Materiały źródłowe

• #1 Managing antibiotic associated diarrhoea

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1123310/

  Diarrhoea is a common adverse effect of antibiotic treatments. Antibiotic associated diarrhoea occurs in about 5-30% of patients either early during antibiotic therapy or up to two months after the end of the treatment. The frequency of antibiotic associated diarrhoea depends on the definition of diarrhoea, the inciting antimicrobial agents, and host factors. […] Almost all antibiotics, particularly those that act on anaerobes, can cause diarrhoea, but the risk is higher with aminopenicillins, a combination of aminopenicillins and clavulanate, cephalosporins, and clindamycin. Host factors for antibiotic associated diarrhoea include age over 65, immunosuppression, being in an intensive care unit, and prolonged hospitalisation. […] Clinical presentations of antibiotic associated diarrhoea range from mild diarrhoea to fulminant pseudomembranous colitis. The latter is characterised by a watery diarrhoea, fever (in 80% of cases), leucocytosis (80%), and the presence of pseudomembranes on endoscopic examination. Severe complications include toxic megacolon, perforation, and shock.

• #1 Managing antibiotic associated diarrhoea

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1123310/

  Antibiotic associated diarrhoea results from disruption of the normal microflora of the gut by antibiotics. This microflora, composed of 1011 bacteria per gram of intestinal content, forms a stable ecosystem that permits the elimination of exogenous organisms. Antibiotics disturb the composition and the function of this flora and enable overgrowth of micro-organisms that induce diarrhoea. […] Managing the diarrhoea depends on the clinical presentation and the inciting agent. In mild to moderate diarrhoea conventional measures include rehydration or discontinuation of the inciting agent or its replacement by an antibiotic with a lower risk of inducing diarrhoea, such as quinolones, co-trimoxazole, or aminoglycosides. […] In cases of severe or persistent antibiotic associated diarrhoea, the challenge is to identify C difficile associated infections since this is the most common identifiable and treatable pathogen.

• #1 Antibiotic-Associated Diarrhea Beyond C. Difficile: A Scoping Review | Published in Journal of Brown Hospital Medicine

  https://bhm.scholasticahq.com/article/39745-antibiotic-associated-diarrhea-beyond-c-difficile-a-scoping-review

  A common complication of antibiotic use is the development of diarrheal illness. The pathogenesis of antibiotic associated diarrhea (AAD) may be mediated through alteration of intestinal microbiota, overgrowth of opportunistic pathogens, and direct drug toxicity on the gut. […] Antibiotic associated diarrhea (AAD) is defined as passage of three or more unformed stools per day beginning anywhere from within a few hours up to 8 weeks after starting antibiotic therapy. […] The likely pathogenesis of AAD includes alteration of intestinal microbiota, direct drug toxicity on the gut and development of a superinfection by a pathogenic microbe. […] The review will also focus on the alteration of intestinal microflora and will provide a stronger basis for the use of non-pharmacologic therapies such as synbiotics as an effective therapeutic and preventive strategy.

• #1 Antibiotic-Associated Diarrhea – Harvard Health

  https://www.health.harvard.edu/a_to_z/antibiotic-associated-diarrhea-a-to-z

  Because C. difficile lives silently in the bowels of about 5% of people, episodes of C. difficile diarrhea occasionally occur in otherwise healthy adults and children who are taking antibiotics. […] C. difficile infections are more common among recently hospitalized patients, the elderly and those with debilitating illnesses. […] If you are taking an antibiotic, the medication will cause a mild change in your population of intestinal bacteria that may cause occasional loose stools or mild diarrhea for a few days. […] These symptoms should stop once your antibiotic treatment ends. […] If you have a more dramatic change in your bowel bacteria, and C. difficile bacteria begin to overgrow, your symptoms can include: watery diarrhea, crampy abdominal pain, abdominal tenderness, fever, pus or blood in your diarrhea (if your illness progresses to C. difficile colitis).

• #1 Patient education: Antibiotic-associated diarrhea caused by Clostridioides difficile (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/antibiotic-associated-diarrhea-caused-by-clostridioides-difficile-beyond-the-basics/print

  Antibiotic-associated diarrhea refers to diarrhea that develops in a person who is taking or recently took antibiotics. One of the most serious causes of antibiotic-associated diarrhea is infection with a bacterium called Clostridioides difficile. C. difficile infections are common, with approximately 500,000 cases per year in the United States. Infection is most common in people who are hospitalized, producing disease in more than 8 hospitalized patients per 1000 (0.9 percent) in 2008 in the United States. […] This topic review discusses the causes, symptoms, diagnosis, and treatment of C. difficile-associated diarrhea. Other types of diarrheas are discussed separately. […] The most important step in treatment of C. difficile is to stop the antibiotic that allowed the infection to develop. If an antibiotic is necessary to treat an ongoing infection, the health care provider may choose an antibiotic that is less likely to allow further growth of C. difficile, when possible.

• #1 Antibiotic-associated diarrhea: Symptoms and treatment

  https://www.medicalnewstoday.com/articles/antibiotics-diarrhea

  Diarrhea is one of the most common side effects of taking antibiotics, though it tends to be mild. Sometimes, antibiotics can cause bacterial infection with Clostrioides difficile (C.diff), leading to severe diarrhea. […] A person with diarrhea on antibiotics should carefully monitor their symptoms. If symptoms are very severe, a person gets sicker, or the diarrhea worsens, they should contact their doctor. Signs of dehydration, confusion, or weakness are a medical emergency. […] Antibiotics can also lead to infection with a bacteria called C.diff, which is one of the most common causes of serious antibiotic-related diarrhea. […] The risk factors for developing C. diff include: taking antibiotics longer than a week, being over the age of 65 years, having immune system issues, such as from HIV, AIDS, cancer, or an organ transplant, a recent hospital or nursing home stay, a history of C. diff infection.

• #1 Clostridioides Difficile: Nursing Diagnoses, Care Plans, Assessment & Interventions | NurseTogether

  https://www.nursetogether.com/clostridioides-difficile-c-diff-nursing-diagnosis-care-plan/

  Since C. difficile infection is often related to a current antibiotic regimen that the patient is taking, it is critical to stop the current antibiotic causing C. difficile infection and replace it with another medication that will be less likely to cause this bacteria. […] Supportive treatment through proper nutrition and adequate fluid intake is necessary to prevent dehydration. Nurses play a vital role in managing symptoms of C. diff like diarrhea and abdominal pain. Nurses also instruct patients and staff on precautions to prevent the transmission of C. diff bacteria. […] Diarrhea and colon inflammation (colitis) are the hallmark signs of C.difficile infection. […] Signs and symptoms of mild to moderate C. difficile include watery diarrhea more than three times a day for more than one day with mild abdominal tenderness and cramping.

• #1 Antibiotic-associated diarrhea – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/antibiotic-associated-diarrhea/diagnosis-treatment/drc-20352237

  To diagnose antibiotic-associated diarrhea, your doctor is likely to question you about your health history, including whether you’ve had recent antibiotic treatments. […] Treatment for antibiotic-associated diarrhea depends on the severity of your signs and symptoms. […] If you have mild diarrhea, your symptoms likely will clear up within a few days after your antibiotic treatment ends. […] If you develop C. difficile infection, your doctor will likely stop whatever antibiotic you’re currently taking, and might prescribe antibiotics specifically targeted to kill the C. difficile bacteria causing your diarrhea. […] To cope with diarrhea: Drink enough fluids. […] It’s a good idea to avoid dairy as well as fatty and spicy foods while you have diarrhea. […] In some cases of mild antibiotic-associated diarrhea, your doctor may recommend anti-diarrheal medications, such as loperamide (Imodium A-D).

