Tetracycline diarrhea with

Treatment of H. pylori infection typically consists of a combination therapy, using several drugs simultaneously.42 For example, one common form of triple therapy consists of two antibacterials (amoxicillin and clarithromycin) and one of the PPIs described earlier in this chapter.17 36 Alternatively, various quadruple therapies have been used combining bismuth compound (described later in the section on Treatment of Diarrhea ) with a PPI and two antibacterials (e.g., tetracycline and metronidazole).5,36 These drug regimens are typically administered for 1 to 2 weeks and... 

Although their effectiveness is similar to the tetracyclines, the use of erythromycin and clindamycin is often limited due to their potential adverse outcomes. Erythromycin has treatment failure due to resistance and a high incidence of gastrointestinal intolerance, while clindamycin causes diarrhea and carries a risk of developing pseudomembranous colitis with long-term use.3,8... 

There are a number of factors that limit the effectiveness of regimens designed to eradicate H. pylori. The first, antibiotic resistance, is seen with metronidazole and clarithromycin but has not been reported with bismuth, amoxicillin, or tetracycline. Second, mild adverse effects (eg, diarrhea, metallic taste, black stools) do occur in approximately 30% to 50% of patients. Therefore, shorter treatment periods in this group of patients may be better tolerated. 

Adverse effects consist mainly of gastrointestinal intolerance such as nausea, epigastric pain and diarrhea and, especially in the elderly constipation with continued therapy. All ferrous salts may cause a black coloration of the faeces. Children are particularly susceptible to potentially lethal iron intoxications. Oral iron preparations should not be administered concurrently with tetracyclines as mutual interference with absorption will occur. 

Didanosine (ddl) NRTT1 Tablets, 400 mg daily,3 adjusted for weight. 30 min before or 2 h after meals. Separate dosing from fluoroquinolones and tetracyclines by 2 h Peripheral neuropathy, pancreatitis, diarrhea, nausea, hyperuricemia. Possible increase in myocardial infarction Avoid concurrent neuropathic drugs (eg, stavudine, zalcitabine, isoniazid), ribavirin, and alcohol. Do not administer with tenofovir... 

Malarone is generally well tolerated. Adverse effects include abdominal pain, nausea, vomiting, diarrhea, headache, and rash, and these are more common with the higher dosage required for treatment. Reversible elevations in liver enzymes have been reported. The safety of atovaquone in pregnancy is unknown. Plasma concentrations of atovaquone are decreased about 50% by co-administration of tetracycline or rifampin. 

As recently as 1980 it was estimated that there were 100 million cases of acute diarrhea in Asia, Africa, and Latin America 3 in 1991 there were four million deaths among children under five years of age.b The causative agents are bacteria and one of the most dangerous is Vibrio cholerae, which multiplies in the small intestine and secretes an exotoxin. Cholera toxin causes such a rapid loss of fluid and salts from the body that death occurs very quickly, even in adults. There is little cellular damage and almost all deaths can be prevented by intravenous administration of water, salts, and the antibiotic tetracycline. Fluids can also be given orally if glucose, which promotes intestinal absorption, is included with the Na+, K+, Cl, and HC03 salts.b... 

Gastrointestinal distress (nausea, vomiting, diarrhea) may be a problem with tetracycline use. Hypersensitivity reactions (such as rashes) may also occur, as well as an increase in skin sensitivity to ultraviolet light (photosensitivity).16 Tetracyclines form chemical complexes with calcium that may impair the growth and development of calcified tissues such as bone and teeth, especially in children.69 Tetracyclines also cause discoloration of teeth in children and pregnant women, apparently because of the tetracycline-calcium interaction.69 As mentioned previously, development of tetracycline-resistant strains and resulting superinfections may be a serious problem during tetracycline therapy. 

Amebiasis. The causative agent, Entamoeba histolytica, lives and multiplies in the colon (symptom diarrhea), its cyst form residing also in the liver among other sites. In tropical regions, up to half the population can be infested, transmission occurring by the fe-cal-oral route. The most effective treatment against both intestinal infestation and systemic disease is administration of metronidazole. If monotherapy fails, combination therapy with chloroquine, emetine or tetracyclines may be indicated. 

Doxycycline is commonly used for moderate to severe acne vulgaris. It is more effective and produces less resistance than tetracycline. The initial dose is 100 or 200 mg daily, followed by 50 mg daily as a maintenance dose after improvement is seen. Doxycycline maybe given with food, but it is more effective when taken 30 minutes before meals. / Minocycline is also commonly used for moderate to severe acne vulgaris. It is more effective than tetracycline. It is dosed similar to doxycycline (100 mg/day or 50 mg twice daily) and on an indefinite basis in selected patients. Minocycline has the most reported adverse effects of the tetracyclines, some of which may be serious. Trimethoprim-sulfamethoxazole (or trimethoprim alone) is a second-line oral agent that may be used for patients who do not tolerate tetracyclines and erythromycin or in cases of resistance to these antibiotics. The adult dose is usually 800 mg sulfamethoxazole and 160 mg trimethoprim twice daily. Clindamycin use is limited by diarrhea and the risk of pseudomembranous colitis. 

In a study of the effect of berberine in acute watery diarrhea, oral doses of 400 mg were well tolerated, except for complaints about its bitter taste and a few instances of transient nausea and abdominal discomfort. However, patients with cholera given tetracycline plus berberine were more ill, suffered longer from diarrhea, and required larger volumes of intravenous fluid than those given tetracycline alone (5). 

Doxycycline can cause nausea, vomiting, and diarrhea. The bioavailability of doxycycline is reduced if coadministered with multivalent ions such as iron or magnesium. However, unlike tetracycline, it can be administered with food and dairy products. In addition, patients taking tetracyclines may experience photosensitivity, especially if they are fair skinned. Patients taking tetracyclines should avoid prolonged exposure to sunlight. 

The gastrointestinal tract is a frequent site for adverse effects of antimicrobial drugs, primarily because of disruption of normal intestinal microbial populations and proliferation of enteropatho-gens. Diarrhea, often with accompanying signs of endotoxemia, is the usual clinical manifestation. Antimicrobial agents known to be, or implicated in being, associated with antimicrobial-induced diarrhea include penicillin, ceftiofur, lincomycin, tetracycline, erythromycin and the potentiated sulfonamides. Erythromycin can also promote diarrhea via its motilide activity. 

Four hundred adults presenting with acute watery diarrhea were entered into a randomized, placebo controlled, double blind clinical trial of berberine, tetracycline, and tetracycline + berberine to study the antisecretory and vibriostatic effects of the alkaloid. Of 18S patients with cholera, those given tetracycline or tetracycline + berberine had considerably reduced volume and frequency of diarrheal stools, duration of diarrhea, and volumes of required intravenous and oral rehydration fluid. Berberine did not produce an antisecretory effect, but analysis by factorial design equations showed a reduction in diarrheal stools by one liter and a reduction in cyclic AMP concentrations in stools by 77% in the groups given berberine. Many fewer patients given tetracycline or tetracycline + berberine excreted vibrios in their stools after 24 hours in comparison with those given berberine alone. Neither tetracycline nor berberine had any benefit over placebo in 215 patients with noncholera diarrhea [219]. 

The tetracyclines administered orally or parenterally may lead to the development of superinfections caused by strains of bacteria or fungi resistant to these agents. Pseudomembranous colitis due to overgrowth of toxin-producing C. difficile presents with severe diarrhea, fever, and stools containing mucous membrane neutrophils. Discontinuation of the drug, combined with the oral administration of metronidazole or vancomycin, usually is curative. 

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