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• #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. […] Managing the diarrhoea depends on the clinical presentation and the inciting agent.710 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. […] 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.

• #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.

• #3 Focus on antibiotic associated diarrhea (AAD) | Content for health professionals | Microbiota institute

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

  Antibiotics are a powerful tool in the fight against bacterial infections, however they also disrupt the protective intestinal microbiota and this can lead to unintended consequences including antibiotic-associated diarrhea (AAD) in as much as 35% of patients. The incidence of AAD depends on several factors: age (among children this percentage can reach up to 80%), setting, type of antibiotic, etc. Most of the time, AAD is caused by antibiotic-induced dysbiosis, is of mild intensity and is self-limiting, lasting between 1 and 5 days. […] While the etiologies for AAD are diverse, approximately one-third of AAD cases are attributed to C. difficile. Under certain conditions, C. difficile will trigger an inflammatory response leading to a range of clinical outlooks, from mild diarrhea to pseudomembranous colitis, toxic megacolon and/or death.

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

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

  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. In 10%-20% of cases the diarrhea results from an infection by Clostridioides difficile (C. difficile). The management of AAD depends on the symptoms and the pathogen (e.g. C. difficile). For mild to moderate diarrhea, treatment involves ending antibiotic use (or replacing the antibiotic with one less likely to cause diarrhea) to allow the microbiota to recover and the patient to rehydrate. Numerous studies have shown that probiotics may help reconstitute the gut microbiota, while some probiotics have proven effective in preventing and treating AAD. When taken during antibiotic treatment, other probiotics have been shown to reduce the risk of primary and secondary infection with C. difficile. Lastly, fecal microbiota transplantation is currently only used for the most serious infections, i.e. relapses of infections with C. difficile.

• #5 Managing antibiotic associated diarrhoea | The BMJ

  https://www.bmj.com/content/324/7350/1345

  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. […] Antibiotic associated diarrhoea results from disruption of the normal microflora of the gut by antibiotics.

• #6 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. […] Research suggesting that probiotics may reduce the severity or incidence of antibiotic-related diarrhea supports the idea that disrupting the gut bacteria causes diarrhea. For this reason, antibiotics that kill more bacteria classes broad-spectrum antibiotics and using multiple antibiotics at once may increase the risk of diarrhea.

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

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

  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. You may also be asked to stop taking stomach-acid-suppressing drugs. For people with this type of infection, diarrhea symptoms may return and require repeated treatment. […] In some cases of mild antibiotic-associated diarrhea, your doctor may recommend anti-diarrheal medications, such as loperamide (Imodium A-D). But check with your doctor before taking anti-diarrheal medications because they can interfere with your body’s ability to eliminate toxins and lead to serious complications. These medications should not be used if you develop C. difficile infection. […] Taking probiotics doesn’t appear to be harmful, however, unless you have a weakened immune system.

• #8

  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). […] 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. […] 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.

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

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

  For cases of mild antibiotic-associated diarrhea, try the following suggestions: […] 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. […] If treatment fails to eradicate a C. difficile infection, your doctor may advise a fecal transplant.

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

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

  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. You may also be asked to stop taking stomach-acid-suppressing drugs. For people with this type of infection, diarrhea symptoms may return and require repeated treatment.

• #11 Antibiotic-associated diarrhea | Beacon Health System

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

  To help prevent antibiotic-associated diarrhea, try to: Take antibiotics only when necessary. […] In some cases of mild antibiotic-associated diarrhea, your doctor may recommend anti-diarrheal medications, such as loperamide (Imodium A-D). But check with your doctor before taking anti-diarrheal medications because they can interfere with your body’s ability to eliminate toxins and lead to serious complications. These medications should not be used if you develop C. difficile infection.