• #1 Clostridioides (formerly Clostridium) difficile–Induced Diarrhea – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/anaerobic-bacteria/clostridioides-formerly-clostridium-difficile-induced-diarrhea

  Antibiotic-induced changes in gastrointestinal flora are the dominant predisposing factors. […] Antibiotic therapy can cause intestinal overgrowth of toxin-secreting C. difficile, resulting in a pseudomembranous colitis that can be severe and difficult to cure. […] Cephalosporins (particularly 3rd-generation), penicillins, clindamycin, and fluoroquinolones pose the highest risk. […] Diagnose using a stool assay for C. difficile antigen and toxin and sometimes PCR testing for the toxin gene. […] Treat with oral fidaxomicin or vancomycin. […] Recurrence is common; re-treat with antibiotics, and consider fecal transplantation or bezlotoxumab for refractory recurrences.

• #1 Managing antibiotic associated diarrhoea

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1123310/

  Treatment of C difficile related diarrhoea is based on oral metronidazole (250 mg four times daily) or oral vancomycin (125 mg four times daily) for 10 days. The response to metronidazole or vancomycin is similar (90%), and diarrhoea usually resolves in two or three days. […] The key measure for preventing antibiotic associated diarrhoea, however, is to limit antibiotic use. Probiotics have proved useful in preventing diarrhoea, but the number of clinical trials is limited and further controlled trials using different probiotics are needed. […] In the case of C difficile related diarrhoea hygiene measures (single rooms, use of gloves, and handwashing) should be systematically associated with treatment in order to prevent transmission and dissemination of this nosocomial bacteria.

• #1 Diarrhea Nursing Diagnosis & Care Plan – Nurseslabs

  https://nurseslabs.com/diarrhea/

  Use this nursing care plan and management guide to help care for patients with diagnosis of diarrhea. Learn about the nursing assessment, nursing interventions, goals and nursing diagnosis for diarrhea in this guide. […] Nurses and the healthcare team members must take precautions to prevent transmission of infection associated with some causes of diarrhea. […] Diarrhea can be caused by certain medications such as thyroid hormone replacement, stool softeners, laxatives, prokinetic agents, antibiotics, chemotherapy, antiarrhythmics, antihypertensives, magnesium-based antacids. Antibiotics are a common cause of hospital-acquired diarrheas in about 20% of patients receiving broad-spectrum antibiotics. […] If diarrhea is associated with cancer or cancer treatment, once the infectious cause of diarrhea is ruled out, provide medications as ordered to stop diarrhea.

• #1 Diarrhea Nursing Diagnosis & Care Plans | NurseTogether

  https://www.nursetogether.com/diarrhea-nursing-diagnosis-care-plan/

  Nurses should monitor a patients diarrhea for worsening symptoms and subsequent alterations to nutrition, vital signs, lab values, and skin integrity. Nurses should also educate patients on diet recommendations, medication use, and hydration guidelines to prevent diarrhea. […] Antibiotic use is a common cause of diarrhea. […] Administer antidiarrheals as appropriate. Once the cause of diarrhea has been determined and it is not contraindicated, administer antidiarrheals to stop diarrhea. […] Promote skin integrity. Frequent diarrhea can cause skin breakdown to the perianal area. Educate on proper wiping from front to back and the use of non-irritating cleansers. If the patient is incontinent, provide frequent diaper changes and keep the perineum dry and apply skin barrier ointments. […] Educate on proper food handling. Food poisoning is a common cause of diarrhea. Ensure the patient understands how to properly handle and cook food. Prevent cross-contamination when handling raw meats and clean produce before ingesting. Do not eat food that has not been properly refrigerated or cooked. Always wash hands before eating. […] Chronic diarrhea that lasts longer than four weeks requires further assessment. The patient may need a referral to a gastroenterologist to investigate for a possible inflammatory bowel disease or a cause of malabsorption.

• #1 Clostridioides Difficile: Nursing Diagnoses, Care Plans, Assessment & Interventions | NurseTogether

  https://www.nursetogether.com/clostridioides-difficile-c-diff-nursing-diagnosis-care-plan/

  C. difficile is highly contagious and can easily be transmitted through person-to-person contact and contaminated fomites. […] Antibiotic use is the most common cause of C. difficile infection. Antibiotics like clindamycin, penicillins, and cephalosporins tend to destroy healthy bacteria in the body along with the bacteria they are formulated to kill. Without these helpful bacteria, C. difficile can proliferate and cause infection. […] Frequent, foul-smelling, watery stools characterize CDI. […] Since CDI causes severe diarrhea, there is a higher risk of dehydration. […] Serious complications like severe dehydration can arise from diarrhea related to CDI. […] Fluid losses occur quickly with diarrhea. Severe dehydration may need to be treated with IV therapy. Encourage plenty of oral fluids as tolerated. Hydration can also prevent kidney failure.

• #1 Diarrhea Nursing Diagnosis & Care Plan – Nurseslabs

  https://nurseslabs.com/diarrhea/

  Many diarrheas have more than one mechanism. One of the many causes of diarrhea is medications. Diarrhea triggered by prescription drugs should be reported immediately to prevent the worsening of diarrhea. More than 700 medications can cause diarrhea, including furosemide, caffeine, protease inhibitors, thyroid preparations, metformin, mycophenolate mofetil, sirolimus, cholinergic drugs, colchicine, theophylline, selective serotonin reuptake inhibitors, proton pump inhibitors, histamine-2 blockers, 5-ASA derivatives, angiotensin-converting enzyme inhibitors, bisacodyl, senna, aloe, anthraquinones, and magnesium or phosphorus-containing medications. Antibiotics are a common cause of hospital-acquired diarrheas in about 20% of patients receiving broad-spectrum antibiotics. […] Hygiene reduces the risk of perianal excoriation and promotes comfort. A condition known as Fourniers gangrene was associated with neglected prolonged diarrhea, perianal excoriation resulting from diarrhea, and poor hygiene. […] Diarrhea can cause burning and inflammation around the anus. When cleaning, use a mild cleansing agent (perineal skin cleanser), apply a protective ointment or barrier creams, and if the skin is excoriated or desquamated, apply a wound hydrogel.

• #1 Patient education: Antibiotic-associated diarrhea caused by Clostridioides difficile (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/antibiotic-associated-diarrhea-caused-by-clostridioides-difficile-beyond-the-basics

  Hand washing is an effective way to prevent the spread of C. difficile. Hands should be washed after using the bathroom and before eating. Hands should ideally be wet with water and plain or antibacterial soap and rubbed together for 15 to 30 seconds. […] People who are hospitalized with C. difficile are placed on contact precautions, which mean that anyone who enters the patient’s room must wash their hands before entering and after leaving. The person must also wear a clean gown and clean gloves. These measures can help to prevent the spread of infection to other people in the hospital.

• #1 Antibiotic-associated diarrhea – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/antibiotic-associated-diarrhea/symptoms-causes/syc-20352231

  Antibiotic-associated diarrhea refers to passing loose, watery stools three or more times a day after taking medications used to treat bacterial infections (antibiotics). […] Most often, antibiotic-associated diarrhea is mild and requires no treatment. The diarrhea typically clears up within a few days after you stop taking the antibiotic. More-serious antibiotic-associated diarrhea requires stopping or sometimes switching antibiotics. […] Call your doctor right away if you have serious signs and symptoms of antibiotic-associated diarrhea. […] To help prevent antibiotic-associated diarrhea, try to: Take antibiotics only when necessary. Don’t use antibiotics unless your doctor feels they’re necessary. Antibiotics can treat bacterial infections, but they won’t help viral infections, such as colds and flu. […] Tell your doctor if you’ve had antibiotic-associated diarrhea or C. difficile before. Having antibiotic-associated diarrhea once or C. difficile in the past increases the chance that antibiotics will cause that same reaction again. Your doctor may be able to select a different antibiotic for you.

