What is Augmentin and Why Is It Prescribed?
Augmentin is a widely used combination antibiotic containing amoxicillin and clavulanate [1.9.3]. Amoxicillin belongs to the penicillin class of antibiotics and works by stopping the growth of bacteria. However, some bacteria produce an enzyme called beta-lactamase, which can render amoxicillin ineffective. This is where clavulanate (or clavulanic acid) comes in. Clavulanate is a beta-lactamase inhibitor; it blocks the enzyme, allowing the amoxicillin to effectively kill the bacteria [1.9.3, 1.9.4]. This combination makes Augmentin a broad-spectrum antibiotic, effective against a wider range of bacterial infections, including those that are resistant to amoxicillin alone. It is often prescribed for more severe infections like sinusitis, pneumonia, and urinary tract infections [1.3.3, 1.9.4].
The Link Between Augmentin and Diarrhea
The short answer is yes, Augmentin frequently causes diarrhea. In fact, it is known to cause more diarrhea than amoxicillin alone [1.2.1]. The incidence rate can vary significantly depending on the dosage, ranging from as low as 3% to as high as 34% of patients [1.2.1, 1.2.2].
There are two primary reasons for this side effect:
- Disruption of Gut Flora: Like all broad-spectrum antibiotics, Augmentin is not selective. While it targets the harmful bacteria causing an infection, it also eliminates many of the beneficial bacteria that reside in your gut [1.7.1]. This disruption to the natural gut microbiome can interfere with normal digestion and lead to loose, watery stools [1.3.1].
- The Role of Clavulanate: The clavulanate component itself is a major contributor. It can speed up how quickly the gut moves, a process known as gut motility [1.3.1, 1.7.1]. This accelerated movement means less water is absorbed from the stool, resulting in diarrhea. The effect is often dose-dependent, with higher doses of clavulanate being associated with a higher incidence of diarrhea [1.2.1, 1.5.2]. Different formulations, such as the extended-release (ER) version, are also thought to cause diarrhea more often than the immediate-release (IR) version [1.5.2].
Managing and Preventing Augmentin-Associated Diarrhea
While bothersome, mild diarrhea from Augmentin can often be managed with simple strategies. It's crucial to complete your full course of antibiotics, as stopping early can lead to antibiotic resistance [1.3.4].
Dietary Adjustments
To ease digestive distress, it's recommended to take Augmentin with a meal or a snack [1.5.1, 1.5.2]. Adopting a bland diet can also be beneficial. The "BRAT" diet, consisting of bananas, rice (white), applesauce, and toast, is often suggested because these foods are low in fiber and can help firm up the stool [1.4.4, 1.4.5]. It's also wise to avoid spicy, greasy, or high-fiber foods, as well as caffeine and alcohol, which can further irritate the gut [1.4.3, 1.4.5]. Staying hydrated by drinking plenty of fluids like water, broth, or electrolyte drinks is essential to replace fluids lost through diarrhea [1.3.5, 1.4.5].
The Role of Probiotics
Taking probiotics is one of the most effective strategies for preventing or reducing the severity of antibiotic-associated diarrhea [1.4.1, 1.10.2]. Probiotics are beneficial live bacteria and yeasts that help restore the natural balance of your gut microbiome [1.4.2]. Studies have shown that taking probiotics can significantly lower the risk of developing diarrhea while on antibiotics [1.10.2].
- Which strains are best?: Research points to Lactobacillus rhamnosus GG (LGG) and the yeast Saccharomyces boulardii as being particularly effective [1.6.1, 1.6.3, 1.6.4].
- When to take them?: To ensure the antibiotic doesn't kill the probiotic, it's generally recommended to take the probiotic at least 2 hours apart from your Augmentin dose [1.6.1, 1.10.3]. You can also continue taking them for a few weeks after finishing your antibiotic course to help your gut flora recover fully [1.4.5, 1.6.2].
- Food sources: Probiotic-rich foods like yogurt with live active cultures, kefir, and other fermented foods can also be beneficial [1.4.5, 1.10.4].
| Management Strategy | Description |
|---|---|
| Take with Food | Taking Augmentin with a meal or snack helps reduce stomach upset [1.5.2]. |
| Bland Diet (BRAT) | Eating bananas, rice, applesauce, and toast can help make stools firmer [1.4.4]. |
| Hydration | Drink plenty of water, broth, or electrolyte solutions to prevent dehydration [1.3.5]. |
| Probiotics | Supplements like Lactobacillus rhamnosus GG or Saccharomyces boulardii can restore gut bacteria [1.6.1, 1.6.4]. |
| Avoid Irritants | Steer clear of spicy foods, greasy foods, caffeine, and alcohol [1.4.5]. |
A More Serious Concern: Clostridioides difficile (C. diff)
In some cases, antibiotic use can lead to a more severe form of diarrhea caused by an overgrowth of the bacterium Clostridioides difficile (C. diff) [1.3.1, 1.5.5]. When antibiotics wipe out protective gut bacteria, C. diff can multiply and release toxins that damage the colon, leading to a condition called pseudomembranous colitis [1.2.2, 1.3.2]. Augmentin is one of the antibiotics that has been associated with an increased risk of C. diff infection [1.8.1, 1.8.3].
Symptoms of a C. diff infection are more severe than typical antibiotic-associated diarrhea and include:
- Severe, watery diarrhea (often 10 or more times a day) [1.11.3]
- Abdominal cramping and pain [1.5.5, 1.11.3]
- Fever [1.11.2]
- Blood or pus in the stool [1.11.3]
- Nausea and loss of appetite [1.11.1]
This condition can occur during or even up to two months after finishing antibiotic treatment [1.3.2, 1.5.4]. If you experience these severe symptoms, it is crucial to contact your healthcare provider immediately [1.11.2, 1.11.4].
Conclusion
Diarrhea is a very common and expected side effect of taking Augmentin, largely due to its impact on gut flora and the specific action of its clavulanate component [1.2.1, 1.3.1]. For most people, this side effect is mild and manageable by taking the medication with food, adjusting diet, staying hydrated, and using probiotics [1.4.1, 1.4.4]. However, it is essential to monitor your symptoms. If diarrhea is severe, accompanied by fever, abdominal pain, or blood in the stool, you should seek immediate medical attention to rule out a more serious C. diff infection [1.11.2, 1.11.3]. Always consult with your doctor or pharmacist before starting or stopping any medications or supplements to manage side effects.
