Materiały źródłowe

• #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). […] About 1 in 5 people who take antibiotics develop antibiotic-associated diarrhea. […] It’s commonly thought to develop when antibacterial medications (antibiotics) upset the balance of good and bad bacteria in your gastrointestinal tract. […] Nearly all antibiotics can cause antibiotic-associated diarrhea. […] The antibiotics most commonly linked to C. difficile infection include clindamycin, fluoroquinolones, cephalosporins and penicillins though taking virtually any antibiotic can put you at risk.

• #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

  Symptoms of C. difficile may begin during antibiotic therapy or 5 to 10 days after the antibiotic is stopped; less commonly, symptoms do not develop until as late as 10 weeks later. The most common symptoms include diarrhea (three or more unformed bowel movements per day), or diarrhea associated with abdominal cramping. In more severe cases, patients may develop profuse watery diarrhea, blood or pus in the stool, dehydration, abdominal tenderness and cramping, fever, nausea, loss of appetite, and weight loss. […] The diagnosis of C. difficile is based upon laboratory analysis of a stool sample to identify toxin-producing C. difficile or its toxins. […] 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. Antibiotic treatment – In most cases, an oral antibiotic (most often fidaxomicin or vancomycin) is used to treat people who are infected with C. difficile.

• #3 Antibiotic-associated diarrhea: a refresher on causes and possible prevention with probiotics–continuing education article – PubMed

  https://pubmed.ncbi.nlm.nih.gov/24064436/

  Antibiotic-associated diarrhea (AAD) describes any unexplained diarrhea associated with the use of an antibiotic. AAD also includes infection caused by Clostridium difficile, however this organism only accounts for a small percentage of diarrhea caused by antibiotics. AAD can be caused by multiple other organisms including C perfringens, S aureus, and Candida. Some antibiotics are more likely to cause non-C difficile AAD, such as erythromycin and the penicillin class. AAD develops through the loss of normal flora and reduced colonic bacterial carbohydrate metabolism during antibiotic administration. […] There is an increasing interest in the use of probiotics for the prevention of AAD. There are several meta-analyses that report a relative risk reduction of AAD with the use of probiotics during antibiotic administration. […] Since AAD can be a reason for a patient to become non-compliant or receive incomplete treatment, clinicians should monitor for this potential adverse effect caused by antibiotics.

• #4 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. […] Estimates of how common antibiotic-associated diarrhea vary widely, but a 2020 review suggests a rate of 20 to 35% among children taking antibiotics. A 2018 article suggests the incidence in adults is 5% to 25%. […] 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. […] As antibiotics can alter the microbial flora or microorganisms in the large intestines, a person may be more susceptible to C. diff infection. A primary symptom of infection is very severe diarrhea, which in turn can lead to complications such as dehydration and electrolyte imbalances.

• #5 Antibiotics & Diarrhea – IFFGD

  https://iffgd.org/gi-disorders/diarrhea/antibiotics-diarrhea/

  Antibiotic therapy is a common source of diarrhea in both hospitalized patients and outpatients. Approximately 20% of patients taking antibiotics will develop diarrhea. […] Antibiotics can cause a change in the normal colonic flora or the type of bacteria that normally reside in the colon. […] When antibiotics are taken, they alter the number and types of bacteria present in the colon. The result is an impaired absorption of carbohydrates. This leads to water secretion and looser stools. […] The second factor, which can cause diarrhea after antibiotic use, is C. difficile colitis. C. difficile is a bacterium that can increase in number after a course of antibiotics. This bacterium produces a toxin that causes inflammatory changes in the colon. These inflammatory changes result in both impaired water reabsorption in the colon and secretion of fluid resulting in diarrhea.

• #6 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. Many are harmless or even helpful to the body, but a few have the potential to be aggressive troublemakers. […] This can change dramatically when a person begins treatment with an antibiotic. This is because antibiotics can kill large numbers of the bowel’s normal bacteria, altering the delicate balance among the various species. […] 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.

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

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

  Antibacterial drugs can disrupt normal gut flora. […] It may not have been a bug or something you ate; it could have been a result of an adverse effect of an antibiotic. […] Antibiotics work by killing off bacteria but cannot distinguish between „good” and „bad” bacteria. If the natural balance of the gut flora is disturbed, the „bad” bacteria can sometimes predominate and trigger loose stools and diarrhea. […] Antibiotic-associated diarrhea is more common when: More than one antibiotic is prescribed, An antibiotic is used for an extended period of time, An antibiotic is taken at a higher dose, A powerful broad-spectrum antibiotic is used. […] One of the more common „bad” bacteria is called Clostridioides difficile. […] If this happens, C difficile can begin to multiply and cause symptoms.

• #8 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. […] Currently fewer than 33% of AAD cases can be attributable to Clostridioides difficile leaving a large number of cases undiagnosed and poorly treated. […] Although the pathogenesis of Clostridioides difficile infection (CDI) has been well documented, the role of other putative microbial etiologies (Clostridium perfringens, Staphylococcus aureus, Klebsiella oxytoca, Candida species) and their pathogenic mechanisms in AAD has been unclear. […] 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.

• #9 Antibiotic-associated diarrhea | Content for the lay public | Microbiota institute

  https://www.biocodexmicrobiotainstitute.com/en/antibiotic-associated-diarrhea

  Antibiotics are a powerful tool in the fight against bacterial infections. While treatments sometimes appear to be without obvious short-term side effects, the gut microbiota imbalance they provoke can cause diarrhea in up to 35% of patients. This antibiotic-associated diarrhea (AAD) can at times cloak serious intestinal infections. […] This imbalance (known as dysbiosis) causes AAD, as the gut microbiota is less able to perform its protective functions. AAD can affect up to 35% of patients and up to 80% of children receiving antibiotic treatment. […] The main short-term consequence of antibiotic treatment is the altered bowel movements experienced by some patients, most often resulting in diarrhea. AAD is defined as three or more very loose or liquid stools within 24 hours of the beginning of antibiotic treatment or up to 2 months after its cessation. Its incidence depends on several factors, including age, context and the type of antibiotic. The diarrhea is usually mild to moderate in intensity and in the vast majority of cases is functional, i.e. associated with a gut microbiota imbalance. Antibiotics with the broadest spectrum of antimicrobial activity are associated with higher rates of diarrhea.

• #10

  https://journals.lww.com/infectdis/fulltext/2002/02000/antibiotic_associated_diarrhea.24.aspx

  This is a review of antibiotic associated diarrhea with the following points: Antibiotics: The highest rates of AAD are with amoxicillin, amoxicillin-clavulanate (Augmentin) and cefixime; lower rates of 25% are seen with most other antibiotics including oral cephalosporins, fluoroquinolones, macrolides and tetracycline. […] C. difficile accounts for 10-20% of all cases of antibiotic-associated diarrhea, most cases of antibiotic-associated colitis, and virtually all cases of PMC. […] Major other causes of antibiotic-associated diarrhea are: other enteric pathogens (C. perfringens type A, S. aureus and salmonella), direct effect on the gut by antibiotics (erythromycin, clavulanate) and, probably most important, the results of reducing fecal anaerobes (decreased metabolism of carbohydrates with osmotic diarrhea and reduced breakdown of primary bile acids which are potent colonic secretory agents).