• #1 Probiotics use for antibiotic-associated diarrhea: a pragmatic participatory evaluation in nursing homes | BMC Gastroenterology | Full Text

  https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-020-01297-w

  Antibiotic-associated diarrhea (AAD) occurs in 225% of nursing home residents, which may lead to dehydration, malnutrition, severe complications and hospitalizations. […] Research shows that probiotics can be effective and safe in reducing AAD. […] The number of episodes with AAD when using probiotics was significantly lower than when no probiotics was used (20% vs 36%; p=0,022, Chi-square). […] Successful implementation of probiotics demonstrated the prevention of AAD in nursing home residents. […] The aim of this evaluation was twofold: 1) evaluation of changes in the occurrence of AAD by administrating multispecies probiotics to nursing home residents, and 2) evaluation of the implementation process of probiotics in daily nursing home practice. […] The occurrence of AAD incidence in episodes of antibiotic use with and without probiotic supplementation is reported in Table 2. The number of episodes of antibiotic use with AAD when using probiotics was significantly lower than when no probiotics were used (20% vs 36%; p=0,022). […] In conclusion, successful implementation of probiotics demonstrated a reduction in the occurrence of AAD in nursing home residents.

• #1 Probiotics for the Prevention of Antibiotic-Associated Diarrhea in Outpatients—A Systematic Review and Meta-Analysis

  https://www.mdpi.com/2079-6382/6/4/21

  A common adverse effect of antibiotic use is diarrhea. Probiotics are living microorganisms, which, upon oral ingestion, may prevent antibiotic-associated diarrhea (AAD) by the normalization of an unbalanced gastrointestinal flora. […] The objective of this systematic review and meta-analysis was thus to assess the benefits and harms of probiotics used for the prevention of antibiotic-associated diarrhea in outpatients of all ages. […] Diarrhea is a common adverse effect of systemic antibiotic treatment. Antibiotic-associated diarrhea (AAD) occurs in 5% to 39% of patients, from the beginning and up to two months after the end of treatment. […] Probiotics are defined as “live microorganisms which when administered in adequate amounts confer a health benefit on the host.” […] The results of this review point towards a protective effect of the use of probiotics as adjunct therapy to prevent antibiotic-associated diarrhea in outpatients of all ages. Data from 17 studies with a total of 3631 patients found that the use of a probiotic may reduce the risk of AAD by 51% (RR 0.49; 95% CI 0.36 to 0.66; I2 = 58%), with no apparent increase in the risk of side effects. […] The use of probiotics appears safe.

• #1 Evidence Based Appraisal of the Use of Probiotics to Prevent Antibiotic-associated Diarrhea in Intensive Care Settings | FSU Digital Repository

  https://repository.lib.fsu.edu/islandora/object/fsu%3A204725

  It is estimated that between 5-25% of adults who receive antibiotic therapy develop antibiotic-associated diarrhea (AAD) (Cimperman et al., 2011; McFarland, 2009). […] When untreated, AAD can lead to dehydration, electrolyte imbalances, and skin breakdown, which may cause hospitalization. […] Based on the available evidence, there is consensus that antibiotic-associated diarrhea is significantly decreased when higher doses of probiotics (10^10 CFU, BID) are given within 36 hours of antibiotic administration. […] In addition, the probiotics should be continued for 4-6 weeks, using preparations of Lactobacillus or the strain Saccahromyces boulardi.

• #1 Antibiotic-associated diarrhea (AAD) | Time of Care

  https://www.timeofcare.com/antibiotic-associated-diarrhea-aad/

  Probiotics (particularly Saccharomyces boulardii) prevent antibiotic-associated diarrhea. NNT to prevent one case of diarrhea is 10. […] Probiotics, particularly Saccharomyces boulardii, have been shown to prevent the antibiotic-associated diarrhea that occurs in 5%30% of children who receive antibiotics (SOR A). The number needed to treat to prevent one case of diarrhea is 10. […] Probiotics have not been shown to prevent colic in any infants.

• #1 Probiotics use for antibiotic-associated diarrhea: a pragmatic participatory evaluation in nursing homes

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7222499/

  Antibiotic-associated diarrhea (AAD) occurs in 225% of nursing home residents, which may lead to dehydration, malnutrition, severe complications and hospitalizations. Research shows that probiotics can be effective and safe in reducing AAD. […] Probiotics administration was implemented in three nursing homes of the Rivas Zorggroep for residents with somatic and/or psychogeriatric conditions. […] The number of episodes with AAD when using probiotics was significantly lower than when no probiotics was used (20% vs 36%; p=0,022, Chi-square). […] Successful implementation of probiotics demonstrated the prevention of AAD in nursing home residents. […] The aim of this evaluation was twofold: 1) evaluation of changes in the occurrence of AAD by administrating multispecies probiotics to nursing home residents, and 2) evaluation of the implementation process of probiotics in daily nursing home practice.

• #1 Feasibility of a Lactobacillus casei Drink in the Intensive Care Unit for Prevention of Antibiotic Associated Diarrhea and Clostridium difficile

  https://www.mdpi.com/2072-6643/10/5/539

  Antibiotics are amongst the most prescribed medications worldwide, and are particularly common place in the Intensive Care Unit (ICU). The US Centers for Disease Control indicates that 55% of all hospitalized patients receive at least one antibiotic during their hospital stay. In ICU, this number increases to greater than 70%, often with multiple antibiotics. Antibiotic treatment can disturb the colonization resistance of gastrointestinal flora resulting in antibiotic-associated diarrhea (AAD) caused by pathogenic bacterial overgrowth. Of the patients who develop AAD, approximately 1/3 will develop Clostridium difficile infection (CDI). Clostridium difficile toxin is the pathogen most often associated with adverse events in the ICU. Certain populations are at higher risk for the development of AAD. The prevalence of diarrhea in ICU has been reported to be as high as 68%. Anyone who has taken antibiotics within the past month is at risk with a documented prevalence of 5–39% in adults and 15–20% in the elderly. Probiotics are microorganisms that are believed to counteract disturbances in intestinal flora, thus reducing its risk of colonization by pathogenic bacteria. Probiotic benefits to ICU patients may include the prevention of AAD and CDI. Current probiotic research is complicated by the heterogeneity of probiotic strains, doses and treatment durations. However, a 2013 systematic review of this literature, which included 31 randomized trials with a total of 4492 participants, offers moderate quality evidence suggesting that prophylactic probiotics are both safe and effective for preventing Clostridium difficile associated diarrhea. The efficacy of a probiotic containing food on AAD and CDI rates is less well documented in the literature. In a German study conducted on 107 hospitalized patients, the incidence of AAD was significantly reduced in the intervention group (6.5% vs. 28.4%) and the duration of AAD was significantly shorter in the probiotic group (1.7 days vs. 3.1 days). Based on recent evidence, the Canadian Critical Care Guidelines upgraded their recommendation for probiotic usage in the ICU in 2013. The recommendation is that probiotics should be considered in critically ill patients for their modest treatment effect on reduction of infections. The purpose of this study is to determine feasibility of delivering a probiotic yogurt as a prevention strategy of AAD in critically ill adults. Our primary goal is to determine safety and feasibility of administering a probiotic containing drink via gastric feeding tube or by addition to oral diet. The secondary outcome to be measured is the occurrence of AAD and CDI. We have shown that a probiotic containing drink can be safely delivered via naso/oralgastric feeding tube in the ICU, and is acceptable for oral consumption once patients transition to an oral diet. The trial was successful in recruiting 32 patients despite screening 850 patients over 25 months. We demonstrated safety and feasibility of a probiotic drink in enterally fed critically ill patients. The low recruitment rate demonstrates the need to begin probiotics earlier on surgical and medical wards, or in the community, when antibiotics are ordered. Although positive benefits of probiotics in ICU have been realized with a decrease in infectious episodes, including CDI, immunocompromised patients should continue to be excluded due to safety concerns. This pilot points to the need to assess a probiotic drink as standard adjunctive preventative therapy for all ICU patients at risk for AAD and CDI.

• #1 Probiotics for Antibiotic-Associated Diarrhea and C. diff | Effective Health Care (EHC) Program

  https://effectivehealthcare.ahrq.gov/get-involved/nominated-topics/probiotics-antibiotics

  The impact of antibiotic associated diarrhea (AAD) and Clostridium difficile infection (CDI) on healthcare is significant. […] AAD also drives poor medication compliance and the overuse of broad spectrum antibiotics. The prevention of AAD may lead to significant improvements in patient outcomes and lower costs of care. […] Many physicians commonly recommend probiotics for the prevention AAD. […] Evidence supporting the use of probiotics along with antibiotics in the prevention of AAD is important; there is also compelling evidence to support the administration of probiotics along with antibiotics in the prevention of CDI. […] Probiotics are stocked in many hospital pharmacies and are often used by physicians for the prevention or management of AAD. […] Fifty-nine percent of physicians recommend probiotic supplements.