• #12 Antibiotic-associated diarrhea – Augusta HealthSearchClose SearchSearch IconSearch IconClose Search IconMobile Menu IconMobile Menu Close IconInstagramFacebookTwitterYoutube

  https://www.augustahealth.com/disease/antibiotic-associated-diarrhea/

  In some cases of mild antibiotic-associated diarrhea, your doctor may recommend anti-diarrheal medications, such as loperamide (Imodium A-D). But check with your doctor before taking anti-diarrheal medications because they can interfere with your body’s ability to eliminate toxins and lead to serious complications. These medications should not be used if you develop C. difficile infection.

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

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

  Antibiotic-associated 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. […] If youre experiencing diarrhea from antibiotics, adjusting your diet may help ease your symptoms. Some general suggestions include: Eating low fiber foods. […] Based on these suggestions, try to consume the following foods and beverages when you have diarrhea: fluids including water, broths, or decaffeinated tea; fruit such as bananas, applesauce, or small amounts of canned fruit without syrup; grains such as white rice, white bread, and noodles; peeled potatoes (good source of potassium) that have been boiled or baked; protein sources like poultry, lean meats, and fish; yogurt that contains live cultures.

• #14 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

  If a person fails to improve with antibiotics and supportive care and the infection worsens, surgery (removal of the colon) may be warranted; this is generally limited to people with severe colitis and life-threatening illness. […] 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. […] 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. […] Treatment of recurrent C. difficile infection includes treatment with an oral antibiotic regimen (10- to 14-day course) or longer treatment with an oral antibiotic that is slowly tapered over several weeks. Additional treatment with specific oral probiotic capsules or a rectal enema may also be considered.

• #14 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

  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. This topic review discusses the causes, symptoms, diagnosis, and treatment of C. difficile-associated diarrhea. […] 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. […] 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).

• #15 Antibiotic Associated Diarrhea: Treatment, Procedure, Cost, Recovery, Side Effects And More

  https://www.lybrate.com/topic/antibiotic-associated-diarrhea

  At any rate, diarrhea can be treated easily, if the proper treatment is followed. […] The side effects of loperamide includes dizziness, nausea, abdominal pain and constipation. […] The adverse effects of antibiotics include skin allergies, vaginal itchiness or white discharge, appearance of white patches on the tongue of the patient, watery diarrhoea and abdominal cramps. […] The post-treatment guidelines include drinking plenty of fluids such as fresh fruit juices, clear broth and fizzy drinks. […] Abstain from drinking dairy products such as milk for at least a week after your treatment is complete. […] The results of a diarrhoea treatment are not permanent and the person suffering from it can also face recurrent diarrhoea even after a few months because of bacterial infections.

• #15 Antibiotic Associated Diarrhea: Treatment, Procedure, Cost, Recovery, Side Effects And More

  https://www.lybrate.com/topic/antibiotic-associated-diarrhea

  The really mild cases of diarrhoea can be resolved without needing any treatment at all. […] In case of severe dehydration the patient is required to drink lots of fluids or receive fluids intravenously. […] Patients in such a case will be advised to drink ORS (Oral Rehydration Salts) which is a constitution comprising of glucose and salts that gets easily absorbed and fills the void created by the loss of electrolytes and water from the body. […] Antidiarrheal medications include Imodium or Loperamide which is a drug that lowers the frequency of stool passage. […] The diarrhoea has been caused as a result of bacterial infection then only antibiotics are prescribed. […] Probiotics is very helpful for reducing the diarrhoeal tendency in children and works great as a preventive measure is consumed daily.

• #16 Patient Basics: Antibiotic-Associated Diarrhea | 2 Minute Medicine

  https://www.2minutemedicine.com/patient-basics-antibiotic-associated-diarrhea/

  For cases of mild antibiotic-associated diarrhea, try the following suggestions: Drink plenty of fluids to replace any body water that has been lost to diarrhea. You can try soft drinks, sports drinks, broth or over-the-counter oral rehydration fluids. Temporarily avoid milk products and foods that contain wheat flour (bread, macaroni, pizza), since your digestive tract may be unusually sensitive to them for a few days. Also temporarily avoid high-fiber foods, such as fruits, corn and bran. Do not take antidiarrhea medicines without first checking with your doctor. These medicines may interfere with your intestine’s ability to pass harmful bacteria and toxins out of your body through the stool. […] If you have more severe diarrhea due to a C. difficile infection, your doctor probably will stop your antibiotic treatment and prescribe an antimicrobial drug called metronidazole (Flagyl) to eliminate C. difficile. If metronidazole fails, an alternative medication such as vancomycin (Vancocin) may be used.