• #11 Antibiotics Diarrhea: Causes, Treatment, and Prevention

  https://www.healthline.com/health/antibiotics-diarrhea

  Antibiotic-related diarrhea is caused by disrupting the bacterial balance in your intestines. Certain antibiotics are more likely to cause it, such as penicillins and cephalosporins. […] Antibiotic-associated diarrhea is fairly common. Its estimated that between 5 and 25 percent of adults may experience diarrhea while taking antibiotics. […] Antibiotics can disrupt the balance of these bacteria. One of the side effects of killing off the good bacteria, in addition to the bad bacteria, is the possibility of looser stools. […] Toxins produced by C. diff can cause inflammation in the intestines, leading to diarrhea. […] Although all antibiotics can cause diarrhea, some types are more closely associated with the condition. […] Antibiotics that have a higher likelihood of causing diarrhea include: penicillins, such as ampicillin and amoxicillin; cephalosporins, such as cephalexin and cefpodoxime; clindamycin.

• #12 Antibiotic associated diarrhoea: infectious causes – PubMed

  https://pubmed.ncbi.nlm.nih.gov/17642966/

  Nearly 25% of antibiotic associated diarrhoeas (AAD) is caused by Clostridium difficile, making it the commonest identified and treatable pathogen. Other pathogens implicated infrequently include Clostridium perfringens, Staphylococcus aureus, Klebsiella oxytoca, Candida spp. and Salmonella spp. […] Most mild cases of AAD are due to non-infectious causes which include reduced break down of primary bile acids and decrease metabolism of carbohydrates, allergic or toxic effects of antibiotic on intestinal mucosa and pharmacological effect on gut motility. The antibiotics most frequently associated with C. difficile associated diarrhoea are clindamycin, cephalosporin, ampicillin and amoxicillin. […] Clinical presentation may vary from mild diarrhoea to severe colitis and pseudomembranous colitis associated with high morbidity and mortality. The most sensitive and specific diagnostic test for C. difficile infection is tissue culture assay for cytotoxicity of toxin B. Commercial ELISA kits are available. Though less sensitive, they are easy to perform and are rapid. […] For severe cases of AAD, oral metronidazole is the first line of treatment, and oral vancomycin is the second choice. Probiotics have been used for recurrent cases.

• #13 Antibiotic-associated diarrhea: a refresher on causes and possible prevention with probiotics–continuing education article – PubMed

  https://pubmed.ncbi.nlm.nih.gov/24064436/

  Antibiotic-associated diarrhea (AAD) describes any unexplained diarrhea associated with the use of an antibiotic. AAD also includes infection caused by Clostridium difficile, however this organism only accounts for a small percentage of diarrhea caused by antibiotics. AAD can be caused by multiple other organisms including C perfringens, S aureus, and Candida. Some antibiotics are more likely to cause non-C difficile AAD, such as erythromycin and the penicillin class. AAD develops through the loss of normal flora and reduced colonic bacterial carbohydrate metabolism during antibiotic administration. […] There is an increasing interest in the use of probiotics for the prevention of AAD. There are several meta-analyses that report a relative risk reduction of AAD with the use of probiotics during antibiotic administration. […] Since AAD can be a reason for a patient to become non-compliant or receive incomplete treatment, clinicians should monitor for this potential adverse effect caused by antibiotics.

• #14 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. Many are harmless or even helpful to the body, but a few have the potential to be aggressive troublemakers. […] This can change dramatically when a person begins treatment with an antibiotic. This is because antibiotics can kill large numbers of the bowel’s normal bacteria, altering the delicate balance among the various species. […] 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.

• #15 Antibiotic associated diarrhoea: infectious causes – PubMed

  https://pubmed.ncbi.nlm.nih.gov/17642966/

  Nearly 25% of antibiotic associated diarrhoeas (AAD) is caused by Clostridium difficile, making it the commonest identified and treatable pathogen. Other pathogens implicated infrequently include Clostridium perfringens, Staphylococcus aureus, Klebsiella oxytoca, Candida spp. and Salmonella spp. […] Most mild cases of AAD are due to non-infectious causes which include reduced break down of primary bile acids and decrease metabolism of carbohydrates, allergic or toxic effects of antibiotic on intestinal mucosa and pharmacological effect on gut motility. The antibiotics most frequently associated with C. difficile associated diarrhoea are clindamycin, cephalosporin, ampicillin and amoxicillin. […] Clinical presentation may vary from mild diarrhoea to severe colitis and pseudomembranous colitis associated with high morbidity and mortality. The most sensitive and specific diagnostic test for C. difficile infection is tissue culture assay for cytotoxicity of toxin B. Commercial ELISA kits are available. Though less sensitive, they are easy to perform and are rapid. […] For severe cases of AAD, oral metronidazole is the first line of treatment, and oral vancomycin is the second choice. Probiotics have been used for recurrent cases.

• #16 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

  Although the role of C. difficile in the pathogenesis of AAD has been well studied, there are considerable gaps in our understanding of the pathogenesis of non-CDI AAD due to putative microbial etiologies including C. perfringens, S. aureus, K. oxytoca, and Candida species. […] C. difficile has been proven to cause AAD. C. difficile AAD is reported to be 4 and 60 times more common than C. perfringens or S. aureus, respectively. […] K. oxytoca is considered in patients with C. difficile negative bloody diarrhea. […] C. perfringens enterotoxin has been detected in studies along with C. difficile toxin and may act alone or in synergy. […] Studies reported distinct clinical features in patients where S. aureus enterotoxin was isolated. […] The role of Candida spp. in AAD has been debated since the 1950s and continues to be controversial. […] Only 40% of AAD can be accounted for by the above causes leaving a majority of AAD cases without an etiology. […] Limited studies have shown that strains of Pseudomonas aeruginosa may be a possible cause of AAD.

• #17 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. […] C. difficile is a disease-causing bacterium that can infect the large bowel and cause colitis. Taking antibiotics can kill these „good” bacteria, allowing C. difficile to multiply and release toxins that damage the cells lining the intestinal wall, causing diarrhea, abdominal pain, and fever as well as other symptoms.

