Antibiotic-associated diarrhea
{{See also|Pseudomembranous colitis}}
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Antibiotic-associated diarrhea (AAD) results from an imbalance in the colonic microbiota caused by antibiotics. Microbiotal alteration changes carbohydrate metabolism with decreased short-chain fatty acid absorption and an osmotic diarrhea as a result. Another consequence of antibiotic therapy leading to diarrhea is an overgrowth of potentially pathogenic organisms such as Clostridioides difficile. It is defined as frequent loose and watery stools with no other complications.{{cite book|title=Harwood-Nuss' Clinical Practice of Emergency Medicine|editor=Allan B. Wolfson|year=2005|edition=4th|page=400|isbn=0-7817-5125-X}}
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Cause
Clostridioides difficile, also known more commonly as C. diff, accounts for 10 to 20% of antibiotic-associated diarrhea cases, because the antibiotics administered for the treatment of certain disease processes such as inflammatory colitis also inadvertently kill a large portion of the gut flora, the normal flora that is usually present within the bowel. With this lower level of "healthy" bacteria present, the overgrowth of C. diff is then responsible "for elaborating the enterotoxin".
Treatment
Meta-analyses have concluded that probiotics may protect against antibiotic-associated diarrhea in both children and adults.{{cite journal|last=Hempel|first=S|author2=Newberry, SJ|author3=Maher, AR|author4=Wang, Z|author5=Miles, JN|author6=Shanman, R|author7=Johnsen, B|author8= Shekelle, PG|title=Probiotics for the prevention and treatment of antibiotic-associated diarrhea: a systematic review and meta-analysis |journal=JAMA: The Journal of the American Medical Association|date=May 9, 2012|volume=307|issue=18|pages=1959–69|pmid=22570464|doi=10.1001/jama.2012.3507|doi-access=}}{{cite journal |pmid=31039287 | doi=10.1002/14651858.CD004827.pub5 | volume=4 | title=Probiotics for the prevention of pediatric antibiotic-associated diarrhea | pmc=6490796 | year=2019 | author=Guo Q, Goldenberg JZ, Humphrey C, El Dib R, Johnston BC | journal=Cochrane Database Syst Rev | issue=4 | page=CD004827}} Evidence is insufficient, however, regarding an effect on rates of C. difficile colitis.{{cite journal|last=Pillai|first=A|author2=Nelson, R|title=Probiotics for treatment of Clostridium difficile-associated colitis in adults |journal=Cochrane Database of Systematic Reviews|date=January 23, 2008|issue=1|pages=CD004611|pmid=18254055|doi=10.1002/14651858.CD004611.pub2}}
The efficacy of probiotic AAD prevention is dependent on the probiotic strain(s) used and on the dosage.{{Cite journal | last1 = Doron | first1 = S. I. | last2 = Hibberd | first2 = P. L. | last3 = Gorbach | first3 = S. L. | author-link3=Sherwood Gorbach |title = Probiotics for Prevention of Antibiotic-associated Diarrhea | doi = 10.1097/MCG.0b013e3181618ab7 | journal = Journal of Clinical Gastroenterology | volume = 42 | pages = S58–S63 | year = 2008 | pmid = 18542041 | s2cid = 2070623 }}{{Cite journal | last1 = Surawicz | first1 = C. M. | doi = 10.1097/MCG.0b013e3181646d09 | title = Role of Probiotics in Antibiotic-associated Diarrhea, Clostridium difficile-associated Diarrhea, and Recurrent Clostridium difficile-associated Diarrhea | journal = Journal of Clinical Gastroenterology | volume = 42 | pages = S64–S70 | year = 2008 | pmid = 18545161 | s2cid = 37993276 }} Up to a 50% reduction of AAD occurrences has been found.{{cite journal|last=Sazawal|first=S|author2=Hiremath, G|author3= Dhingra, U|author4= Malik, P|author5= Deb, S|author6= Black, RE|title=Efficacy of probiotics in prevention of acute diarrhoea: a meta-analysis of masked, randomised, placebo-controlled trials |journal=The Lancet Infectious Diseases|date=June 2006|volume=6|issue=6|pages=374–82|pmid=16728323|doi=10.1016/S1473-3099(06)70495-9}}
References
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{{Gastroenterology}}
{{Digestive system and abdomen symptoms and signs}}