Antibiotic associated diarrhoea

Danna PL, Urban C, Beilin E, Rahal JJ Role of Candida in pathogenesis of antibiotic-associated diarrhoea in elderly inpatients. Lancet 1991 337 511-514. 

Ponnuvel KM, Rajkumar R, Menon T, Sanka-ranarayanan VS Role of Candida in indirect pathogenesis of antibiotic associated diarrhoea in infants. Mycopathologia 1996 135 145— 147. 

Wistrom J, Norrby SR, Myhre EB, Eriksson S, Granstrom G, Lagergren L, Englund G, Nord CE, Svenungsson B Frequency of antibiotic-associated diarrhoea in 2462 antibiotic-treated hospitalized patients A prospective study. J Antimicrob Chemother 2001 47 43-50. 

Wunderlich PF, Braun L, Fumagalli I, D Apuz-zo V, Heim F, Karly M, Lodi R, Politta G, Vonbank F, Zeltner L Double-blind report on the efficacy of lactic-acid-producing Enterococcus SF68 in the prevention of antibiotic-associated diarrhoea and in the treatment of acute diarrhoea. J Int Med Res 1989 17 333-338. 

Clostridium difficile is a commensal Gram-positive anaerobic bacterium of the human intestine, found in about 2-5% of the population. C. difficile is the most serious cause of antibiotic-associated diarrhoea and can lead to pseudomembranous colitis, a severe infection of the colon, often resulting from eradication of the normal gut flora by antibiotics. Discontinuation of causative antibiotic treatment is often curative. In more serious cases, oral administration of metronidazole or vancomycin is the treatment of choice. The bacterium produces several known toxins, including enterotoxin (toxin A) and cytotoxin (toxin B), both of which are responsible for the diarrhoea and inflammation seen in infected patients another toxin, binary toxin, has also been described. 

Oral therapy of infections is usually cheaper and avoids the risks associated with maintenance of intravenous access on the other hand, it may expose the gastrointestinal tract to higher local concentrations of antibiotic with consequently greater risks of antibiotic-associated diarrhoea. Some antimicrobial agents are available only for topical use to skin, anterior nares, eye or mouth in general it is better to avoid antibiotics that are also used for systemic therapy because topical use may be especially likely to select for resistant strains. Topical... 

Adverse reactions. Heartburn, nausea and vomiting due to gastric irritation are common, and attempts to reduce this with milk or antacids impair absorption of tetracyclines (see below). Loose bowel movements occur, due to alteration of the bowel flora, and this sometimes develops into diarrhoea and opportunistic infection (antibiotic associated or pseudomembranous colitis) may supervene. Disorders of epithelial surfaces, perhaps due partly to vitamin B complex deficiency and partly due to mild opportunistic infection with yeasts and moulds, lead to sore mouth and throat, black hairy tongue, dysphagia and perianal soreness. Vitamin B preparations may prevent or arrest alimentary tract symptoms. 

The most serious adverse effect is antibiotic-associated (pseudomembranous) colitis (see p. 210) usually due to opportunistic infection of the bowel with Clostridium difficile which produces an entero-toxin clindamycin should be stopped if any diarrhoea occurs. 

Antimicrobials are the commonest drugs that cause diarrhoea, probably due to alteration of bowel flora. It may range from a mild inconvenience to life-threatening antibiotic-associated (pseudomembranous colitis), due to colonisation of the bowel with Clostridium difficile. The condition particularly affects... 

Aronsson B, Mollby R, Nord CE. Clostridium difficile and antibiotic associated diarrhoea in Sweden. Scand J Infect Dis Suppl 1982 35 53-8. 

S. boulardii Reduction of antibiotic associated diarrhoea Erdeve et al. (2004)... 

Clostridium difficile is a Gram-positive bacteria, spore-forming, responsible for 15-20% of the antibiotic-associated diarrhoeas (Hamrick et al. 1989 Eckel et al. 2002). The gold-standard technique for the detection of Clostridium difficile is the stool cytotoxin assay. The microbiological mechanism is related to the production of two toxins (toxins A and B) by Clostridium difficile (Kyne et al. 2000). Disturbance of the normal bacterial flora in the colonic lumen is an important factor for the development of PMC (Ros et al. 1996). Children younger than 1 year develop symptomatic disease probably because of immature enterocytic membrane receptors for the toxin (Ros et al. 1996). 

D Souza, A.L., Rajkumar, C., Cooke, J., and Bulpitt, C.J. 2002. Probiotics in prevention of antibiotic associated diarrhoea meta-analysis. Brit Med Jl 324(7350), 1361-1364. 

Antibiotic - associated- diarrhoea/ B. longum Decreased course of eryth romyc i n -i nd uced diarrhoea Colombel etal. (1987)... 

Beneficial effects of probiotic consumption in the prevention and treatment of several gastrointestinal diseases, such as inflammatory bowel diseases, antibiotic associated-diarrhoea, neonatal necrotizing enterocolitis, irritahle bowel syndrome, Helicobacter pylori infection, as well as food allergies and intolerances, have been clearly assessed (Sanders et al. 2013). Furthermore, probiotics are effective in reducing cholesterol levels and lowering blood pressure (Kumar et al. 2012). However, molecular mechanisms underlying strain-specific probiotic action and the identity of effector molecules (peptidoglycan, teichoic acid, cell surface polysaccharides, extracellular proteins) still remain to be fully elucidated. 

Adverse effects. Ampicillin may cause diarrhoea but the incidence (12%) is less with amoxicillin. Ampicillin and amoxicillin are the commonest antibiotics to be associated with Clostridium difficile diarrhoea, although this is related to the frequency... 

Diarrhoea is also part of some inflammatory disorders, such as irritable bowel syndrome, ulcerative colitis and Crohn s disease. These may best be relieved by treatment with corticosteroids and aminosalicylates. Diarrhoea is commonly associated with bacterial or other pathogenic infections (e.g. food poisoning) and these may require treatment with antibiotics or other antimicrobials. 

Matsaniotis N, Messaritakis J, Vlachou C. HypopFothrombinaemic bleedii in infants associated witii diarrhoea and antibiotics. Arch Dis Child( 9nG) 45,586-7. 

Teicoplanin is an antibiotic agent used in the prevention and the treatment of serious infections caused by gram-positive bacteria. It is a semis5mthetic glycopeptide antibiotic with a spectrum of activities similar to vancomycin. Teicoplanin is marketed by Sanofi Aventis Corp. as Targocid . The oral adnunistration of teicoplanin is effective in the treatment of Pseudomembranous colitis and Clostridium difficile-associated diarrhoea, with a comparable efficacy to vancomycin. The effectiveness of teicoplanin and its structure effect on treatment has been reviewed (50). The effect of teicoplanin is directly related to the length of its carbon chain. 

Orthopaedic hospital patients often need lincomycin or clindamycin therapy an analysis of 1158 of these patients treated with antibiotics revealed 58 cases of diarrhoea, many of them in association with lincomycin, as well as several cases during treatment with other antibiotics such as the penicillins and tetracyclines. Since in this study there were only 3 documented cases of lincomycin-associated colitis, the conclusion was drawn that continued use of lincomycin or clindamycin appears to be fully justified by the low incidence of colitis (49 -, 50 ). In another study there have been 3 severe cases out of 144 patients receiving lincomycins as a prophylactic measure for total hip replacements. It is concluded in this study that as these drugs may produce a lethal condition, they should be used with appropriate discretion, especially in the elderly female who appears to be most at risk (48 ). 

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