Augmentin (amoxicillin/clavulanate) is associated with higher gastrointestinal side effect rates compared to amoxicillin alone, primarily due to the clavulanic acid component. Diarrhea occurs in approximately 19.8% of patients receiving amoxicillin/clavulanate versus 8.1% with amoxicillin alone. Augmentin is currently the most common cause of drug-induced liver disease in the United States and Europe, though hepatotoxicity remains rare in pediatric populations. Most side effects are mild and self-limiting.
Diarrhea is the most common adverse reaction, occurring in 9-19.8% of pediatric patients depending on formulation and dosing. The clavulanic acid component increases GI intolerance compared to amoxicillin alone. Every 12-hour dosing is associated with less diarrhea than every 8-hour dosing. Management: Give with food to reduce stomach upset, maintain hydration, and consider probiotics (L. rhamnosus GG or S. boulardii at 5-40 billion CFU/day) for prevention. Monitoring: Watch for severe, persistent, or bloody diarrhea which may indicate C. difficile-associated colitis.
Augmentin is the leading cause of drug-induced liver injury globally, with hundreds of documented cases. Most cases present as cholestatic injury occurring 1-6 weeks after treatment initiation, though mixed hepatocellular patterns can occur. Pediatric cases are less common but documented. Management: Monitor liver function in high-risk patients or with prolonged therapy. Discontinue immediately if jaundice or liver injury signs develop. Monitoring: Watch for jaundice, dark urine, right upper quadrant pain, unusual fatigue, or pale stools.
A rare but serious non-IgE mediated reaction characterized by protracted vomiting 1-4 hours after ingestion, occurring primarily in pediatric patients ≤18 years. Unlike typical allergic reactions, DIES lacks skin or respiratory symptoms. Can lead to severe dehydration and requires immediate medical attention. Management: Discontinue medication immediately, provide supportive care for dehydration, and avoid re-exposure. Monitoring: Report persistent vomiting, especially without other allergic symptoms, particularly in young children.
Brown, yellow, or gray tooth staining can occur, primarily in pediatric patients during tooth development. Usually superficial and can be reduced with proper dental hygiene. Thrush (oral candidiasis) may also develop. Management: Maintain excellent oral hygiene, brush teeth after doses when possible, regular dental cleaning can eliminate most discoloration. Consider antifungal treatment for thrush. Monitoring: Watch for persistent tooth staining or white patches in mouth indicating fungal overgrowth.
The 250mg tablet should not be used in children weighing <40kg due to excessive clavulanic acid content leading to increased diarrhea risk. Drug interactions include reduced effectiveness with antacids and potential interactions with anticoagulants. Management: Use appropriate pediatric formulations, separate antacids by 2+ hours, monitor INR if on warfarin. Monitoring: Ensure proper weight-based dosing and watch for signs of reduced effectiveness or increased bleeding if on anticoagulants.
Augmentin side effects are primarily gastrointestinal (diarrhea 9-19.8%), with hepatotoxicity being the most serious concern despite its rarity. Pediatric-specific issues include DIES (protracted vomiting), tooth discoloration, and the importance of weight-appropriate formulations. The clavulanic acid component is responsible for both increased efficacy and higher side effect rates compared to amoxicillin alone.
3 documented effects
Usually resolves within days of treatment completion
Give with food; maintain hydration; consider probiotics (L. rhamnosus GG or S. boulardii 5-40 billion CFU/day); every 12-hour dosing preferred over 8-hour
Report severe, bloody, or persistent diarrhea >3 days; watch for signs of dehydration or C. difficile infection
Self-limited; usually resolves between doses
Take with food to reduce stomach upset; ensure adequate fluid intake; consider dose timing adjustments
Report persistent vomiting preventing oral intake or signs of dehydration
Can persist for hours; requires immediate intervention
Discontinue medication immediately; supportive care for dehydration; avoid re-exposure; consider alternative antibiotics
Watch for protracted vomiting without skin or respiratory symptoms; seek emergency care for severe dehydration
1 documented effect
Variable; most recover but some develop chronic injury
Monitor liver function in high-risk patients; discontinue immediately if liver injury suspected; supportive care
Watch for jaundice, dark urine, right upper quadrant pain, unusual fatigue, pale stools
2 documented effects
Usually resolves after discontinuation
Discontinue if severe; antihistamines for mild reactions; topical steroids per provider guidance
Watch for widespread rash, fever, blistering, or signs of severe allergic reaction
Usually resolves after treatment completion
Frequent diaper changes; barrier creams; antifungal treatment if candidal infection suspected
Watch for severe, persistent, or spreading rash; report signs of secondary infection
2 documented effects
Usually reversible with dental cleaning
Maintain excellent oral hygiene; brush teeth after medication when possible; professional dental cleaning
Monitor for brown, yellow, or gray tooth staining; ensure proper dental hygiene
May persist after antibiotic completion