• #18 About C. diff | C. diff | CDC

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

  C. diff is a germ that causes diarrhea and colitis (an inflammation of the colon) and can be life-threatening. […] Most cases of C. diff infection occur when you’ve been taking antibiotics or not long after you’ve finished the antibiotic course. […] While C. diff infection can affect anyone, most cases occur when you’ve been taking antibiotics or soon after you’ve finished taking antibiotics. People are up to 10 times more likely to get C. diff infection while taking an antibiotic or during the three months after, with longer courses potentially doubling their risk. […] C. diff germs spread from person to person in poop, but the bacteria are often found in the environment. […] Taking antibiotics can affect your microbiome, making you more susceptible to illnesses like C. diff infection.

• #19 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. […] C. difficile is a disease-causing bacterium that can infect the large bowel and cause colitis. Taking antibiotics can kill these „good” bacteria, allowing C. difficile to multiply and release toxins that damage the cells lining the intestinal wall, causing diarrhea, abdominal pain, and fever as well as other symptoms.

• #20 Pseudomembranous colitis – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pseudomembranous-colitis/symptoms-causes/syc-20351434

  Pseudomembranous colitis is sometimes called antibiotic-associated colitis or C. difficile colitis. […] This overgrowth of Clostridioides difficile (C. difficile) is often related to a recent hospital stay or antibiotic treatment. […] Symptoms of pseudomembranous colitis can begin as soon as 1 to 2 days after you start taking an antibiotic, or as long as several months or longer after you finish taking the antibiotic. […] Pseudomembranous colitis occurs when certain bacteria, usually C. difficile, rapidly outgrow other bacteria that typically keep them in check. Certain toxins produced by C. difficile can rise to levels high enough to damage the colon. […] While almost any antibiotic can cause pseudomembranous colitis, some antibiotics are more commonly linked to pseudomembranous colitis than others, including: Fluoroquinolones, such as ciprofloxacin (Cipro) and levofloxacin; Penicillins, such as amoxicillin and ampicillin; Clindamycin (Cleocin); Cephalosporins, such as cefixime (Suprax).

• #21 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

  C. difficile infections have become more frequent, more severe, more difficult to treat, and more likely to recur after initial treatment. […] A number of factors can increase a person’s risk of becoming infected with C. difficile: Current or recent antibiotic use – Certain antibiotics increase the risk of becoming infected with C. difficile more than others. Current or recent hospitalization – Up to 20 percent of people who are hospitalized and up to 50 percent of people in long-term care facilities carry C. difficile in their feces. Older age – The risk of becoming infected with C. difficile is 10 times greater in people who are 65 years or older. Severe illness – People who have a weakened immune system as a result of an underlying medical condition or a treatment are at increased risk of becoming infected with C. difficile. Recent infection with C. difficile – People who have been recently infected with C. difficile and treated have an increased risk of becoming infected again soon after stopping the treatment. Inflammatory bowel disease (ulcerative colitis or Crohn’s disease with colitis) – People with colitis from inflammatory bowel disease have an increased risk of developing C. difficile infection.

• #22 Pseudomembranous colitis – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pseudomembranous-colitis/symptoms-causes/syc-20351434

  Other medicines besides antibiotics can sometimes cause pseudomembranous colitis. […] More and more often, C. difficile is being reported in people with no known risk factors, including people with no recent health care contact or use of antibiotics. […] An aggressive strain of C. difficile has emerged that produces far more toxins than other strains do. The new strain may be more resistant to certain medicines and has been reported in people who haven’t been in the hospital or taken antibiotics.

• #23 Antibiotic associated diarrhoea: infectious causes – PubMed

  https://pubmed.ncbi.nlm.nih.gov/17642966/

  Nearly 25% of antibiotic associated diarrhoeas (AAD) is caused by Clostridium difficile, making it the commonest identified and treatable pathogen. Other pathogens implicated infrequently include Clostridium perfringens, Staphylococcus aureus, Klebsiella oxytoca, Candida spp. and Salmonella spp. […] Most mild cases of AAD are due to non-infectious causes which include reduced break down of primary bile acids and decrease metabolism of carbohydrates, allergic or toxic effects of antibiotic on intestinal mucosa and pharmacological effect on gut motility. The antibiotics most frequently associated with C. difficile associated diarrhoea are clindamycin, cephalosporin, ampicillin and amoxicillin. […] Clinical presentation may vary from mild diarrhoea to severe colitis and pseudomembranous colitis associated with high morbidity and mortality. The most sensitive and specific diagnostic test for C. difficile infection is tissue culture assay for cytotoxicity of toxin B. Commercial ELISA kits are available. Though less sensitive, they are easy to perform and are rapid. […] For severe cases of AAD, oral metronidazole is the first line of treatment, and oral vancomycin is the second choice. Probiotics have been used for recurrent cases.

• #24 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

  Although the role of C. difficile in the pathogenesis of AAD has been well studied, there are considerable gaps in our understanding of the pathogenesis of non-CDI AAD due to putative microbial etiologies including C. perfringens, S. aureus, K. oxytoca, and Candida species. […] C. difficile has been proven to cause AAD. C. difficile AAD is reported to be 4 and 60 times more common than C. perfringens or S. aureus, respectively. […] K. oxytoca is considered in patients with C. difficile negative bloody diarrhea. […] C. perfringens enterotoxin has been detected in studies along with C. difficile toxin and may act alone or in synergy. […] Studies reported distinct clinical features in patients where S. aureus enterotoxin was isolated. […] The role of Candida spp. in AAD has been debated since the 1950s and continues to be controversial. […] Only 40% of AAD can be accounted for by the above causes leaving a majority of AAD cases without an etiology. […] Limited studies have shown that strains of Pseudomonas aeruginosa may be a possible cause of AAD.

• #25 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. […] 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. […] Although the role of C. difficile in the pathogenesis of AAD has been well studied, there are considerable gaps in our understanding of the pathogenesis of non-CDI AAD due to putative microbial etiologies including C. perfringens, S. aureus, K. oxytoca, and Candida species. Identifying the etiology and understanding the pathogenesis of AAD will help in improving healthcare and in reducing the economic burden.

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

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

  C. difficile has been proven to cause AAD. C. difficile AAD is reported to be 4 and 60 times more common than C. perfringens or S. aureus, respectively. […] Although C. difficile is implicated in most AAD cases, other causes of Non-C. difficile Pathogen-specific AAD should also be considered. […] C. perfringens type A has also been implicated in 3-20% cases. […] The role of Candida spp. in AAD has been debated since the 1950s and continues to be controversial. […] Only 40% of AAD can be accounted for by the above causes leaving a majority of AAD cases without an etiology.

• #27 Diarrhea, Antibiotic-Associated | Johns Hopkins ABX Guide

  https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540163/all/Diarrhea__Antibiotic_Associated

  C. difficile (see C. difficile module) […] Staphyloccocus aureus […] Klebsiella oxytoca […] Salmonella species (see Salmonella module) […] Clostridium perfringens.