• #1 Risk factors, incidence, and morbidity associated with antibiotic-associated diarrhea in intensive care unit patients receiving antibiotic monotherapy

  https://www.wjgnet.com/2307-8960/full/v8/i10/1908.htm

  Antibiotic-associated diarrhea (AAD) is diarrhea associated with antibiotic administration. Symptoms can range from mildly self-limiting disease to more severe Clostridium difficile-associated diarrhea (CDAD). Due to the widespread use of antibiotics, the incidence of AAD has gradually increased and has been reported to be as high as 35% in some studies. This increase is directly related to the use of antibiotics. AAD has become an important nosocomial disease, especially in critically ill patients. The incidence of AAD in the intensive care unit (ICU) is growing, and it is becoming a serious condition. Therefore, prevention of AAD is essential for critically ill patients. […] The overall incidence of AAD was 21.53%. Age, proton pump inhibitor usage time, duration of antibiotic, and ICU stay time were associated with AAD.

• #1 Antibiotic-associated diarrhea

  https://www.aboutkidshealth.ca/antibiotic-associated-diarrhea

  Many antibiotics cause diarrhea. Learn about antibiotic-associated diarrhea, including causes and treatment options. […] Diarrhea is common in children taking antibiotics. In most cases, it is mild. […] Children with mild diarrhea should finish their antibiotics. […] Make sure your child is drinking enough fluids to stay hydrated. […] If your child’s diarrhea is mild and your child is otherwise well, continue the antibiotics and care for your child at home. […] Offer your child water often. Do not give fruit juice or soft drinks, as they can make diarrhea worse. […] Call your child’s regular health-care provider right away if your child has severe diarrhea. […] If the diarrhea is severe, your child may need to change the antibiotic.

• #1 Probiotics for the prevention of antibiotic-associated diarrhea in children | Cochrane

  https://www.cochrane.org/CD004827/IBD_probiotics-prevention-antibiotic-associated-diarrhea-children

  Antibiotic-associated diarrhea (AAD) occurs when antibiotics disturb the natural balance of „good” and „bad” bacteria in the intestinal tract causing harmful bacteria to multiply beyond their normal numbers. The symptoms of AAD include frequent watery bowel movements and crampy abdominal pain. […] The researchers investigated whether probiotics prevent AAD in children receiving antibiotic therapy and whether probiotics causes any harms (side effects). […] Analyses showed that probiotics are effective for preventing AAD. The incidence of AAD in the probiotic group was 8% (259/3232) compared to 19% (598/3120) in the control group, demonstrating a moderate reduction (11% fewer will suffer diarrhea). […] Evidence suggested that probiotics are effective for a moderate reduction in duration of diarrhea (almost one day).

• #1 Antibiotic-associated diarrhea | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/antibiotic-associated-diarrhea

  Antibiotic-associated diarrhea refers to passing loose, watery stools three or more times a day after taking medications used to treat bacterial infections (antibiotics). […] Most often, antibiotic-associated diarrhea is mild and requires no treatment. The diarrhea typically clears up within a few days after you stop taking the antibiotic. More-serious antibiotic-associated diarrhea requires stopping or sometimes switching antibiotics. […] Call your doctor right away if you have serious signs and symptoms of antibiotic-associated diarrhea. […] To help prevent antibiotic-associated diarrhea, try to: Take antibiotics only when necessary. […] If you have mild diarrhea, your symptoms likely will clear up within a few days after your antibiotic treatment ends. […] If you develop C. difficile infection, your doctor will likely stop whatever antibiotic you’re currently taking, and might prescribe antibiotics specifically targeted to kill the C. difficile bacteria causing your diarrhea.

• #2

  https://www.kuh.ku.edu.tr/mayo-clinic-care-network/mayo-clinic-health-information-library/diseases-conditions/antibiotic-associated-diarrhea

  Antibiotic-associated diarrhea refers to passing loose, watery stools three or more times a day after taking medications used to treat bacterial infections (antibiotics). […] About 1 in 5 people who take antibiotics develop antibiotic-associated diarrhea. Most often, antibiotic-associated diarrhea is mild and requires no treatment. The diarrhea typically clears up within a few days after you stop taking the antibiotic. More-serious antibiotic-associated diarrhea requires stopping or sometimes switching antibiotics. […] Call your doctor right away if you have serious signs and symptoms of antibiotic-associated diarrhea. […] To help prevent antibiotic-associated diarrhea, try to: Take antibiotics only when necessary. Don’t use antibiotics unless your doctor feels they’re necessary. […] To diagnose antibiotic-associated diarrhea, your doctor is likely to question you about your health history, including whether you’ve had recent antibiotic treatments.

• #2 Antibiotic-Associated Diarrhea – Harvard Health

  https://www.health.harvard.edu/a_to_z/antibiotic-associated-diarrhea-a-to-z

  In healthy people, many different species of bacteria live inside the bowel. […] This can change dramatically when a person begins treatment with an antibiotic. […] In most cases, the result is only a mild case of short-term diarrhea that goes away quickly after the antibiotic treatment ends. […] Occasionally, however, an antibiotic eliminates so many of the bowel’s „good” and harmless bacteria that the aggressive „bad” ones are free to multiply out of control. […] One type of bacteria in particular, a species called Clostridium difficile (C. difficile), can overgrow inside the bowel, producing irritating chemicals that damage the bowel wall and trigger bowel inflammation, called colitis. […] In some cases, high-volume, diarrhea is so frequent that the person develops dehydration (very low levels of body water).

• #2 Antibiotic-Associated Diarrhea Beyond C. Difficile: A Scoping Review | Published in Journal of Brown Hospital Medicine

  https://bhm.scholasticahq.com/article/39745

  A common complication of antibiotic use is the development of diarrheal illness. The pathogenesis of antibiotic associated diarrhea (AAD) may be mediated through alteration of intestinal microbiota, overgrowth of opportunistic pathogens, and direct drug toxicity on the gut. Currently fewer than 33% of AAD cases can be attributable to Clostridioides difficile leaving a large number of cases undiagnosed and poorly treated. Antibiotic associated diarrhea (AAD) is defined as passage of three or more unformed stools per day beginning anywhere from within a few hours up to 8 weeks after starting antibiotic therapy. The frequency of AAD has been reported to occur in 5-35% persons exposed to antimicrobials and varies upon the class of antibiotics received, health of the host and exposure to pathogens. AAD may range from mild, self-limiting illness to fulminant, pseudomembranous colitis that can be life threatening. The likely pathogenesis of AAD includes alteration of intestinal microbiota, direct drug toxicity on the gut and development of a superinfection by a pathogenic microbe. Identifying the etiology and understanding the pathogenesis of AAD will help in improving healthcare and in reducing the economic burden. The review will also focus on the alteration of intestinal microflora and will provide a stronger basis for the use of non-pharmacologic therapies such as synbiotics as an effective therapeutic and preventive strategy. The first-line treatments for AAD are discontinuation of the offending antibiotic and supportive care including maintaining adequate hydration. For non-severe CDI, oral vancomycin 125mg four times daily for 10 days or fidaxomicin 200mg twice daily for 10 days is the first line treatment. Fecal microbial therapy (FMT) should be considered in patients with two or more recurrences to correct the disruption in microbiota caused by recurrent use of antibiotics. As the prevalence of AAD increases, the health and economic burden associated with this illness continues to be significant. Because a majority of the AAD cases are due to altered intestinal microbiota, modulating the microbiota, and adopting preventive strategies such as diet, prebiotics, probiotics, and drugs may be ultimately necessary to ensure optimal health and favorable outcomes in disease prone individuals.