Antifungal medication (nystatin or fluconazole); maintain oral hygiene; probiotics may help prevent
Watch for white patches in mouth, soreness, or difficulty swallowing
1 documented effect
May require specific antifungal treatment
Antifungal medication; maintain hygiene; consider probiotics for prevention
Report unusual discharge, itching, or discomfort
Age under 40kg (increased diarrhea risk with 250mg tablets due to excessive clavulanic acid)
History of hepatic impairment or previous drug-induced liver injury
Prolonged treatment courses (increased hepatotoxicity risk)
Elderly patients (increased risk of jaundice and hepatotoxicity)
Previous penicillin or cephalosporin allergy
History of antibiotic-associated colitis or C. difficile infection
Use probiotics (L. rhamnosus GG or S. boulardii at 5-40 billion CFU/day) to prevent diarrhea; give with food to reduce GI upset; use appropriate weight-based formulations; maintain excellent oral hygiene; complete full course even if symptoms improve; monitor liver function if risk factors present
📞 Call your pediatrician immediately if you notice any of these symptoms:
Signs of liver injury (jaundice, dark urine, right upper quadrant pain, unusual fatigue)
Severe or bloody diarrhea with fever or cramping
Protracted vomiting 1-4 hours after medication (especially in children)
Signs of serious allergic reaction (widespread rash, difficulty breathing, swelling)
Severe dehydration from vomiting or diarrhea
Persistent tooth staining or oral thrush
Unusual bleeding or bruising (if on anticoagulants)
| Effect | Augmentin | Amoxicillin |
|---|---|---|
| Diarrhea | 19.8% (combination) | 8.1% (amoxicillin alone) |
| Hepatotoxicity | Leading cause of drug-induced liver injury | Rare/minimal hepatotoxicity |
| GI tolerance | Higher GI side effects due to clavulanic acid | Better GI tolerance |
May reduce absorption of amoxicillin/clavulanate; separate by 2+ hours
May enhance anticoagulant effect; monitor INR closely
May reduce effectiveness; recommend backup contraception
Increases amoxicillin levels; may increase side effect risk
May reduce vaccine effectiveness; complete antibiotic course before vaccination
Your baby's tummy might get upset from Augmentin - this happens to about 1 in 5 babies. Give the medicine with their feeding to help. Watch for loose stools or diaper rash. If baby has yellow skin or eyes, call us right away.
Augmentin might give your toddler loose poops or tummy aches. This is normal and usually gets better. Give it with food to help their tummy. If they throw up a lot (especially 1-4 hours after taking it) or their skin turns yellow, call the doctor immediately.
Augmentin can cause diarrhea in about 2 out of 10 kids. Taking it with meals helps. Probiotics (special helpful bacteria) can prevent tummy troubles. Tell us right away if you see yellow skin/eyes, dark pee, or if your child throws up repeatedly after taking the medicine.
Augmentin causes diarrhea in up to 20% of patients due to the clavulanic acid component. Take with food and consider probiotics. Watch for signs of liver problems: yellowing of skin/eyes, dark urine, unusual fatigue, or right-sided stomach pain. Report persistent vomiting 1-4 hours after doses.
A: Give Augmentin with meals to reduce stomach upset. Ask about probiotics - studies show Lactobacillus rhamnosus GG or Saccharomyces boulardii (5-40 billion CFU/day) can reduce diarrhea risk by up to 64%. Use the every-12-hour dosing when possible, as it causes less diarrhea than every-8-hour dosing.
When to validate: Call immediately if diarrhea is severe, bloody, or lasts more than 3 days, or if your child shows signs of dehydration (dry mouth, no tears, decreased urination).
A: While rare in children, Augmentin can affect the liver. Watch for: yellowing of skin or whites of eyes (jaundice), dark brown urine, pale or clay-colored stools, unusual tiredness, loss of appetite, or pain in the upper right belly. These symptoms can appear during treatment or up to 6 weeks after stopping.
When to validate: Contact us immediately if you notice any yellowing of skin/eyes or dark urine. These require urgent evaluation as Augmentin is the most common antibiotic cause of liver problems.
A: If vomiting occurs 1-4 hours after the dose without rash or breathing problems, this might be DIES (Drug-Induced Enterocolitis Syndrome), not an allergy. It's rare but serious and mainly affects children. Unlike allergies, there's no rash or swelling, just severe vomiting that can cause dehydration.
When to validate: Seek immediate medical attention for persistent vomiting 1-4 hours after doses, especially if your child becomes dehydrated. Do not give another dose - this reaction means your child cannot take Augmentin.
A: The clavulanic acid in Augmentin makes it work against more bacteria, but it also causes more diarrhea - about 20% of children versus 8% with amoxicillin alone. Your doctor prescribed Augmentin because your child's infection needs the extra power. The diarrhea usually improves after treatment ends.
When to validate: Most diarrhea is mild and manageable. Call if stools are bloody, your child has severe cramping or fever, or if diarrhea persists more than 3 days after finishing the antibiotic.
Evidence-based clinical assessment framework for Augmentin adverse effects with hepatotoxicity monitoring and ratio-based dosing decisions.
Parent and clinician concerns about Augmentin