Amoxicillin and IBD

I have ulcerative colitis, and a sinus infection. My primary doc called in an amox script for the sinus infection, and I have been taking it as directed. I happened to mention it to my gastro doc as part of our regular schedule of communication, and he told me that Amoxicillin, really any of the Penicilin or cephalosporin antibiotic drugs, are the worst kind to take for someone with Crohn’s disease. I didn’t get a chance to correct him and say that I have UC and not Crohn’s, but I am wondering if the same holds true for both diseases.

Note, he did not tell me to stop the meds, and I am not seeking medical advice here, I am just curious about the impact of these drugs on UC. Should I gently remind my PCP doc of this the next time I get a sinus infection?

While I can’t answer the main question, I can answer the last one.

Of course you should remind your doc. If you have any concerns, you should always voice them. The worse that can happen is that the doc will tell you that your concerns are groundless.

There is an precaution listed in the administration of beta-lactam antibiotics in people with UC. The problem is that it makes them even more susceptible to developing Clostridium difficile. In most cases, it would be fine to take it during a short course of treatment, but precautions should be taken during chronic therapy. You can also eating yogurt or taking other pro-biotic with the antibiotic.

Here is the relevent paragraph in Clinical Pharmacology (on Amoxicillin in particular).

I surfed the literature (Micromedex and Scholar) and couldn’t find any associations linking amoxicillin to worse outcomes for ulcerative colitis. Indeed I found one article indicating that patients put on amoxicillin plus clavulinic acid had less inflammation and fewer flare-ups.

However, as noted above by Hirka, one needs to proceed cautiously in prescribing antibiotics for patients with inflammatory bowel disease. They can be quite beneficial at the right time and place, but C. Diff colitis in a patient who already has ulcerative colitis is such a not-good thing.

But who the hell is using amoxicillin for sinus infections anymore, anyway?

And don’t wait until the next time you see your Primary doctor – call the office right now, explain this concern, and ask if you should continue taking the Amoxicillin. They’d much prefer to change your prescription now rather than treat you later for a worsened colitis.

The urgent care place I was at a couple months ago, for one. In fact, Amoxicillin’s been the go-to antibiotic for most of my sinus infections, seems like. is there something as cheap but more targeted that I should ask for?

I love Amoxicillin simply because it’s so cheap. If you don’t have insurance, it’s a life saver. A few years back I had an infected tooth and the dentist gave me some antibiotic that was ourtrageous. I called him back and said, “Isn’t there anything cheaper” and he gave me Amoxicillin. It worked great.

In the future if you’re uncomfortable taking any kind of med tell your doctor. And now is the time, if you feel you cannot talk to your doctor, and some doctors are like that, they are too imtimidating, now is the time to find a new doctor you CAN talk to.

Usually, but not always, there are alternatives when it comes to antibiotics, so don’t be afraid to speak up. Of course depending on your insurance, some of them are very expensive, but at least you’ve taken charge of your own health and YOU made the choice

Sinus infections are vastly overtreated with antibiotics. However, if a sinus infection is confirmed to be likely to be bacterial (by either radiological evidence via a maxillary sinus x-ray, or by bacteriological evidence via a culture of sinus contents), then cephalosporins or macrolide antibiotics are preferred over amoxicillin due to a much lower frequency of side-effects.

However, if a person tolerates amoxicillin all right, it is considered effective for sinus infections meeting the above criteria.

Well I talked it over with my GI doc and he did not tell me to discontinue, so I beleive things to be OK. I did not develop any diarrhea, and I only have one day’s worth left, so I will finish off this course.

Unfortunately, the way this went was, I called the doc’s office, explained I have a sinus infection (my secondary concern, actually) and ongoing tinnitus (a few months now). I wanted to see what the doc had available for appointments, but I guess he is pretty busy and also wanted to clear up the sinus infection before delving deeper into the tinnitus. so I got a call back (from the pharmacy, not the doc) saying he had called in a script…I never got a chance to talk to him. Once I finish off this course, I will call and try to set up an appointment.

I don’t know if it’s irresponsible use of antibiotics or not, but I do know that, untreated, my sinus infections tend to hang on for a long effing time and turn into upper respiratory infections because of all the suppressive effects of the colitis drugs on my immune system. With antibiotics, they will typically mostly clear up within a week to 10 days. I have little kids at my house as well, so if I don’t treat my infection and get it cleared up, the kids will usually pass it back to me and keep me pretty miserable throughout the winter months.

Thank you all for the info, I appreciate it. I have been treated with amoxicillin/augmentin in the past and gotten diarrhea, I had no idea it was bad. Next time I will either ask for zithromax or make sure I eat a lot of yogurt as a preventive.

Heh. The best differential I’ve ever gotten on a sinus infection was this last one, where he wasn’t going to prescribe antibiotics because he wasn’t sure there was an infection, but when I told him I’d already seen some green/yellow mucus (which he warned me to watch for), he wrote it right up.

I’ve had a side-effect from Amoxicillin once, but it has not recurred with subsequent use.

Anecdotally, I have Crohns and recently took a course of Amoxicillin for a chest infection, with no Crohns side effects.

Your mileage may vary of course.