Diarrhea antimicrobial therapy

Adachi JA, Ostrosky-Zeichner L, DuPont HL, Ericsson CD Empirical antimicrobial therapy for traveler s diarrhea. Clin Infect Dis 2000 31 1079-1083. 

Children are also susceptible to opportunistic infection, notably Y. enterocolitica sepsis (142). In 10 children receiving intravenous deferoxamine (25 mg/kg) there were unexpected infections in four three had episodes of fever and S. aureus in blood cultures, and one had Y. enterocolitica sepsis (128). Because of the possibility of septicemic dissemination secondary to digestive Y. enterocolitica infection, the occurrence of febrile diarrhea in a child with thalassemia is a reason for immediate withdrawal of deferoxamine and the administration of antimicrobial therapy (co-trimoxazole) (142). 

It is difficult to identify who wiU benefit from antimicrobial therapy. With or without treatment, about 60% of children who have acute otitis media are symptom-free within 24 hours. In almost 40% of the remaining children, antibiotic use reduces the duration of symptoms by about 1 day. A trial of 315 children (6 months to 10 years of age) compared immediate antibiotic treatment with a 72-hour delay in treatment that was to be given only if the child had not improved. Symptoms continued for 1 extra day in 10% to 20% of the delayed-therapy group, but 10% fewer also experienced diarrhea. At 3 days, there was no difference in symptoms. In the delayed-therapy group, only 24% of children evenmally received antibiotics, and 77% of parents reported being satisfied with this approach. ... 

For patients who develop diarrhea after 3 days of hospitalization, 15% to 20% of cases are due to C. difficile.This suggests that in hospitalized patients, especially in those who are exposed to antimicrobial therapy or chemotherapy, the stool specimen should be tested for C. difficile toxin(s). In immunocompromised hosts, a wide range of viral, bacterial, and parasitic agents should be tested. 

Viral or bacterial-induced diarrhea is usually transient and requires only a clear liquid diet and increased fluid intake. Antimicrobial therapy may be indicated by the presence of blood in the stool or fecal leukocytes. Intravenous fluids may be required if dehydration occurs. 

DuPont HL, Ericsson CD, Reves RR, Galindo E. Antimicrobial therapy for travelers diarrhea. Rev InfectDis ( 9S6) 8, (Suppl 2), S217-S222. 

Diarrhea is a common side effect of the administration of antimicrobial therapy such as antibiotic administration. While some bacteria are undoubtedly killed during the process, during long term or regular... 

As with all drugs, the specific side effects of the quinolones must be considered when they are chosen for treatment of bacterial infections [5]. Reactions of the gastrointestinal tract and the central neivous system are the most often observed adverse effects during therapy with quinolones. It should be underlined, however, that compared with many other antimicrobials, diarrhea is less frequently observed during quinolone treatment. Antibiotic-associated colitis has been observed rarely during quinolone therapy. Similarly, hypersensitivity reactions, as observed during therapy with penicillins and other (3-lactams, is less frequently caused by quinolones. Some other risks of quinolone therapy have been defined and must be considered if a drug from this class is chosen for treatment of bacterial infections. 

Nosocomial Clostridium difficile-associated diarrhea (CDAD) is almost always associated with antimicrobial use therefore, we should avoid unnecessary and inappropriate antibiotic therapy. Almost all antibiotics except aminoglycosides have been associated with CDAD. 

DuPont HL, Ericsson CD, Mathewson JJ, Palazzini E, DuPont MW, Jiang ZD, Mosavi A, de la Cabada FJ Rifaximin A nonab-sorbed antimicrobial in the therapy of travelers diarrhea. Digestion 1998 59 708-714. 

Diarrhea is a well-known complication of antibiotic therapy. Rates of antibiotic-associated diarrhea (AAD) vary from 5 to 25%. Some antibiotics are more likely to cause diarrhea than others, specifically, those that are broad spectrum and those that target anaerobic flora. This paper reviews the effects of antibiotics on the fecal flora as well as host factors which contribute to AAD. Clinical features and treatment of AAD are also described. Prevention of AAD rests on wise antibiotic policies, the use of probiotics and prevention of acquisition in the hospital setting. Data from clinical trials suggest that poorly absorbed antimicrobials might have a decreased risk of causing AAD and Clostridium difficile-associated disease, as concluded from studies of antibiotics used for preoperative bowel decontamination and poorly absorbed antibiotics used for traveler s diarrhea. Controlled trials would prove this but are not yet available. Probiotics may be a good adjunct to poorly absorbed antibiotics to minimize the risk of diarrhea associated with antibiotics. 

The most common drug-related adverse experiences in patients treated with ertapenem, including those who were switched to therapy with an oral antimicrobial, were diarrhea, infused vein complication, nausea, headache, vaginitis, phlebitis/thrombophlebitis, and vomiting. 

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