Diarrhea antimicrobials

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. 

Okhuysen PC. Current concepts in travelers diarrhea Epidemiology, antimicrobial resistance and treatment. Curr Opin Infect Dis 2005 18 522-526. 

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

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. 

Surawicz CM Antibiotic-associated diarrhea and pseudomembranous colitis Are they less common with poorly absorbed antimicrobials Chemotherapy 2005 51(suppl 1 ) 81—89. 

As proposed in earlier publications, an ideal antimicrobial agent for the treatment of bacterial causes of infectious diarrhea would have the following features [1, 2] (1) excellent activity against a broad range of bacterial enteropathogens (2) nonabsorbable (3) favorable side effect profile (4) efficacious in the treatment of infectious diarrhea (5) major indication is enteric disease, and (6) does not easily develop resistance or promote cross-resistance. 

Finally, while a nonabsorbable antimicrobial agent has theoretic advantages as a choice for the treatment of infectious diarrhea, such an agent should not be used to treat hosts thought to have or be at risk for bacteremic disease (e.g. seriously immunocompromised patients). 

Steffen R Rifaximin A nonabsorbed antimicrobial as a new tool for treatment of travelers diarrhea. J Travel Med 2001 8(suppl 2) S34-S39. 

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. 

Mechanism of Action An antinauseant and antiulcer agent that absorbs water and toxins in the large intestine and forms a protective coating in the intestinal mucosa. Also possesses antisecretory and antimicrobial effects. Therapeutic Effect Prevents diarrhea. Helps treat Helicobacter pybri-associated peptic ulcer disease. 

All sulfonamides, including antimicrobial sulfas, diuretics, diazoxide, and the sulfonylurea hypoglycemic agents, have been considered to be partially cross-allergenic. Flowever, evidence for this is not extensive. The most common adverse effects are fever, skin rashes, exfoliative dermatitis, photosensitivity, urticaria, nausea, vomiting, diarrhea, and difficulties referable to the urinary tract (see below). Stevens-Johnson syndrome, although relatively uncommon (ie, < 1% of treatment courses), is a particularly serious and potentially fatal type of skin and mucous membrane eruption associated with sulfonamide use. Other unwanted effects include stomatitis, conjunctivitis, arthritis, hematopoietic disturbances (see below), hepatitis, and, rarely, polyarteritis nodosa and psychosis. 

Cassia is stated to possess carminative, antispasmodic, antiemetic, antidiarrheal, and antimicrobial properties. It has been used to treat flatulent dyspepsia, flatulent colic, diarrhea, the common cold, and especially colic or dyspepsia with flatulent distension and nausea. Cassia bark is also documented to possess astringent properties, and the oil has carminative and antiseptic characteristics. 

Cinnamon is believed to have antispasmodic, carminative, orexigenic, antidiarrheal, antimicrobial, refrigerant, and anthelmintic properties. It is used for anorexia, intestinal colic, infantile diarrhea, common cold, influenza, and specifically for flatulent colic and dyspepsia with nausea. Cinnamon bark is also an astringent, and cinnamon oil is reported to possess carminative and antiseptic properties. 

Bergogne-Berezin, E. (2000),Treatment and prevention of antibiotic-associated diarrhea, Int. J. Antimicrobial. Agents, 16, 521-526. 

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