• #28 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

  Although the role of C. difficile in the pathogenesis of AAD has been well studied, there are considerable gaps in our understanding of the pathogenesis of non-CDI AAD due to putative microbial etiologies including C. perfringens, S. aureus, K. oxytoca, and Candida species. […] C. difficile has been proven to cause AAD. C. difficile AAD is reported to be 4 and 60 times more common than C. perfringens or S. aureus, respectively. […] K. oxytoca is considered in patients with C. difficile negative bloody diarrhea. […] C. perfringens enterotoxin has been detected in studies along with C. difficile toxin and may act alone or in synergy. […] Studies reported distinct clinical features in patients where S. aureus enterotoxin was isolated. […] The role of Candida spp. in AAD has been debated since the 1950s and continues to be controversial. […] Only 40% of AAD can be accounted for by the above causes leaving a majority of AAD cases without an etiology. […] Limited studies have shown that strains of Pseudomonas aeruginosa may be a possible cause of AAD.

• #29 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). […] About 1 in 5 people who take antibiotics develop antibiotic-associated diarrhea. […] It’s commonly thought to develop when antibacterial medications (antibiotics) upset the balance of good and bad bacteria in your gastrointestinal tract. […] Nearly all antibiotics can cause antibiotic-associated diarrhea. […] The antibiotics most commonly linked to C. difficile infection include clindamycin, fluoroquinolones, cephalosporins and penicillins though taking virtually any antibiotic can put you at risk.

• #30 Antibiotic-associated diarrhea | Beacon Health System

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

  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. […] Why antibiotic-associated diarrhea occurs isn’t completely understood. It’s commonly thought to develop when antibacterial medications (antibiotics) upset the balance of good and bad bacteria in your gastrointestinal tract. […] Nearly all antibiotics can cause antibiotic-associated diarrhea.

• #31 Antibiotic-associated diarrhea | Beacon Health System

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

  Antibiotics most commonly involved include: Macrolides, such as clarithromycin; Cephalosporins, such as cefdinir and cefpodoxime; Fluoroquinolones, such as ciprofloxacin and levofloxacin; Penicillins, such as amoxicillin and ampicillin. […] When antibiotics upset the balance of bacteria in your digestive system, the bacteria C. difficile can quickly grow out of control. […] C. difficile bacteria create toxins that attack the lining of the intestine. […] The antibiotics most commonly linked to C. difficile infection include clindamycin, fluoroquinolones, cephalosporins and penicillins though taking virtually any antibiotic can put you at risk.

• #32 Antibiotics Diarrhea: Causes, Treatment, and Prevention

  https://www.healthline.com/health/antibiotics-diarrhea

  Antibiotic-related diarrhea is caused by disrupting the bacterial balance in your intestines. Certain antibiotics are more likely to cause it, such as penicillins and cephalosporins. […] Antibiotic-associated diarrhea is fairly common. Its estimated that between 5 and 25 percent of adults may experience diarrhea while taking antibiotics. […] Antibiotics can disrupt the balance of these bacteria. One of the side effects of killing off the good bacteria, in addition to the bad bacteria, is the possibility of looser stools. […] Toxins produced by C. diff can cause inflammation in the intestines, leading to diarrhea. […] Although all antibiotics can cause diarrhea, some types are more closely associated with the condition. […] Antibiotics that have a higher likelihood of causing diarrhea include: penicillins, such as ampicillin and amoxicillin; cephalosporins, such as cephalexin and cefpodoxime; clindamycin.

• #33 Antibiotic-Associated Diarrhea – Harvard Health

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

  C. difficile infections are more common among recently hospitalized patients, the elderly and those with debilitating illnesses. […] Many different types of antibiotics have been blamed for causing C. difficile diarrhea and colitis. Common culprits include clindamycin (Cleocin), ampicillin (sold under several brand names) and cephalosporins, such as cephalexin (Keflex). […] 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. […] C. difficile diarrhea usually begins to subside within the first 72 hours of treatment with medication. However, some people develop severe symptoms with a longer recovery time. C. difficile diarrhea can recur despite adequate initial therapy.

• #34 Antibiotic-associated diarrhea Guide: Causes, Symptoms and Treatment Options

  https://www.drugs.com/health-guide/antibiotic-associated-diarrhea.html

  Many different types of antibiotics have been blamed for causing C. difficile diarrhea and colitis. Common culprits include clindamycin (Cleocin), ampicillin (sold under several brand names) and cephalosporins, such as cephalexin (Keflex). […] 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. […] C. difficile diarrhea usually begins to subside within the first 72 hours of treatment with medication. However, some people develop severe symptoms with a longer recovery time. C. difficile diarrhea can recur despite adequate initial therapy. […] About 3% of people with C. difficile infection will become seriously ill, with high fevers, severe abdominal pain, and a complication called toxic megacolon (enlarged colon) that will show up on a computed tomography (CT) scan.

• #35 Can antibiotics cause diarrhea?

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

  According to the Mayo Clinic, antibiotic-induced diarrhea typically starts about a week after the first antibiotic dose. […] Most antibiotics have the potential to cause diarrhea. […] Antibiotic drug classes associated with the most significant risk of antibiotic-induced diarrhea include: Lincosamides (like clindamycin) pose the highest risk of antibiotic-induced bacteria, according to a meta-analysis of more than 2 million reports of reactions to antibiotics. […] In some cases, multiple courses of antibiotics can cause a bacteria called Clostridioides difficile (C. diff) to run rampant in the colon. […] When it is allowed to overgrow C. diff releases a toxin that damages the lining of our gut. […] The result of this is an infection that causes severe diarrhea and inflammation. […] Most cases of antibiotic-associated diarrhea are mild, and symptoms include: Loose, watery stools, Frequent bowel movements (three times per day or more).

• #36

  https://journals.lww.com/infectdis/fulltext/2002/02000/antibiotic_associated_diarrhea.24.aspx

  This is a review of antibiotic associated diarrhea with the following points: Antibiotics: The highest rates of AAD are with amoxicillin, amoxicillin-clavulanate (Augmentin) and cefixime; lower rates of 25% are seen with most other antibiotics including oral cephalosporins, fluoroquinolones, macrolides and tetracycline. […] C. difficile accounts for 10-20% of all cases of antibiotic-associated diarrhea, most cases of antibiotic-associated colitis, and virtually all cases of PMC. […] Major other causes of antibiotic-associated diarrhea are: other enteric pathogens (C. perfringens type A, S. aureus and salmonella), direct effect on the gut by antibiotics (erythromycin, clavulanate) and, probably most important, the results of reducing fecal anaerobes (decreased metabolism of carbohydrates with osmotic diarrhea and reduced breakdown of primary bile acids which are potent colonic secretory agents).

