Risk factors host-associated

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 risk factors for sulfadiazine nephrotoxicity in patients with AIDS include (a) more prolonged courses of therapy as compared to those for community-acquired infections in normal hosts (b) difficulty in maintaining high oral fluid intake in patients with toxoplasma encephalitis because of chronic illness, anorexia, and altered mental status (c) concurrent fluid loses due to diarrhea (d) levels of plasma creatinine within the range of "normal" despite impaired renal function due to AIDS-associated... 

Cigarette smoking is the primary modifiable risk factor for the development of COPD however, the disease can be attributed to a combination of risk factors that results in lung injury and tissue destruction. The risk factors associated with the development of COPD can be divided into host factors and environmental factors (Table 27-1), and commonly, the interaction between these risks leads to expression of the disease. Host factors, such as genetic predisposition, may not be modifiable but are important for identifying patients at high risk of developing the disease. Environmental factors, such as tobacco smoke and occupational dust and chemicals, are modifiable factors that, if avoided, may reduce the risk of disease development. 

Host- and Device-Associated Risk Factors for Nosocomiai Pneumonia... 

Table 1 Host-Associated Risk Factors and Preventive Measures for Nosocomial Pneumonia Caused by Bacteria... 

Clinical research designed to further identify both host- and device-associated risk factors and to assess the benefit of specific preventive measures is required. Unfortunately, funding and institutional support for research may receive a lower priority under managed care and capitation policies. There is a need for increased recognition of host-associated risk factors, necessitating involvement of primary care physicians, and for increased emphasis on pre-... 

Guidelines are needed to test the safety of probiotics. However, taking into account the great diversity of probiotic microorganisms, it is necessary to identify the specific risks associated with the respective strains, as well as the risk factors associated with the host and the possible interactions between probiotic-host-food components in order to assess the safety of these products. Additional epidemiological surveillance and follow-up of novel strains should be conducted. In this context, the specific risks related to each probiotic strain must be carefully identified. With regard to this, knowledge of mechanisms involved is a key factor not only for the assessment of health effects but also for the safety aspects of probiotics. 

---