• #17 About C. diff | C. diff | CDC

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

  Treatment for C. diff infection usually involves taking a specific antibiotic such as vancomycin or fidaxomicin for at least 10 days. […] If you were taking an antibiotic for another infection, a healthcare professional might ask you to stop taking it if they think it’s safe to do so. […] 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. […] For those with repeat infections, innovative treatments, including fecal microbiota transplants, have shown promising results.

• #18 Clostridioides (Clostridium) Difficile Colitis Treatment & Management: Approach Considerations, Pharmacologic Management, Fecal Microbiota Transplantation

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

  The decision to treat C difficile infection (CDI) and the type of therapy administered depend on the severity of infection, as well as the local epidemiology and type of C difficile strains present. Except for perioperative prophylaxis, it is recommended that the use of cephalosporin and clindamycin be restricted for infection prevention. No treatment is necessary for asymptomatic carriers. […] For symptomatic patients, the Infectious Diseases Society of America (ISDA) and Society for Healthcare Epidemiology of America (SHEA) 2021 updated guideline for CDI treatment recommend administering fidaxomicin for initial and recurrent infections, with oral vancomycin as an alternative. Fecal microbiota transplantation (FMT) may also be added after treating the second recurrence. Bezlotoxumab had been recommended as adjunctive treatment for recurrent CDI, but it has been discontinued as of January 31, 2025.

• #19 Clostridioides (Clostridium) Difficile Colitis Treatment & Management: Approach Considerations, Pharmacologic Management, Fecal Microbiota Transplantation

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

  In patients with severe, complicated, or fulminant CDI (hypotension, shock, ileus or megacolon), oral (or via nasogastric tube) vancomycin 500 mg every 6 hours along with intravenous (IV) metronidazole is recommended. Rectal vancomycin may also be added in patients with ileus. […] Cessation of the causative antibiotic is essential when possible, as this may affect the risk of recurrence of infection with C difficile. Avoid antidiarrheal agents (eg, diphenoxylate with atropine); they have been reported to increase the duration and severity of symptoms. […] Treatment recommendations for CDI have evolved over the past few years. One reason for change is the frequent relapse rate of CDI (20-27%). In 2021, the ISDA recommended using fidaxomicin first line for treatment of an initial CDI episode as well as subsequent recurrence. Relative to vancomycin, fidaxomicin is not only a more targeted intestinal antibiotic but also associated with fewer CDI recurrences. Vancomycin is still considered to be an acceptable alternative. However, metronidazole is no longer recommended unless fidaxomicin and vancomycin are not available.

• #20 Clostridioides (Clostridium) Difficile Colitis Treatment & Management: Approach Considerations, Pharmacologic Management, Fecal Microbiota Transplantation

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

  Initial treatment: Treatment with fidaxomicin 200 mg by mouth twice a day for 10 days. If fidaxomicin is not available, then use oral vancomycin 125 mg by mouth four times a day for 10 days as an alternative. In nonsevere CDI (white blood cell [WBC] count 15,000 cells/uL and creatinine level 1.5 mg/dL), if fidaxomicin and vancomycin are not available, then use metronidazole 500 mg every 8 hours for 10-14 days. […] The FDA approved fidaxomicin for children aged 6 months or older in January 2020 for treatment of C difficile-associated diarrhea (CDAD). Approval was based on the phase 3 SUNSHINE clinical trial that included 148 randomized patients younger than 18 years with confirmed CDI, of whom 142 received either fidaxomicin or vancomycin in a 2:1 ratio. […] Fulminant (hypotension or shock, ileus, or megacolon) CDI: Vancomycin 500 mg every 6 hours by mouth or nasogastric tube, combined with IV metronidazole 500 mg every 8 hours. In patients with ileus, consider adding rectal vancomycin 500 mg every 6 hours in 100 mL normal saline as a retention enema.

