now. Your clinical picture suggests either a serious complication of your initial infection, a new concurrent illness, or potentially Clostridioides difficile-associated diarrhea (CDAD) from the amoxicillin.

Why You Need Immediate Evaluation

Red Flags in Your Presentation

Your constellation of symptoms raises several urgent concerns:

• Fever of 104°F - This is dangerously high and indicates severe systemic illness
• Severe pain with coughing involving ribs and chest - This suggests possible pneumonia, pleurisy, or other pulmonary complications
• Persistent vomiting and diarrhea - While diarrhea is a common side effect of amoxicillin 1, the severity and combination with high fever and vomiting is concerning
• Worsening despite antibiotics - You started amoxicillin for your ear infection but are getting worse, not better

Potential Serious Complications

Clostridioides difficile infection must be considered. The FDA label for amoxicillin explicitly warns that CDAD can range from mild diarrhea to fatal colitis, and can occur during or after antibacterial treatment 1. Your diarrhea starting after amoxicillin initiation, combined with fever and abdominal pain, fits this pattern.

Suppurative complications of your initial infection are also possible. While antibiotics reduce the risk of complications like mastoiditis, they don't eliminate it - studies show 33-81% of patients with acute mastoiditis had already been on antibiotics 2.

Pneumonia or other respiratory complications could explain your severe chest pain with coughing and high fever.

What to Tell the Emergency Department

When you arrive, make sure to mention:

• You started amoxicillin approximately 2-3 days ago for an ear infection
• Your fever reached 104°F
• You have severe pain when coughing involving your chest and ribs
• You've had vomiting and ongoing diarrhea since starting the antibiotic
• Your symptoms are worsening, not improving

Critical Pitfalls to Avoid

Do not wait to see if symptoms improve on their own. A fever of 104°F combined with your other symptoms requires immediate evaluation. Delaying care could allow a serious infection or CDAD to progress.

Do not assume this is just a side effect of the antibiotic. While amoxicillin commonly causes diarrhea 1, the severity of your presentation - especially with high fever and systemic symptoms - suggests something more serious.

Do not stop the amoxicillin on your own until evaluated by a physician, but do inform them of all your symptoms so they can determine if the antibiotic needs to be changed or discontinued.

What the Emergency Team Will Likely Do

They will need to:

• Assess for dehydration from vomiting and diarrhea
• Evaluate for pneumonia or other pulmonary complications (chest X-ray likely needed)
• Consider testing for C. difficile infection
• Re-examine your ears for progression of infection or complications
• Check for other sources of infection
• Potentially change your antibiotic regimen or provide supportive care

Go now - do not delay seeking care.