• #2 Fast Five Quiz: Antibiotic-Associated Diarrhea

  https://reference.medscape.com/viewarticle/933228

  Antibiotic-associated diarrhea results from a disequilibrium of the normal intestinal flora of the gut by antibiotics. Almost all antibiotics can cause diarrhea, but the risk is higher with broad-spectrum antibiotics such as cephalosporins (eg, cefdinir and cefpodoxime) and penicillins (eg, amoxicillin and ampicillin). Generally, antibiotic-associated diarrhea is mild, resolving shortly after the antibiotic therapy is stopped and requiring no treatment. However, older individuals and those in nursing homes or hospitals are more susceptible to severe diarrhea as a result of infection with Clostridioides (formerly Clostridium) difficile, the major enteropathogen of antibiotic-associated diarrhea. […] Outbreaks of C difficile diarrhea may occur in hospitals and outpatient facilities where contamination with spores is prevalent and difficult to control. […] Although the normal gut flora resists C difficile colonization and overgrowth, the use of antibiotics allows proliferation of C difficile, toxin production, and diarrhea.

• #2 Risk factors, incidence, and morbidity associated with antibiotic-associated diarrhea in intensive care unit patients receiving antibiotic monotherapy

  https://www.wjgnet.com/2307-8960/full/v8/i10/1908.htm

  Antibiotic-associated diarrhea (AAD) is diarrhea associated with antibiotic administration. Symptoms can range from mildly self-limiting disease to more severe Clostridium difficile-associated diarrhea (CDAD). Due to the widespread use of antibiotics, the incidence of AAD has gradually increased and has been reported to be as high as 35% in some studies. This increase is directly related to the use of antibiotics. AAD has become an important nosocomial disease, especially in critically ill patients. The incidence of AAD in the intensive care unit (ICU) is growing, and it is becoming a serious condition. Therefore, prevention of AAD is essential for critically ill patients. […] The overall incidence of AAD was 21.53%. Age, proton pump inhibitor usage time, duration of antibiotic, and ICU stay time were associated with AAD.

• #2 Antibiotic-associated diarrhea – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/antibiotic-associated-diarrhea/symptoms-causes/syc-20352231

  Antibiotic-associated diarrhea refers to passing loose, watery stools three or more times a day after taking medications used to treat bacterial infections (antibiotics). […] Most often, antibiotic-associated diarrhea is mild and requires no treatment. The diarrhea typically clears up within a few days after you stop taking the antibiotic. More-serious antibiotic-associated diarrhea requires stopping or sometimes switching antibiotics. […] Call your doctor right away if you have serious signs and symptoms of antibiotic-associated diarrhea. […] To help prevent antibiotic-associated diarrhea, try to: Take antibiotics only when necessary. Don’t use antibiotics unless your doctor feels they’re necessary. Antibiotics can treat bacterial infections, but they won’t help viral infections, such as colds and flu. […] Tell your doctor if you’ve had antibiotic-associated diarrhea or C. difficile before. Having antibiotic-associated diarrhea once or C. difficile in the past increases the chance that antibiotics will cause that same reaction again. Your doctor may be able to select a different antibiotic for you.

• #2 Antibiotic-Associated Diarrhea – Canadian Digestive Health Foundation

  https://cdhf.ca/en/antibiotic-associated-diarrhea/

  Antibiotic-associated diarrhea (AAD) is a common complication of antibiotic treatment. It refers to the passage of loose, watery stool, at least three times per day, in individuals who are taking or recently took antibiotics (Kelly & Lamont, 2021; Gianelli 2017). […] Most cases of AAD are mild, requiring no further treatment. However, sometimes a more serious type of AAD can occur which is caused by the bug (bacterium) Clostridioides difficile, also known as C. diff for short (Barbut & Meynard, 2002). […] In most cases, the diarrhea caused by antibiotics is mild and does not require further medical intervention. However, on occasion, a more severe form of AAD can occur. Symptoms include: Fever, Abdominal pain or tenderness, Profuse watery diarrhea with mucus and/or blood, Dehydration – typical signs and symptoms include feeling tired and lightheaded, thirsty, passing dark coloured urine and less frequent urination, Nausea and loss of appetite (Lewis, 2022; Barbut & Meynard, 2002).

• #2 Antibiotic-associated diarrhea: Symptoms and treatment

  https://www.medicalnewstoday.com/articles/antibiotics-diarrhea

  Diarrhea is one of the most common side effects of taking antibiotics, though it tends to be mild. Sometimes, antibiotics can cause bacterial infection with Clostrioides difficile (C.diff), leading to severe diarrhea. […] A person with diarrhea on antibiotics should carefully monitor their symptoms. If symptoms are very severe, a person gets sicker, or the diarrhea worsens, they should contact their doctor. Signs of dehydration, confusion, or weakness are a medical emergency. […] Antibiotics can also lead to infection with a bacteria called C.diff, which is one of the most common causes of serious antibiotic-related diarrhea. […] The risk factors for developing C. diff include: taking antibiotics longer than a week, being over the age of 65 years, having immune system issues, such as from HIV, AIDS, cancer, or an organ transplant, a recent hospital or nursing home stay, a history of C. diff infection.

• #2 About C. diff | C. diff | CDC

  https://www.cdc.gov/c-diff/about/index.html

  C. diff can affect anyone. Most cases of C. diff infection occur when you’ve been taking antibiotics or not long after you’ve finished the antibiotic course. […] C. diff infection is more common among patients in healthcare settings, such as hospitals and nursing homes. This is because many people carrying C. diff stay or get treated in those facilities. […] Developing diarrhea is common while on or after taking antibiotics. Only in a few cases is that diarrhea caused by C. diff infection. If your diarrhea is severe, do not delay getting medical care. […] Treatment for C. diff infection usually involves taking a specific antibiotic such as vancomycin or fidaxomicin for at least 10 days. […] The healthcare team might admit you to the hospital. In this case, they will use certain precautions, like wearing gowns and gloves to prevent the spread of C. diff infection to themselves and other patients. […] If you start having symptoms again, seek medical care. […] For those with repeat infections, innovative treatments, including fecal microbiota transplants, have shown promising results.

• #2 Clostridioides Difficile: Nursing Diagnoses, Care Plans, Assessment & Interventions | NurseTogether

  https://www.nursetogether.com/clostridioides-difficile-c-diff-nursing-diagnosis-care-plan/

  Frequent watery diarrhea irritates the perineal area and can cause skin breakdown, pressure ulcers, and other infections. […] C. difficile infection causes abdominal pain, cramping, and inflammation of the colon. Frequent diarrhea also causes burning and discomfort to the perianal area. […] Patients with C. difficile infection experience watery diarrhea. In severe cases, diarrhea can occur as often as 15 times per day, causing severe dehydration. […] Diarrhea is the primary symptom of C. difficile infection and can occur up to 15 times per day and last until the infection has resolved. […] C. difficile infection causes severe diarrhea, which results in dehydration and nutrient deficiency.

• #2 Antibiotic-associated diarrhea – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/antibiotic-associated-diarrhea/diagnosis-treatment/drc-20352237

  To diagnose antibiotic-associated diarrhea, your doctor is likely to question you about your health history, including whether you’ve had recent antibiotic treatments. […] Treatment for antibiotic-associated diarrhea depends on the severity of your signs and symptoms. […] If you have mild diarrhea, your symptoms likely will clear up within a few days after your antibiotic treatment ends. […] If you develop C. difficile infection, your doctor will likely stop whatever antibiotic you’re currently taking, and might prescribe antibiotics specifically targeted to kill the C. difficile bacteria causing your diarrhea. […] To cope with diarrhea: Drink enough fluids. […] It’s a good idea to avoid dairy as well as fatty and spicy foods while you have diarrhea. […] In some cases of mild antibiotic-associated diarrhea, your doctor may recommend anti-diarrheal medications, such as loperamide (Imodium A-D).

