Antibiotic-associated diarrhea: Difference between revisions
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==Differential Diagnosis== |
==Differential Diagnosis== |
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*[[Clostridioides difficile]] |
*[[Clostridioides difficile]]-associated diarrhea (10 to 20%) |
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*Other microbes: |
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*Other microbes: [[Clostridium perfringens]] type A (food poisoning), [[Staphylococcus aureus]], [[Salmonella enterica]], and possible [[Candida albicans]] |
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**[[Clostridium perfringens]] type A, weeks after therapy |
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**Methicillin-resistant [[Staphylococcus aureus]] |
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**[[Salmonella species]], particularly drug-resistant [[Salmonella newport]] |
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**Possibly [[Candida albicans]] overgrowth |
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*Direct effects on intestinal tract |
*Direct effects on intestinal tract |
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**[[Erythromycin]] and [[clavulanate]] cause increased motility |
**[[Erythromycin]] and [[clavulanate]] cause increased motility |
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**[[Penicillins]] may rarely cause |
**[[Penicillins]] may rarely cause an acute, hemorrhagic [[segmental colitis]], usually within 4 days of therapy |
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*Effects on the fecal microbiota |
*Effects on the fecal microbiota |
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**Decreased |
**Decreased metabolism of carbohydrates, leading to osmotic diarrhea |
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** |
**Decreased metabolism of primary bile acids, leading to secretory diarrhea |
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*Concomitant use of laxatives, antacids, contrast, lactose- or sorbitol-containing products, NSAIDs, antiarrhythmic drugs, and cholinergic drugs |
*Concomitant use of laxatives, antacids, contrast, lactose- or sorbitol-containing products, NSAIDs, antiarrhythmic drugs, and cholinergic drugs |
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== Management == |
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* Treat the underlying cause |
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== Prevention == |
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* Research has mostly focussed on the use of probiotics to prevent antibiotic-associated diarrhea |
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* A systematic review has shown that probiotics decrease antibiotic-associated diarrhea from 18% to 8%[[CiteRef::blaabjerg2017pr]] |
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** No harms found, except rare bacteremia in severely immunocompromised patients or those with active Crohn disease |
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** [[Lactobacillus rhamnosus]] and [[Saccharomyces boulardii]] appear to be more effective than [[Lactobacillus acidophilus]] plus [[Bifidobacterium animalis lactis]] |
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== Further Reading == |
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* Mechanisms and Management of Antibiotic-Associated Diarrhea. ''Clin Infect Dis''. 1998;27(4):702-710. doi: [https://doi.org/10.1086/514958 10.1086/514958] |
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[[Category:Adverse drug reactions]] |
[[Category:Adverse drug reactions]] |
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Revision as of 18:28, 17 September 2020
Differential Diagnosis
- Clostridioides difficile-associated diarrhea (10 to 20%)
- Other microbes:
- Clostridium perfringens type A, weeks after therapy
- Methicillin-resistant Staphylococcus aureus
- Salmonella species, particularly drug-resistant Salmonella newport
- Possibly Candida albicans overgrowth
- Direct effects on intestinal tract
- Erythromycin and clavulanate cause increased motility
- Penicillins may rarely cause an acute, hemorrhagic segmental colitis, usually within 4 days of therapy
- Effects on the fecal microbiota
- Decreased metabolism of carbohydrates, leading to osmotic diarrhea
- Decreased metabolism of primary bile acids, leading to secretory diarrhea
- Concomitant use of laxatives, antacids, contrast, lactose- or sorbitol-containing products, NSAIDs, antiarrhythmic drugs, and cholinergic drugs
Management
- Treat the underlying cause
Prevention
- Research has mostly focussed on the use of probiotics to prevent antibiotic-associated diarrhea
- A systematic review has shown that probiotics decrease antibiotic-associated diarrhea from 18% to 8%1
- No harms found, except rare bacteremia in severely immunocompromised patients or those with active Crohn disease
- Lactobacillus rhamnosus and Saccharomyces boulardii appear to be more effective than Lactobacillus acidophilus plus Bifidobacterium animalis lactis
Further Reading
- Mechanisms and Management of Antibiotic-Associated Diarrhea. Clin Infect Dis. 1998;27(4):702-710. doi: 10.1086/514958
References
- ^ Sara Blaabjerg, Daniel Artzi, Rune Aabenhus. Probiotics for the Prevention of Antibiotic-Associated Diarrhea in Outpatients—A Systematic Review and Meta-Analysis. Antibiotics. 2017;6(4):21. doi:10.3390/antibiotics6040021.