• #37 Antibiotic-Associated Diarrhea – Gastrointestinal Infections – Intestinal Diseases – Gastrointestinal Diseases – Gastroenterology – Diseases – McMaster Textbook of Internal Medicine

  https://empendium.com/mcmtextbook/chapter/B31.II.4.24.1.7.

  The risk of antibiotic-associated diarrhea is higher in patients treated with cephalosporins, amoxicillin/clavulanic acid, ampicillin and other semisynthetic broad-spectrum penicillins, clindamycin, fluoroquinolones, patients receiving long-term treatment (4 weeks), and patients with multiple comorbidities. […] Risk factors for C difficile infection: see Clostridioides difficile Infection.

• #38

  https://journals.lww.com/infectdis/fulltext/2002/02000/antibiotic_associated_diarrhea.24.aspx

  Major risk factors are increased age, selected antibiotics (clindamycin, expanded-spectrum penicillins and cephalosporins), hospitalization and immunologic susceptibility as indicated by absent serum levels of toxin A IgG antibody. […] The major problem with antibiotic treatment of the antibiotic-associated complication is relapses noted in 20-25%; these occur with equal frequency with metronidazole or vancomycin and they are easily diagnosed by the patients history showing they now have the identical symptoms back. […] Many or most cases will resolve without antibiotic treatment and this avoids the problem of relapse. Treatment is necessary when there are severe or persistent symptoms despite discontinuation of the implicated agent. The preferred drug is oral metronidazole.

• #39 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

  C. difficile infections have become more frequent, more severe, more difficult to treat, and more likely to recur after initial treatment. […] A number of factors can increase a person’s risk of becoming infected with C. difficile: Current or recent antibiotic use – Certain antibiotics increase the risk of becoming infected with C. difficile more than others. Current or recent hospitalization – Up to 20 percent of people who are hospitalized and up to 50 percent of people in long-term care facilities carry C. difficile in their feces. Older age – The risk of becoming infected with C. difficile is 10 times greater in people who are 65 years or older. Severe illness – People who have a weakened immune system as a result of an underlying medical condition or a treatment are at increased risk of becoming infected with C. difficile. Recent infection with C. difficile – People who have been recently infected with C. difficile and treated have an increased risk of becoming infected again soon after stopping the treatment. Inflammatory bowel disease (ulcerative colitis or Crohn’s disease with colitis) – People with colitis from inflammatory bowel disease have an increased risk of developing C. difficile infection.

• #40 Antibiotic-associated diarrhea: Clinical characteristics and the presence of Clostridium difficile | Revista de Gastroenterología de México

  http://www.revistagastroenterologiamexico.org/en-diarrea-asociada-antibioticos-caracteristicas-clinicas-articulo-S2255534X17300142

  The high frequency of simultaneous, multiple antibiotic use was noteworthy. […] The risk factors we found to be most frequently associated with AAD were previous hospitalization within the last 90 days (51.2%), active cancer (32.6%), the use of immunosuppressants, such as chemotherapy and steroids (27.9%), and prior stay in the ICU (25.6%). […] Only 15% of the patients with AAD were positive for CD infection in the PCR test, making it very important to consider other causes of diarrhea in the hospitalized patient.

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

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

  In the present study, we analysed the occurrence of AAD in a paediatric outpatient population receiving antimicrobial treatment. The participants were followed up for eight weeks and 10.4% of cases had an AAD episode. […] Antibiotics disarrange intestinal microbiota, thus changing the diversity and numbers of bacteria in the gut, which leads to AAD. […] In terms of risk factors for the occurrence of AAD in outpatient clinics, Truck et al. found that the incidence of AAD was particularly high after AMC administration, while Crew et al. showed that recent CEP use was an important risk factor for community-acquired Clostridium difficile diarrhoea. […] An intriguing finding of our study was that the frequency of AAD differed significantly between the geographic areas in Turkey, which may be due to the well-known nutritional factors differ between regions. […] 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.

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

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

  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. […] Taking antibiotics can kill these „good” bacteria, allowing C. difficile to multiply and release toxins that damage the cells lining the intestinal wall, causing diarrhea, abdominal pain, and fever as well as other symptoms. […] A number of factors can increase a person’s risk of becoming infected with C. difficile: Current or recent antibiotic use – Certain antibiotics increase the risk of becoming infected with C. difficile more than others. Current or recent hospitalization – Up to 20 percent of people who are hospitalized and up to 50 percent of people in long-term care facilities carry C. difficile in their feces, but many do not have diarrhea or other symptoms.

• #43 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. […] Currently fewer than 33% of AAD cases can be attributable to Clostridioides difficile leaving a large number of cases undiagnosed and poorly treated. […] Although the pathogenesis of Clostridioides difficile infection (CDI) has been well documented, the role of other putative microbial etiologies (Clostridium perfringens, Staphylococcus aureus, Klebsiella oxytoca, Candida species) and their pathogenic mechanisms in AAD has been unclear. […] 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.

• #44 Antibiotic-associated diarrhea | Content for the lay public | Microbiota institute

  https://www.biocodexmicrobiotainstitute.com/en/antibiotic-associated-diarrhea

  Antibiotics are a powerful tool in the fight against bacterial infections. While treatments sometimes appear to be without obvious short-term side effects, the gut microbiota imbalance they provoke can cause diarrhea in up to 35% of patients. This antibiotic-associated diarrhea (AAD) can at times cloak serious intestinal infections. […] This imbalance (known as dysbiosis) causes AAD, as the gut microbiota is less able to perform its protective functions. AAD can affect up to 35% of patients and up to 80% of children receiving antibiotic treatment. […] The main short-term consequence of antibiotic treatment is the altered bowel movements experienced by some patients, most often resulting in diarrhea. AAD is defined as three or more very loose or liquid stools within 24 hours of the beginning of antibiotic treatment or up to 2 months after its cessation. Its incidence depends on several factors, including age, context and the type of antibiotic. The diarrhea is usually mild to moderate in intensity and in the vast majority of cases is functional, i.e. associated with a gut microbiota imbalance. Antibiotics with the broadest spectrum of antimicrobial activity are associated with higher rates of diarrhea.

• #45 Antibiotic-Associated Diarrhea – Gastrointestinal Infections – Intestinal Diseases – Gastrointestinal Diseases – Gastroenterology – Diseases – McMaster Textbook of Internal Medicine

  https://empendium.com/mcmtextbook/chapter/B31.II.4.24.1.7.

  Antibiotic-associated diarrhea develops in the course of antimicrobial treatment or within 2 months of its discontinuation. […] Antibiotic treatment has a direct influence on the gastrointestinal tract and induces quantitative and qualitative changes in the intestinal flora, which lead to impaired digestion and metabolism of some nutrients (this is nonspecific antibiotic-associated diarrhea, accounting for 70%-80% of cases). […] The disease may also be caused by selection of antibiotic-resistant bacterial strains, predominantly Clostridioides difficile strains producing toxin B (15%-25% of cases, associated with the most severe disease) or rarely other bacteria (~3% of cases: Klebsiella oxytoca, enterotoxic strains of Staphylococcus aureus, Clostridium perfringens type A). […] The disease occurs in up to 30% of patients receiving antibiotics.