• #2 Antibiotic-Associated Diarrhea – Harvard Health

  https://www.health.harvard.edu/a_to_z/antibiotic-associated-diarrhea-a-to-z

  Diarrhea caused by the C. difficile toxin usually starts while you are taking an antibiotic, but the diarrhea may be delayed and start a few weeks after you have stopped taking the medication. […] If you have mild, uncomplicated antibiotic-associated diarrhea, your bowel movements should gradually return to normal once your antibiotic treatment ends. […] C. difficile diarrhea usually begins to subside within the first 72 hours of treatment with medication. […] For cases of mild antibiotic-associated diarrhea, try the following suggestions: Drink plenty of fluids to replace body water that has been lost to diarrhea. […] If you have more severe diarrhea due to a C. difficile infection, your doctor probably will stop your antibiotic treatment and prescribe an oral antimicrobial drug called vancomycin or fidaxomicin.

• #2 Antibiotic-associated diarrhea | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/antibiotic-associated-diarrhea?content_id=CON-20166948

  Treatment for antibiotic-associated diarrhea depends on the severity of your signs and symptoms. […] If you have mild diarrhea, your symptoms likely will clear up within a few days after your antibiotic treatment ends. In some cases, your doctor may advise you to stop your antibiotic therapy until your diarrhea subsides. […] If you develop C. difficile infection, your doctor will likely stop whatever antibiotic you’re currently taking, and might prescribe antibiotics specifically targeted to kill the C. difficile bacteria causing your diarrhea. […] To cope with diarrhea: Drink enough fluids. To counter a mild loss of fluids from diarrhea, drink more water or drinks that contain electrolytes. […] Avoid certain foods. It’s a good idea to avoid dairy as well as fatty and spicy foods while you have diarrhea.

• #2 Patient education: Antibiotic-associated diarrhea caused by Clostridioides difficile (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/antibiotic-associated-diarrhea-caused-by-clostridioides-difficile-beyond-the-basics/print

  In most cases, an oral antibiotic (most often fidaxomicin or vancomycin, although a different drug may be used) is used to treat people who are infected with C. difficile. It is important to take each dose of the antibiotic on time and to finish the entire course of treatment (usually 10 to 14 days). […] Diarrhea can cause a person to become dehydrated quickly, especially if it is severe. To avoid becoming dehydrated, several strategies are recommended. It is important to drink an adequate amount of fluids to counteract the loss of fluids from diarrhea. The fluids should contain water, salt, and sugar. […] There is no particular food or group of foods that is best for a person with diarrhea. However, adequate nutrition is important during an episode of acute diarrhea. For patients without an appetite, it is acceptable to consume only liquids for a short period of time.

• #2 Clostridioides (formerly Clostridium) difficile–Induced Diarrhea – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/anaerobic-bacteria/clostridioides-formerly-clostridium-difficile-induced-diarrhea

  Antibiotic-induced changes in gastrointestinal flora are the dominant predisposing factors. […] Antibiotic therapy can cause intestinal overgrowth of toxin-secreting C. difficile, resulting in a pseudomembranous colitis that can be severe and difficult to cure. […] Cephalosporins (particularly 3rd-generation), penicillins, clindamycin, and fluoroquinolones pose the highest risk. […] Diagnose using a stool assay for C. difficile antigen and toxin and sometimes PCR testing for the toxin gene. […] Treat with oral fidaxomicin or vancomycin. […] Recurrence is common; re-treat with antibiotics, and consider fecal transplantation or bezlotoxumab for refractory recurrences.

• #2 Diarrhea Nursing Diagnosis & Care Plan – Nurseslabs

  https://nurseslabs.com/diarrhea/

  Many diarrheas have more than one mechanism. One of the many causes of diarrhea is medications. Diarrhea triggered by prescription drugs should be reported immediately to prevent the worsening of diarrhea. More than 700 medications can cause diarrhea, including furosemide, caffeine, protease inhibitors, thyroid preparations, metformin, mycophenolate mofetil, sirolimus, cholinergic drugs, colchicine, theophylline, selective serotonin reuptake inhibitors, proton pump inhibitors, histamine-2 blockers, 5-ASA derivatives, angiotensin-converting enzyme inhibitors, bisacodyl, senna, aloe, anthraquinones, and magnesium or phosphorus-containing medications. Antibiotics are a common cause of hospital-acquired diarrheas in about 20% of patients receiving broad-spectrum antibiotics. […] Hygiene reduces the risk of perianal excoriation and promotes comfort. A condition known as Fourniers gangrene was associated with neglected prolonged diarrhea, perianal excoriation resulting from diarrhea, and poor hygiene. […] Diarrhea can cause burning and inflammation around the anus. When cleaning, use a mild cleansing agent (perineal skin cleanser), apply a protective ointment or barrier creams, and if the skin is excoriated or desquamated, apply a wound hydrogel.

• #2 Patient education: Antibiotic-associated diarrhea caused by Clostridioides difficile (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/antibiotic-associated-diarrhea-caused-by-clostridioides-difficile-beyond-the-basics

  In most cases, an oral antibiotic (most often fidaxomicin or vancomycin, although a different drug may be used) is used to treat people who are infected with C. difficile. It is important to take each dose of the antibiotic on time and to finish the entire course of treatment (usually 10 to 14 days). […] Diarrhea can cause a person to become dehydrated quickly, especially if it is severe. To avoid becoming dehydrated, several strategies are recommended. It is important to drink an adequate amount of fluids to counteract the loss of fluids from diarrhea. The fluids should contain water, salt, and sugar. […] There is no particular food or group of foods that is best for a person with diarrhea. However, adequate nutrition is important during an episode of acute diarrhea. For patients without an appetite, it is acceptable to consume only liquids for a short period of time. Boiled starches and cereals with salt are recommended for people with watery diarrhea; crackers, bananas, and soup may also be eaten.

• #2 Clostridioides Difficile: Nursing Diagnoses, Care Plans, Assessment & Interventions | NurseTogether

  https://www.nursetogether.com/clostridioides-difficile-c-diff-nursing-diagnosis-care-plan/

  C. difficile is highly contagious and can easily be transmitted through person-to-person contact and contaminated fomites. […] Antibiotic use is the most common cause of C. difficile infection. Antibiotics like clindamycin, penicillins, and cephalosporins tend to destroy healthy bacteria in the body along with the bacteria they are formulated to kill. Without these helpful bacteria, C. difficile can proliferate and cause infection. […] Frequent, foul-smelling, watery stools characterize CDI. […] Since CDI causes severe diarrhea, there is a higher risk of dehydration. […] Serious complications like severe dehydration can arise from diarrhea related to CDI. […] Fluid losses occur quickly with diarrhea. Severe dehydration may need to be treated with IV therapy. Encourage plenty of oral fluids as tolerated. Hydration can also prevent kidney failure.

• #2 Managing antibiotic associated diarrhoea

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1123310/

  Treatment of C difficile related diarrhoea is based on oral metronidazole (250 mg four times daily) or oral vancomycin (125 mg four times daily) for 10 days. The response to metronidazole or vancomycin is similar (90%), and diarrhoea usually resolves in two or three days. […] The key measure for preventing antibiotic associated diarrhoea, however, is to limit antibiotic use. Probiotics have proved useful in preventing diarrhoea, but the number of clinical trials is limited and further controlled trials using different probiotics are needed. […] In the case of C difficile related diarrhoea hygiene measures (single rooms, use of gloves, and handwashing) should be systematically associated with treatment in order to prevent transmission and dissemination of this nosocomial bacteria.

• #2 Antibiotic-Associated Diarrhea – Canadian Digestive Health Foundation

  https://cdhf.ca/en/antibiotic-associated-diarrhea/

  Here are some strategies to adopt if you have diarrhea: Hydration: Drink plenty of fluids containing adequate amounts of water, sugar and salts to stay hydrated. It is important to counteract the fluid and electrolyte lost though diarrhea. If you are unable to take fluids by mouth, contact your physician or visit the nearest emergency room. […] Contact your health care provider: If you have mild diarrhea, your symptoms will generally clear up once the antibiotic therapy is completed. However, in some cases your doctor may decide to stop the antibiotic until symptoms resolve. Your doctor may also order some tests to determine the cause of diarrhea and depending on the results and/or the severity of your symptoms you may require hospital admission. If C. diff is found to be the cause of AAD, another antibiotic may need to be prescribed for treatment (Kelly & Lamont, 2021; Giannelli 2017). Follow your doctor’s advice and take your medication as prescribed.