• #21 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

  Toxins produced by Clostridioides difficile strains in the gastrointestinal tract cause pseudomembranous colitis, typically after antibiotic use. First-line treatment is with oral vancomycin or fidaxomicin. […] Oral vancomycin or oral fidaxomicin is recommended by the American College of Gastroenterology for the treatment of a primary episode of nonsevere C. difficile induced diarrhea. Fidaxomicin 200 mg orally every 12 hours for 10 days is recommended by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) as first-line therapy for C. difficile infection. Vancomycin 125 mg orally 4 times a day for 10 days is an alternative. Metronidazole is no longer recommended as first-line therapy for C. difficile induced diarrhea. However, oral metronidazole can be used if vancomycin or fidaxomicin is not available.

• #22 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. 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. If fidaxomicin or vancomycin are not available, metronidazole 500mg three times daily for 10 days can be alternatively used. For patients with severe CDI, oral vancomycin or fidaxomicin should be used as first line treatment. In fulminant cases of CDI, oral vancomycin 500mg four times daily and intravenous metronidazole 500mg every 8 hours are recommended. 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.

• #23 Clostridium difficile–Associated Diarrhea | AAFP

  https://www.aafp.org/pubs/afp/issues/2005/0301/p921.html/1000

  Early diagnosis and prompt aggressive treatment are critical in managing C. difficile associated diarrhea. […] Treatment of C. difficile associated diarrhea includes discontinuation of the precipitating antibiotic (if possible) and the administration of metronidazole or vancomycin. […] Specific pharmacotherapy for C. difficile associated diarrhea should be initiated in older patients, patients with multiple medical problems, and patients in whom antibiotics need to be continued. […] First-line therapy consists of metronidazole, 500 mg orally three or four times daily for 10 to 14 days. […] Vancomycin also is an effective treatment, with a response rate of greater than 90 percent. […] If a patient is pregnant or does not respond to or tolerate metronidazole, vancomycin should be initiated in a dosage of 125 to 500 mg orally four times daily for 10 to 14 days.

• #24 Antibiotic-associated diarrhea: Symptoms and treatment

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

  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. […] Treatment often requires hospitalization. A person may need isolation to avoid spreading the infection to others. […] Some interventions a doctor might recommend include: intravenous fluids that healthcare professionals administer through a vein, antibiotics to treat the infection usually vancomycin or fidaxomicin, the placement of a nasogastric tube if a person cannot take any liquids or food by mouth, monoclonal antibody therapy a new, innovative way to treat infection. […] People with mild diarrhea can treat themselves at home by drinking plenty of fluids. Electrolyte drinks or fruit juice may be helpful, and low fiber foods can help the stool become firmer.

• #25 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

  Sometimes, symptoms come back within a few days or weeks of finishing treatment. When this happens, more treatment is needed. […] If a person fails to improve with antibiotics and supportive care and the infection worsens, surgery (removal of the colon) may be warranted; this is generally limited to people with severe colitis and life-threatening illness. […] Treatment of recurrent C. difficile infection includes: Treatment with an oral antibiotic regimen (10- to 14-day course) or longer treatment with an oral antibiotic that is slowly tapered over several weeks. Additional treatment with specific oral probiotic capsules or a rectal enema. A treatment known as a „fecal transplant” may be considered in certain situations (for example, if a person has had three or more recurrences of C. difficile infection). […] Fecal transplant involves administration of bacteria from stool (via colonoscopy, by enema, or capsules taken by mouth) donated by a healthy person to a person who has recurrent C. difficile infection. Fecal transplant is used for patients who have not responded to multiple courses of antibiotics.