• #46

  https://journals.lww.com/infectdis/fulltext/2002/02000/antibiotic_associated_diarrhea.24.aspx

  This is a review of antibiotic associated diarrhea with the following points: Antibiotics: The highest rates of AAD are with amoxicillin, amoxicillin-clavulanate (Augmentin) and cefixime; lower rates of 25% are seen with most other antibiotics including oral cephalosporins, fluoroquinolones, macrolides and tetracycline. […] C. difficile accounts for 10-20% of all cases of antibiotic-associated diarrhea, most cases of antibiotic-associated colitis, and virtually all cases of PMC. […] Major other causes of antibiotic-associated diarrhea are: other enteric pathogens (C. perfringens type A, S. aureus and salmonella), direct effect on the gut by antibiotics (erythromycin, clavulanate) and, probably most important, the results of reducing fecal anaerobes (decreased metabolism of carbohydrates with osmotic diarrhea and reduced breakdown of primary bile acids which are potent colonic secretory agents).

• #47 Study sheds light on antibiotics-associated diarrhea | MIT News | Massachusetts Institute of Technology

  https://news.mit.edu/2022/study-sheds-light-antibiotics-associated-diarrhea-0228

  A joint study by the Singapore General Hospital (SGH) and Singapore-MIT Alliance for Research and Technology (SMART), MITs research enterprise in Singapore, may have found the reason some patients experience diarrhea after taking the antibiotic amoxicillin-clavulanate, commonly known as Augmentin. […] The team of researchers found that the level of gut Ruminococcaceae, a family of bacteria that plays an important role in maintaining an individuals gut health, strongly impacts diarrheal outcomes following antibiotic treatment. […] Results showed that Ruminococcaceae levels in the stools of study volunteers who developed diarrhea were significantly lower when compared to those who did not, both before and during treatment with amoxicillin-clavulanate. This suggests that individuals may, depending on their gut composition, be predisposed to antibiotic-associated diarrhea. […] Our findings provide evidence that an individuals gut microbial composition can influence the risk of developing antibiotics-associated diarrhea. […] Globally, one in three patients prescribed amoxicillin-clavulanate will develop diarrhea.

• #48 Clostridioides (formerly Clostridium) difficile–Induced Colitis – Infections – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/infections/bacterial-infections-anaerobic-bacteria/clostridioides-formerly-clostridium-difficile-induced-colitis

  Clostridioides difficile (C. difficile) induced colitis is an inflammation of the large intestine (colon) that results in diarrhea. The inflammation is caused by toxin produced by C. difficile bacteria and usually develops after people take antibiotics that enable these bacteria to grow in the intestine. […] C. difficile induced colitis usually occurs after taking antibiotics. […] In C. difficile induced colitis, the bacteria produce toxins that cause inflammation of the colon (colitis), usually after antibiotics are taken to treat an infection. Many antibiotics alter the balance among the types and quantity of bacteria that live in the intestine. Thus, certain disease-causing bacteria, such as C. difficile, can overgrow and replace the harmless bacteria that normally live in the intestine. C. difficile is the most common cause of colitis that develops after antibiotics are taken.

• #49 Clostridioides (Clostridium) Difficile Colitis: Background, Etiology, Pathophysiology

  https://emedicine.medscape.com/article/186458-overview

  Even brief exposure to any single antibiotic can cause C difficile colitis. A prolonged antibiotic course or the use of two or more antibiotics increases the risk of disease. […] A US Food and Drug Administration (FDA) safety communication on February 8, 2012, described a possible association between the use of proton pump inhibitors (PPIs) and the development of Clostridium difficile associated diarrhea (CDAD). […] The diagnosis of C difficile colitis should be suspected in any patient with diarrhea who has received antibiotics within the previous 3 months, has been recently hospitalized, and/or has an occurrence of diarrhea 48 hours or more after hospitalization. […] Risk factors for recurrence of CDI include age older than 65 years, immune compromise, severe underlying illnesses, ongoing antibiotic treatments during CDI, and severe CDI on presentation. […] C difficile colitis results from a disruption of the normal bacterial flora of the colon, colonization with C difficile, and release of toxins that cause mucosal inflammation, mucosal damage, and diarrhea.

• #50 About C. diff | C. diff | CDC

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

  C. diff is a germ that causes diarrhea and colitis (an inflammation of the colon) and can be life-threatening. […] Most cases of C. diff infection occur when you’ve been taking antibiotics or not long after you’ve finished the antibiotic course. […] While C. diff infection can affect anyone, most cases occur when you’ve been taking antibiotics or soon after you’ve finished taking antibiotics. People are up to 10 times more likely to get C. diff infection while taking an antibiotic or during the three months after, with longer courses potentially doubling their risk. […] C. diff germs spread from person to person in poop, but the bacteria are often found in the environment. […] Taking antibiotics can affect your microbiome, making you more susceptible to illnesses like C. diff infection.

• #51 Clostridioides (formerly Clostridium) difficile–Induced Colitis – Infections – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/infections/bacterial-infections-anaerobic-bacteria/clostridioides-formerly-clostridium-difficile-induced-colitis

  When C. difficile bacteria overgrow, they release toxins that cause diarrhea, colitis, and the formation of abnormal membranes (pseudomembranes) in the large intestine. […] Almost any antibiotic can cause this disorder, but clindamycin, penicillins (such as ampicillin and amoxicillin), cephalosporins (such as ceftriaxone), and fluoroquinolones (such as levofloxacin and ciprofloxacin) are implicated most often. […] C. difficile induced colitis can occur even after very brief antibiotic courses. […] C. difficile infection is most common when an antibiotic is taken by mouth, but it also occurs when antibiotics are injected into a muscle or given by vein (intravenously). […] Colitis caused by C. difficile infection rarely occurs unless people have recently used antibiotics. However, physically stressful events, such as surgery (typically involving the stomach or intestine), can likely lead to the same kind of imbalance among the type and quantity of bacteria in the intestine or can interfere with the intestine’s intrinsic defense mechanisms, which, in turn, allows C. difficile infection and colitis to develop.

• #52 C. diff Infection: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/15548-c-diff-infection

  Clostridioides difficile, or C. diff, is a highly contagious bacterium that causes diarrhea and colitis. It often infects people who’ve recently taken antibiotics. Antibiotics that kill other bacteria in your gut but don’t kill C. diff allow it to quickly grow out of control. […] The most common cause of C. diff infection is taking antibiotics. Using them upsets the balance between helpful and unhelpful bacteria in your gut microbiome, allowing C. diff to dominate and overgrow. […] C. diff infection causes watery diarrhea, sometimes bloody. C. diff infection causes frequent diarrhea and related symptoms. […] If you develop diarrhea after taking antibiotics, tell your healthcare provider.