• #2 Can antibiotics cause diarrhea?

  https://www.singlecare.com/blog/diarrhea-from-antibiotics/

  Call your healthcare provider immediately if you experience additional symptoms such as weakness, fever, or loss of appetite. A doctor can do a stool sample to test for C. diff and treat it quickly, Dr. Pepin says. […] Prevention of antibiotic-associated diarrhea involves the same practices as treatment options: Take the most targeted treatment for your infection versus a broad-spectrum antibiotic. This reduces the chance of disrupting your gut microbiome.

• #2 Probiotics for Preventing Antibiotic-Associated Diarrhea | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1200/od1.html

  Antibiotic-associated diarrhea was prevented in 1 out of 20 patients taking probiotics. […] There was a 5.1% reduction in antibiotic-associated diarrhea. […] AAD can occur in up to 35% of patients who receive antibiotics and is associated with higher health care costs and increased morbidity and mortality. […] Probiotics reduced the risk of AAD overall (13.7% vs. 18.8%; absolute risk difference = 5.1%; number needed to treat = 20; risk ratio [RR] = 0.63; 95% CI, 0.54 to 0.73; moderate-quality evidence). […] Probiotic use in patients at moderate (11% to 30%) and high (31% or greater) baseline risk of AAD demonstrated a significant overall reduction (RR = 0.61; 95% CI, 0.48 to 0.78, and RR = 0.55; 95% CI, 0.46 to 0.66, respectively). […] Despite significant limitations due to heterogeneity, this meta-analysis found that probiotics reduced the incidence of AAD with no observed serious adverse effects.

• #2 Antibiotic-Associated Diarrhea – Canadian Digestive Health Foundation

  https://cdhf.ca/en/antibiotic-associated-diarrhea/

  Another option is probiotics such as Florastor which add “helpful” or “good” micro-organisms (yeast) to the digestive system (Cannon, 2019; Barbut & Meynard, 2002). […] Many studies have demonstrated that probiotics may help prevent or reduce the risk of antibiotic-associated diarrhea (Barbut & Meynard, 2002). It has been proven that Florastor probiotics reduces the incidence of antibiotic-associated diarrhea by up to 80% in children and up to 84% in adults (Kotowska et. Al, 2005).

• #2 Lactobacillus GG in the Prevention of Antibiotic-Associated Diarrhea in the Pediatric Intensive Care Unit: A Prospective Randomized, Double-Blind Placebo Controlled Intervention in: The Journal of Pediatric Pharmacology and Therapeutics Volume 30: Issue 1

  https://jppt.kglmeridian.com/view/journals/jppt/30/1/article-p47.xml

  This study utilized LGG and a standardized definition of diarrhea to assess and determine the incidence of diarrhea in a lactobacillus group vs a placebo-controlled group of critically ill pediatric patients. […] Results of this pilot study indicate that LGG is safe and could potentially reduce the incidence of AAD in the critically ill pediatric patients at this academic institution. […] Our findings suggest clinicians should consider the use of LGG in appropriate PICU patients.

• #2

  http://www.diva-portal.org/smash/record.jsf?pid=diva2:1432135

  BACKGROUND: Antibiotic-associated diarrhea (AAD) occurs in 2-25% of nursing home residents, which may lead to dehydration, malnutrition, severe complications and hospitalizations. […] The objectives of this evaluation were to develop a procedure for the implementation of probiotics to prevent AAD in nursing homes, to evaluate effects on AAD occurrence, and to evaluate the implementation process of probiotics in daily care. […] The occurrence of AAD was monitored and a process evaluation was conducted to assess facilitators and barriers of probiotics implementation. […] The number of episodes with AAD when using probiotics was significantly lower than when no probiotics was used (20% vs 36%; p=0,022, Chi-square). […] Successful implementation of probiotics demonstrated the prevention of AAD in nursing home residents.

• #2 Probiotics for Antibiotic-Associated Diarrhea and C. diff | Effective Health Care (EHC) Program

  https://effectivehealthcare.ahrq.gov/get-involved/nominated-topics/probiotics-antibiotics

  We believe that the evidence exists to support efficacious probiotics to be stocked in all hospital formularies. […] Currently, it appears that while some clinicians recommend probiotics, they are not being used in an evidence-based manner, this could change with an authoritative review by the EPC. […] A definitive, evidence-based report, such as the EPCs conduct, would likely result in many national organizations revising or clarifying their recommendations about probiotic usage with antibiotics. […] There are enough studies that we believe the EPC review can help dictate how to best implement prophylactic probiotic usage.

• #2 Antibiotic-Associated Diarrhea: Causes, Treatment, Prevention

  https://www.verywellhealth.com/antibiotics-and-diarrhea-1941560

  Antibiotic-associated diarrhea is more common when: […] Generally speaking, antibiotic-associated diarrhea will improve once the course of antibiotics is completed. […] If a C difficile infection is confirmed, the antibiotics metronidazole and vancomycin may be prescribed to kill the bacteria and restore the normal digestive flora. […] Studies have shown replacing the good bacteria in the gut also can be helpful in treating diarrhea. […] In 2020, the American Gastroenterology Association released a statement suggesting some adults and children on antibiotic treatment may benefit from taking a probiotic as a measure to help prevent infection with C. difficile bacteria. […] Severe diarrhea should never be ignored or self-treated with anti-diarrheal drugs.

• #2 Antibiotic-Associated Diarrhea – Harvard Health

  https://www.health.harvard.edu/a_to_z/antibiotic-associated-diarrhea-a-to-z

  Because C. difficile lives silently in the bowels of about 5% of people, episodes of C. difficile diarrhea occasionally occur in otherwise healthy adults and children who are taking antibiotics. […] C. difficile infections are more common among recently hospitalized patients, the elderly and those with debilitating illnesses. […] If you are taking an antibiotic, the medication will cause a mild change in your population of intestinal bacteria that may cause occasional loose stools or mild diarrhea for a few days. […] These symptoms should stop once your antibiotic treatment ends. […] If you have a more dramatic change in your bowel bacteria, and C. difficile bacteria begin to overgrow, your symptoms can include: watery diarrhea, crampy abdominal pain, abdominal tenderness, fever, pus or blood in your diarrhea (if your illness progresses to C. difficile colitis).

• #2 Probiotics use for antibiotic-associated diarrhea: a pragmatic participatory evaluation in nursing homes

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7222499/

  Antibiotic-associated diarrhea (AAD) occurs in 225% of nursing home residents, which may lead to dehydration, malnutrition, severe complications and hospitalizations. Research shows that probiotics can be effective and safe in reducing AAD. […] Probiotics administration was implemented in three nursing homes of the Rivas Zorggroep for residents with somatic and/or psychogeriatric conditions. […] The number of episodes with AAD when using probiotics was significantly lower than when no probiotics was used (20% vs 36%; p=0,022, Chi-square). […] Successful implementation of probiotics demonstrated the prevention of AAD in nursing home residents. […] The aim of this evaluation was twofold: 1) evaluation of changes in the occurrence of AAD by administrating multispecies probiotics to nursing home residents, and 2) evaluation of the implementation process of probiotics in daily nursing home practice.

• #2 Probiotics for the prevention of antibiotic-associated diarrhea in children | Cochrane

  https://www.cochrane.org/CD004827/IBD_probiotics-prevention-antibiotic-associated-diarrhea-children

  Antibiotic-associated diarrhea (AAD) occurs when antibiotics disturb the natural balance of „good” and „bad” bacteria in the intestinal tract causing harmful bacteria to multiply beyond their normal numbers. The symptoms of AAD include frequent watery bowel movements and crampy abdominal pain. […] The researchers investigated whether probiotics prevent AAD in children receiving antibiotic therapy and whether probiotics causes any harms (side effects). […] Analyses showed that probiotics are effective for preventing AAD. The incidence of AAD in the probiotic group was 8% (259/3232) compared to 19% (598/3120) in the control group, demonstrating a moderate reduction (11% fewer will suffer diarrhea). […] Evidence suggested that probiotics are effective for a moderate reduction in duration of diarrhea (almost one day).