• #26 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

  A treatment known as a „fecal transplant” may be considered in certain situations (for example, if a person has had three or more recurrences of C. difficile infection). Fecal transplant involves administration of bacteria from stool (via colonoscopy, by enema, or capsules taken by mouth) donated by a healthy person to a person who has recurrent C. difficile infection.

• #27 Clostridioides (Clostridium) Difficile Colitis Treatment & Management: Approach Considerations, Pharmacologic Management, Fecal Microbiota Transplantation

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

  FMT is a novel therapy that involves the transfer of stool from a healthy donor to a patient with CDI to reconstitute the normal colonic microbial flora. It is given after treating CDI with antibiotics. Studies have evaluated prevention of recurrence of CDI after FMT. […] Several studies have shown that FMT by colonoscopy or enema was an effective approach for patients with recurrent CDI, with clinical success rates of up to 95%. […] In November 2022, the FDA approved microbiota via rectal administration (Rebyota) for prevention of recurrence of CDI in adults following antibiotic treatment for CD recurrence. Approval was based on the PUNCH CD3 phase 3 clinical trial. […] A second orally administered microbiota product (Vowst) received FDA approval in April 2023. Results from the ECOSPOR III phase 3 double-blind, randomized, placebo-controlled trial showed a decreased recurrence of CDI in patients treated orally with microbiota compared with placebo (12% vs 40%, respectively; P 0.001).

• #28 Managing antibiotic associated diarrhoea

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

  The Infectious Diseases Society of America, the American College of Gastroenterology, and the Society for Hospital Epidemiology of America recommend metronidazole as the first line of treatment to prevent the emergence of vancomycin resistant organisms. […] As antibiotic associated diarrhoea mostly results from a disequilibrium of the normal intestinal flora, research has focused on the benefits of administering living organisms (probiotics or biotherapeutic agents) to restore the normal flora. […] 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.

• #29 Treatment and prevention of antibiotic associated diarrhea – PubMed

  https://pubmed.ncbi.nlm.nih.gov/11118872/

  Mild or severe episodes of antibiotic-associated diarrhea (AAD) are common side effects of antibiotic therapy. […] In most cases of AAD discontinuation or replacement of the inciting antibiotic by another drug with lower AAD risk can be effective. […] For more severe cases involving C. difficile, the treatment of diarrhea requires an antibiotic treatment, with glycopeptides (vancomycin) or metronidazole. […] Another approach to AAD treatment or prevention is based on the use of non-pathogenic living organisms, capable of re-establishing the equilibrium of the intestinal ecosystem. […] Several organisms have been used in treatment or prophylaxis of AAD such as selected strains of Lactobacillus acidophilus, L. bulgaricus, Bifidobacterium longum, and Enterococcus faecium. […] Another biotherapeutic agent, a non-pathogenic yeast, Saccharomyces boulardii has been used.

• #30 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. […] 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.

• #31 Antibiotic-associated diarrhea – Wikipedia

  https://en.wikipedia.org/wiki/Antibiotic-associated_diarrhea

  Antibiotic-associated diarrhea (AAD) results from an imbalance in the colonic microbiota caused by antibiotics. […] Meta-analyses have concluded that probiotics may protect against antibiotic-associated diarrhea in both children and adults. […] The efficacy of probiotic AAD prevention is dependent on the probiotic strain(s) used and on the dosage. […] Up to a 50% reduction of AAD occurrences has been found.

• #32 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

  Using probiotics for the prevention of antibiotic-associated diarrhea reduces the risk of AAD by 51% (RR 0.49; 95% CI 0.36 to 0.67) with a moderate quality of evidence according to GRADE. This result was confirmed in analyses of specific strains, namely Lactobacillus rhamnosus GG and Saccharomyces boulardii. Furthermore, we found preliminary evidence to suggest a dose-response relationship.