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

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

  In the present study, we analysed the occurrence of AAD in a paediatric outpatient population receiving antimicrobial treatment. The participants were followed up for eight weeks and 10.4% of cases had an AAD episode. […] Antibiotics disarrange intestinal microbiota, thus changing the diversity and numbers of bacteria in the gut, which leads to AAD. […] In terms of risk factors for the occurrence of AAD in outpatient clinics, Truck et al. found that the incidence of AAD was particularly high after AMC administration, while Crew et al. showed that recent CEP use was an important risk factor for community-acquired Clostridium difficile diarrhoea. […] An intriguing finding of our study was that the frequency of AAD differed significantly between the geographic areas in Turkey, which may be due to the well-known nutritional factors differ between regions. […] 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.

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

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

  Antibacterial drugs can disrupt normal gut flora. […] It may not have been a bug or something you ate; it could have been a result of an adverse effect of an antibiotic. […] Antibiotics work by killing off bacteria but cannot distinguish between „good” and „bad” bacteria. If the natural balance of the gut flora is disturbed, the „bad” bacteria can sometimes predominate and trigger loose stools and diarrhea. […] Antibiotic-associated diarrhea is more common when: More than one antibiotic is prescribed, An antibiotic is used for an extended period of time, An antibiotic is taken at a higher dose, A powerful broad-spectrum antibiotic is used. […] One of the more common „bad” bacteria is called Clostridioides difficile. […] If this happens, C difficile can begin to multiply and cause symptoms.

• #55 Clostridioides (formerly Clostridium) difficile–Induced Colitis – Infections – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/infections/bacterial-infections-anaerobic-bacteria/clostridioides-formerly-clostridium-difficile-induced-colitis

  When C. difficile bacteria overgrow, they release toxins that cause diarrhea, colitis, and the formation of abnormal membranes (pseudomembranes) in the large intestine. […] Almost any antibiotic can cause this disorder, but clindamycin, penicillins (such as ampicillin and amoxicillin), cephalosporins (such as ceftriaxone), and fluoroquinolones (such as levofloxacin and ciprofloxacin) are implicated most often. […] C. difficile induced colitis can occur even after very brief antibiotic courses. […] C. difficile infection is most common when an antibiotic is taken by mouth, but it also occurs when antibiotics are injected into a muscle or given by vein (intravenously). […] Colitis caused by C. difficile infection rarely occurs unless people have recently used antibiotics. However, physically stressful events, such as surgery (typically involving the stomach or intestine), can likely lead to the same kind of imbalance among the type and quantity of bacteria in the intestine or can interfere with the intestine’s intrinsic defense mechanisms, which, in turn, allows C. difficile infection and colitis to develop.

• #56 How to handle when children have diarrhea due to taking antibiotics | Vinmec

  https://www.vinmec.com/eng/blog/how-to-handle-when-children-have-diarrhea-due-to-taking-antibiotics-en

  Most cases of antibiotic-associated diarrhea are mild and resolve on their own after stopping the antibiotics. However, in some severe cases, it can lead to inflammatory damage and swelling in the colon (pseudomembranous colitis). […] Diarrhea can occur with antibiotics administered either orally or intravenously.

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

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

  In the present study, we analysed the occurrence of AAD in a paediatric outpatient population receiving antimicrobial treatment. The participants were followed up for eight weeks and 10.4% of cases had an AAD episode. […] Antibiotics disarrange intestinal microbiota, thus changing the diversity and numbers of bacteria in the gut, which leads to AAD. […] In terms of risk factors for the occurrence of AAD in outpatient clinics, Truck et al. found that the incidence of AAD was particularly high after AMC administration, while Crew et al. showed that recent CEP use was an important risk factor for community-acquired Clostridium difficile diarrhoea. […] An intriguing finding of our study was that the frequency of AAD differed significantly between the geographic areas in Turkey, which may be due to the well-known nutritional factors differ between regions. […] 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.

• #58 Antibiotic-associated diarrhea Guide: Causes, Symptoms and Treatment Options

  https://www.drugs.com/health-guide/antibiotic-associated-diarrhea.html

  In healthy people, many different species of bacteria live inside the bowel. Many are harmless or even helpful to the body, but a few have the potential to be aggressive troublemakers. Under normal circumstances, the „bad” bacteria are far outnumbered. So, the bowel’s natural ecological balance keeps them under control. […] This can change dramatically when a person begins treatment with an antibiotic. This is because antibiotics can kill large numbers of the bowel’s normal bacteria, altering the delicate balance among the various species. […] 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. […] 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.

• #59 Antibiotic-associated diarrhea

  https://www.aboutkidshealth.ca/zh-Hans/healthaz/gastrointestinal/antibiotic-associated-diarrhea-zh-hans/?language=en

  Many antibiotics cause diarrhea. Learn about antibiotic-associated diarrhea, including causes and treatment options. […] One in five children who take antibiotics will develop diarrhea. It is more common in children aged under two years and can occur with any type of antibiotic. […] Inside the intestines are millions of tiny bacteria that help digest food. When antibiotics kill harmful bacteria that cause infection, they also kill these good bacteria. These bacteria cause diarrhea when they die and start growing again in the intestines.

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

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

  When you consume antibiotics, not only are the disease-causing bacteria targeted but occasionally some of the bacteria that usually live in your bowel take a hit too. This upsets the normal balance of the gut flora causing harmful bacteria to flourish and release toxins which can damage the lining of the intestine. This in turn leads to “digestive dilemmas” such as diarrhea, nausea and vomiting and making the body more susceptible to infections e.g C. diff infections (CDI) (Giannelli 2017; Cannon, 2019). […] 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).

• #61 Can antibiotics cause diarrhea?

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

  Antibiotic-induced diarrhea will often go away on its own after a few days. […] Clinical trials suggest that Lactobacillus rhamnosus GG (LGG) and Saccharomyces boulardii (S. boulardii) are the best probiotics for diarrhea caused by antibiotics. […] Antibiotics are ineffective against viruses such as the common cold or seasonal flu. […] 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. […] Dr. Amin says nourishing your gut with good bacteria can help prevent antibiotic-induced diarrhea and treat it when it occurs. […] Stave off post-antibiotic diarrhea by eating yogurt with live active cultures or taking oral probiotic supplements for about a week after completing your antibiotic course.