• #2 Antibiotic associated diarrhea in outpatient pediatric antibiotic therapy | BMC Pediatrics | Full Text

  https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-023-03939-w

  Antibiotic-associated diarrhea is one of the most frequent side effects of antimicrobial therapy. […] Antibiotic-associated diarrhoea (AAD) is defined as diarrhoea that develops any time from a few hours after the onset of antibiotic therapy to eight weeks following antibiotic cessation. […] Antibiotic associated diarrhea was defined by the daily production of at least three soft or liquid stools (BSC4) for at least two consecutive days. […] This study on pediatric antibiotic-associated diarrhea displayed epidemiological data and the differences geographically in our region. […] The incidence of AAD was independent of the site of the infection and the choice of antibiotics. […] The therapeutic doses that are used in clinical practice do not typically reduce the total bacterial biomass in the gastrointestinal system, but can eliminate the subsets of the microbiota, thus shifting the community in ways that promote colonisation by opportunistic pathogens.

• #2 Probiotics for the prevention of antibiotic-associated diarrhea in children | Cochrane

  https://www.cochrane.org/CD004827/IBD_probiotics-prevention-antibiotic-associated-diarrhea-children

  The overall evidence suggests a moderate protective effect of probiotics for preventing AAD (NNTB 9, 95% CI 7 to 13). […] Evidence also suggests that probiotics may moderately reduce the duration of diarrhea, a reduction by almost one day. […] Adverse event rates were low and no serious adverse events were attributable to probiotics. […] Common adverse events included rash, nausea, gas, flatulence, abdominal bloating, and constipation.

• #2 Risk factors, incidence, and morbidity associated with antibiotic-associated diarrhea in intensive care unit patients receiving antibiotic monotherapy

  https://www.wjgnet.com/2307-8960/full/v8/i10/1908.htm

  Older age, longer ICU stay time, proton pump inhibitor usage time, and duration of antibiotic increase the incidence of AAD in ICU patients receiving antibiotic monotherapy. […] In conclusion, the incidence of AAD was high in ICU patients receiving antibiotic monotherapy, especially the use of the beta-lactam plus enzyme inhibitor antibiotics. Longer ICU stay time, duration of antibiotic, and duration of use of proton pump inhibitors increase the risk of AAD. Therefore, in order to prevent AAD in ICU patients, antibiotics should be used rationally, and the use and use time of auxiliary drugs such as proton pump inhibitors should be strictly controlled.

• #2 Lactobacillus GG in the Prevention of Antibiotic-Associated Diarrhea in the Pediatric Intensive Care Unit: A Prospective Randomized, Double-Blind Placebo Controlled Intervention in: The Journal of Pediatric Pharmacology and Therapeutics Volume 30: Issue 1

  https://jppt.kglmeridian.com/view/journals/jppt/30/1/article-p47.xml

  The objective of this study was to assess the efficacy of lactobacillus GG (LGG) to prevent antibiotic-associated diarrhea (AAD) in the pediatric intensive care unit (PICU). […] This was a prospective randomized, double-blind, placebo-controlled pilot trial in an academic PICU over 1 year. […] Antibiotic associated diarrhea (AAD) is a common complication of antibiotic use due to disruption of the normal intestinal microbiota and has a reported incidence of 11% to 62% depending on the location (inpatient, outpatient, intensive care unit [ICU]), age and antibiotic type. […] Currently, no studies have examined the impact of probiotics on the prevention of AAD in the PICU population as their primary outcome. […] The objective of this study was to assess the efficacy of LGG to prevent AAD in the PICU.

• #2 Diarrhea Nursing Diagnosis & Care Plans | NurseTogether

  https://www.nursetogether.com/diarrhea-nursing-diagnosis-care-plan/

  Nurses should monitor a patients diarrhea for worsening symptoms and subsequent alterations to nutrition, vital signs, lab values, and skin integrity. Nurses should also educate patients on diet recommendations, medication use, and hydration guidelines to prevent diarrhea. […] Antibiotic use is a common cause of diarrhea. […] Administer antidiarrheals as appropriate. Once the cause of diarrhea has been determined and it is not contraindicated, administer antidiarrheals to stop diarrhea. […] Promote skin integrity. Frequent diarrhea can cause skin breakdown to the perianal area. Educate on proper wiping from front to back and the use of non-irritating cleansers. If the patient is incontinent, provide frequent diaper changes and keep the perineum dry and apply skin barrier ointments. […] Educate on proper food handling. Food poisoning is a common cause of diarrhea. Ensure the patient understands how to properly handle and cook food. Prevent cross-contamination when handling raw meats and clean produce before ingesting. Do not eat food that has not been properly refrigerated or cooked. Always wash hands before eating. […] Chronic diarrhea that lasts longer than four weeks requires further assessment. The patient may need a referral to a gastroenterologist to investigate for a possible inflammatory bowel disease or a cause of malabsorption.

• #2 Clostridioides Difficile: Nursing Diagnoses, Care Plans, Assessment & Interventions | NurseTogether

  https://www.nursetogether.com/clostridioides-difficile-c-diff-nursing-diagnosis-care-plan/

  Since C. difficile infection is often related to a current antibiotic regimen that the patient is taking, it is critical to stop the current antibiotic causing C. difficile infection and replace it with another medication that will be less likely to cause this bacteria. […] Supportive treatment through proper nutrition and adequate fluid intake is necessary to prevent dehydration. Nurses play a vital role in managing symptoms of C. diff like diarrhea and abdominal pain. Nurses also instruct patients and staff on precautions to prevent the transmission of C. diff bacteria. […] Diarrhea and colon inflammation (colitis) are the hallmark signs of C.difficile infection. […] Signs and symptoms of mild to moderate C. difficile include watery diarrhea more than three times a day for more than one day with mild abdominal tenderness and cramping.

• #2

  https://www.nursingcenter.com/journalarticle?Article_ID=6460244&Journal_ID=54030&Issue_ID=6460051

  Antibiotic-associated diarrhea is a common complication of antibiotic treatment. […] A placebo-controlled, randomized clinical trial was designed to evaluate the efficacy of a multispecies probiotic in the prevention of antibiotic-associated diarrhea in pediatric inpatients and outpatients. […] Compared with placebo, the probiotic didn’t have a significant effect on the risk of antibiotic-associated diarrhea. […] The authors point out that the cause of diarrhea may not be relevant so long as the preventive intervention is effective, concluding that the studied probiotic may be an option for the prevention of diarrhea in children receiving antibiotic treatment.

• #3 Probiotics Decrease Risk for Antibiotic-Associated Diarrhea

  https://www.medscape.org/viewarticle/763825

  This article is intended for primary care clinicians, infectious disease specialists, and other specialists who provide care to patients with antibiotic-associated diarrhea. […] Probiotics appear to reduce risk for antibiotic-related diarrhea, although questions of which probiotics work best, with which antibiotics, or even how much probiotic someone needs to take remain up in the air after a meta-analysis of 63 sometimes shaky randomized controlled trials. […] Antibiotic-related diarrhea occurs in an estimated 30% of patients and can be a reason for nonadherence to treatment, the authors note. Use of probiotics (living microorganisms with possible health benefits, such as those in yogurt) is gaining interest, they write. […] In patients taking antibiotics, probiotic use is associated with a decrease in the risk for antibiotic-associated diarrhea, with an RR of 0.58 and an NNT of 13. […] In patients with antibiotic-associated diarrhea, the link between probiotic use and a reduced risk for antibiotic-associated diarrhea does not vary by age, clinical indications, type of probiotic, or duration of antibiotic use.

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