• #33

  https://www.racgp.org.au/clinical-resources/clinical-guidelines/handi/handi-interventions/nutrition/probiotics-for-the-prevention-of-antibiotic

  Probiotics for the prevention of antibiotic-associated diarrhoea in adults and children. […] There is some evidence that the benefits of probiotics are strain-specific. Lactobacillus rhamnosus GG and Saccharomyces boulardii appear to be the most efficacious choice for preventing antibiotic-associated diarrhoea, while Lactobacillus casei may be the best for specifically preventing severe C. difficile-related diarrhoea. […] To reduce risk of antibiotic-associated diarrhoea in those at higher risk. […] Note: This evidence review did not cover probiotic use for the treatment of established AAD. However, given its efficacy in prevention, the use of probiotics in AAD would be reasonable. […] Probiotics have been shown to reduce antibiotic-associated diarrhoea in adults and children, in admitted and ambulatory patient settings, with different probiotic species, with lower or higher doses of probiotics and in studies at high or low risks of bias. […] Probiotic use is a low-risk, low-cost useful intervention for people at a higher risk of antibiotic-associated diarrhoea. […] Probiotics can be taken during and/or after antibiotic dosing. […] However, probiotic use for the minimum of the antibiotic treatment duration would be reasonable.

• #34 Probiotics for the Prevention of Antibiotic-Associated Diarrhea

  https://www.mdpi.com/2227-9032/10/8/1450

  Past studies have shown that probiotics are useful in the prevention of AAD. […] In one such meta-analysis, Blaabjerg et al. identified 17 prospective, randomized controlled trials with placebo, active, or no-treatment control arms in testing probiotics for the prevention of AAD in an outpatient setting. […] Probiotic supplementation has been shown to significantly reduce the risk of developing C. difficile-associated diarrhea in patients receiving antibiotics, especially hospitalized patients, as these reduce colonization by C. difficile. […] Probiotics can be found in the form of yogurt, kefir, kombucha, tablets, capsules, etc. Probiotics have become quite accessible to the public, as one can find a source in most supermarkets, pharmacies, and supplement stores. […] The Canadian Agency for Drugs and Technologies in Health (CADTH) carried out an evaluation of probiotics for AAD in the pediatric population. A strong recommendation was made for the use of L rhamnosus GG and S. boulardii for preventing AAD in children.

• #35 How to Prevent Diarrhea While You Take Antibiotics

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

  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. They also seem to help with side effects such as cramping and gas. […] 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.

• #36 Treatment and prevention of antibiotic associated diarrhea – PubMed

  https://pubmed.ncbi.nlm.nih.gov/11118872/

  In several clinical randomised trials (versus placebo), S. boulardii has demonstrated its effectiveness by decreasing significantly the occurrence of C. difficile colitis and preventing the pathogenic effects of toxins A and B of C. difficile. […] It has been shown to be a safe and effective therapy in relapses of C. difficile colitis. […] In ICUs prevention of AAD remains based on limitation of antibiotic overuse and spread of C. difficile or other agents of AAD should be prevented by improved hygiene measures (single rooms, private bathrooms for patients, use of gloves and hand washing for personnel). […] In addition the increasing use of biotherapeutic agents such as S. boulardii should permit the prevention of the major side effect of antibiotics, i.e. AAD in at risk patients.

• #37 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).

• #38 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 was to assess the benefits and harms of probiotics used for the prevention of AAD in an outpatient setting. […] The results suggest that probiotic use may be beneficial in the prevention of AAD among outpatients. Furthermore, the use of probiotics appears safe. […] 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 (RD 0.00, 95% CI -0.02 to 0.02, 2.363 participants).

• #39 Probiotics for the Prevention of Antibiotic-Associated Diarrhea

  https://www.mdpi.com/2227-9032/10/8/1450

  The American Gastroenterological Association (AGA) suggested the use of certain organisms such as S. boulardii, or combinations of strains, for example, L. acidophilus CL1285 and L. casei, for adults and children who are being treated with antibiotics. […] Research on microbial administration to modulate the human microbiome and improve health has been increasing at a rapid rate since probiotics were officially defined. The potential to alter these microbial ecosystems offers great hope for new preventative treatment options for antibiotic-associated diarrhea and other gastrointestinal disorders.