• #62 How to Prevent Diarrhea While You Take Antibiotics

  https://health.clevelandclinic.org/how-to-prevent-diarrhea-while-you-take-antibiotics

  Yet many people suffer from an upset stomach when taking antibiotics. Diarrhea is a common concern. […] In the worst cases, long-term antibiotic use can even lead to C. diff, a severe infection that causes colitis, or inflammation in your colon. […] The problem is that when you are trying to kill bacteria in your sinuses, lungs, or elsewhere, antibiotics also kill bacteria that live in your intestine that keep your digestive health in balance, says family medicine physician Michael Rabovsky, MD. […] The thing that has really been shown to help the most with preventing diarrhea is taking probiotics when taking antibiotics, Dr. Rabovsky says. He notes that reviews of studies suggest probiotics are effective both for regular antibiotic-associated diarrhea and for diarrhea related to C. diff.

• #63 Drug-induced diarrhea: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000293.htm

  Drug-induced diarrhea is loose, watery stools that occur when you take certain medicines. […] Nearly all medicines may cause diarrhea as a side effect. The medicines listed below, however, are more likely to cause diarrhea. […] Antibiotics also can produce diarrhea. […] Normally, the intestines have many different bacteria. They keep each other in balance. Antibiotics destroy some of these bacteria, which allow other types to grow too much. […] In some cases, antibiotics can allow a type of bacteria called Clostridioides difficile to grow too much. This can lead to severe, watery, and often bloody diarrhea due to a condition called pseudomembranous colitis. […] To prevent diarrhea due to antibiotic use, talk to your health care provider about taking supplements containing healthy bacteria (probiotics) and/or eating yogurt. Some of these products may reduce the risk for diarrhea. Keep taking these supplements for a few days after you finish your antibiotics.

• #64 Can antibiotics cause diarrhea?

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

  Antibiotic-induced diarrhea will often go away on its own after a few days. […] Clinical trials suggest that Lactobacillus rhamnosus GG (LGG) and Saccharomyces boulardii (S. boulardii) are the best probiotics for diarrhea caused by antibiotics. […] Antibiotics are ineffective against viruses such as the common cold or seasonal flu. […] 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. […] Dr. Amin says nourishing your gut with good bacteria can help prevent antibiotic-induced diarrhea and treat it when it occurs. […] Stave off post-antibiotic diarrhea by eating yogurt with live active cultures or taking oral probiotic supplements for about a week after completing your antibiotic course.

• #65 How to Prevent Diarrhea While You Take Antibiotics

  https://health.clevelandclinic.org/how-to-prevent-diarrhea-while-you-take-antibiotics

  Probiotics come in several varieties. The most commonly studied for antibiotic-associated diarrhea are Lactobacillus rhamnosus-based and Saccharomyces boulardii-based probiotics. […] Common sense would say you are going to disturb the natural balance with antibiotics, Dr. Rabovsky says, so anything else that causes you GI symptoms could make side effects even worse.

• #66 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. […] Currently fewer than 33% of AAD cases can be attributable to Clostridioides difficile leaving a large number of cases undiagnosed and poorly treated. […] Although the pathogenesis of Clostridioides difficile infection (CDI) has been well documented, the role of other putative microbial etiologies (Clostridium perfringens, Staphylococcus aureus, Klebsiella oxytoca, Candida species) and their pathogenic mechanisms in AAD has been unclear. […] 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.

• #67 Antibiotic-associated diarrhea | Content for the lay public | Microbiota institute

  https://www.biocodexmicrobiotainstitute.com/en/antibiotic-associated-diarrhea

  Antibiotics are a powerful tool in the fight against bacterial infections. While treatments sometimes appear to be without obvious short-term side effects, the gut microbiota imbalance they provoke can cause diarrhea in up to 35% of patients. This antibiotic-associated diarrhea (AAD) can at times cloak serious intestinal infections. […] This imbalance (known as dysbiosis) causes AAD, as the gut microbiota is less able to perform its protective functions. AAD can affect up to 35% of patients and up to 80% of children receiving antibiotic treatment. […] The main short-term consequence of antibiotic treatment is the altered bowel movements experienced by some patients, most often resulting in diarrhea. AAD is defined as three or more very loose or liquid stools within 24 hours of the beginning of antibiotic treatment or up to 2 months after its cessation. Its incidence depends on several factors, including age, context and the type of antibiotic. The diarrhea is usually mild to moderate in intensity and in the vast majority of cases is functional, i.e. associated with a gut microbiota imbalance. Antibiotics with the broadest spectrum of antimicrobial activity are associated with higher rates of diarrhea.

• #68 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. […] 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. […] Although the role of C. difficile in the pathogenesis of AAD has been well studied, there are considerable gaps in our understanding of the pathogenesis of non-CDI AAD due to putative microbial etiologies including C. perfringens, S. aureus, K. oxytoca, and Candida species. Identifying the etiology and understanding the pathogenesis of AAD will help in improving healthcare and in reducing the economic burden.

• #69 Antibiotic-associated diarrhea: a refresher on causes and possible prevention with probiotics–continuing education article – PubMed

  https://pubmed.ncbi.nlm.nih.gov/24064436/

  Antibiotic-associated diarrhea (AAD) describes any unexplained diarrhea associated with the use of an antibiotic. AAD also includes infection caused by Clostridium difficile, however this organism only accounts for a small percentage of diarrhea caused by antibiotics. AAD can be caused by multiple other organisms including C perfringens, S aureus, and Candida. Some antibiotics are more likely to cause non-C difficile AAD, such as erythromycin and the penicillin class. AAD develops through the loss of normal flora and reduced colonic bacterial carbohydrate metabolism during antibiotic administration. […] There is an increasing interest in the use of probiotics for the prevention of AAD. There are several meta-analyses that report a relative risk reduction of AAD with the use of probiotics during antibiotic administration. […] Since AAD can be a reason for a patient to become non-compliant or receive incomplete treatment, clinicians should monitor for this potential adverse effect caused by antibiotics.

• #70 Antibiotic-Associated Diarrhea | Symptoms, Causes & Treatment

  https://fitwellhub.pk/antibiotic-associated-diarrhea/

  When antibiotics disturb the natural balance of bacteria in the intestines, they cause loose, watery stools three or more times a day. This is called antibiotic-associated diarrhea. […] The main causes of antibiotic-associated diarrhea are: […] Disruption of Gut Flora: Antibiotics can disturb the balance of beneficial bacteria in the gut. This disturbance decreases microbial diversity and the proliferation of harmful bacteria, resulting in diarrhea. […] Overgrowth of Harmful Bacteria: When the number of beneficial bacteria is reduced, it increases the growth of harmful bacteria. These harmful bacteria cause inflammation and diarrhea. […] Clostridioides difficile (C. diff) Infection: Clostridioides difficile bacteria cause infection leading to diarrhea. It most commonly occurs in hospitalized patients or in those who are taking a long-term antibiotic treatment. This infection causes severe diarrhea and other complications.

• #71

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