• #40 Focus on antibiotic associated diarrhea (AAD) | Content for health professionals | Microbiota institute

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

  If the use of probiotics for preventing antibiotic-associated diarrhea (AAD) is considered because of the existence of risk factors such as class of antibiotic(s), duration of antibiotic treatment, age, need for hospitalization, comorbidities, or previous episodes of AAD, healthcare professionals may recommend high doses (5 billion CFU/day) of S. boulardii or L. rhamnosus GG started simultaneously with antibiotic treatment to prevent AAD in outpatients and hospitalized children (certainty of evidence: moderate; grade of recommendation: strong). […] AAD can take anywhere from 2 hours to 8-10 weeks to develop after antibiotic use. […] Antibiotic Associated Diarrhea (AAD) is a common side effect of antibiotics. Age, spectrum of antibiotics used, underlying illness and recent surgery have been identified as risk factors. Recent evidence shows a new one: composition of the microbiota. In patients treated with -lactams, higher relative abundances of Bacteroides were inversely associated with AAD while higher baseline abundance of Bifidobacterium species and Lachnospiraceae and amino acid biosynthesis pathways (AABP) were associated with AAD. Relative abundances of potentially protective taxa and levels AABP may distinguish children who did and did not experience AAD. Further studies are needed to investigate whether similar trends are observed across different antibiotic types. The identified potentially protective taxa may inform the development of preventive approaches for AAD.

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

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

  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. Usually, probiotics should be taken within 24 hours of antibiotic use.

• #42 Antibiotic-associated diarrhea – sboulardii – CNCM i-745

  https://www.saccharomycesboulardii.com/therapeutic-area/antibiotic-associated-diarrhea/

  The major consequence of antibiotic-induced changes to gut microbiota diversity is antibiotic-associated diarrhea (AAD).1 Diarrhea is the signal that there is an imbalance in the diversity of the microbiota in the gut.1 AAD generally occurs during antibiotic treatment, however diarrhea can occur 2 to 8 weeks after treatment has finished.4 […] Saccharomyces boulardii CNCM I-745 is an effective approach to prevent, treat and recover from antibiotic-associated diarrhea. Probiotics are living microorganisms that when administered in adequate amounts confer a health benefit.6 The single-strain yeast probiotic Saccharomyces boulardii CNCM I-745 is proven to help reduce the occurrence of antibiotic-associated diarrhea.6 For example, it has been demonstrated that the occurrence of diarrhea is reduced by 53% in adults when Saccharomyces boulardii CNCM I-745 is taken at the same time as antibiotics.6 In addition the yeast reduces the impact of antibiotics on the microbiota during treatment.7 […] Unlike bacterial probiotics, S. boulardii CNCM I-745 is naturally resistant to antibiotics which means that it can be taken at the same time as antibiotics to act on the immediate effect of the antibiotics on the microbiota and reduce the risk of antibiotic-associated diarrhea.8

• #43 Antibiotic-associated diarrhea: Symptoms and treatment

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

  While it is not always possible to prevent antibiotic-associated diarrhea, some strategies that may help include: frequent handwashing to prevent the spread of C. diff, taking antibiotics with food, taking probiotics or eating probiotic foods, only taking antibiotics when a doctor prescribes them, avoiding multiple antibiotics except when medically necessary, seeking prompt medical care for severe diarrhea.

• #44 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. […] Take the right drug for the right bug. Dr. Madison suggests taking the most targeted treatment for your infection versus a broad-spectrum antibiotic. This reduces the chance of disrupting your gut microbiome. […] Add a probiotic. Dr. Amin says nourishing your gut with good bacteria can help prevent antibiotic-induced diarrhea and treat it when it occurs. […] Keep protecting your digestive tract after the antibiotics are finished. 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.

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