Antibiotic-associated diarrhea

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Classification according to ICD-10
K52.9 Non-infectious diarrhea, unspecified
ICD-10 online (WHO version 2019)

The antibiotic-associated diarrhea indicates a result of taking antibiotics caused diarrhea .

Explanation of terms

Under antibiotic-associated diarrhea different are diseases combined, all of which lead to diarrhea during or up to eight weeks after taking one or more antibiotics. It does not matter whether the antibiotic is swallowed or given as an infusion directly into the blood . Often the phenomenon is harmless; rarely, however, antibiotic-associated diarrhea can become life-threatening. However, permanent damage to the microbial community in the intestine is also possible through antibiotics , especially if these drugs are given frequently or in high doses in childhood.

Epidemiology

The probability of suffering from antibiotic-associated diarrhea is 5-35% and depends on the type of antibiotic, the patient's health and whether the patient is exposed to a large number of pathogens. Due to the usually poorer health and possible hospital germs, hospitalized patients are more likely to suffer from antibiotic-associated diarrhea than in the outpatient setting.

causes

There are three different causes of illness:

  • Usually receipt is missing! it is a direct effect of the antibiotic or of additives of the antibiotic on the intestine , which thereby stimulates a faster movement of the intestinal contents, the so-called peristalsis , which leads to a mushy diarrhea. This effect occurs primarily with penicillins , especially in combination with clavulanic acid . The effect is harmless and disappears when the antibiotic is stopped.
  • Missing in 10 to 20% receipt! of the cases it is an infection that was favored by the antibiotics. The antibiotic destroys some of the bacteria ( symbionts ) normally living in the intestine, specifically the microorganisms in the intestinal flora that are sensitive to this antibiotic . More resistant or less sensitive germs can be bacteria causing diarrhea, which can then multiply quickly because fewer competing bacteria are present in the area. Usually it is harmless to moderate diarrhea. In rare cases, however, life-threatening loss of fluids and salts from the intestines can occur. Infection with Clostridioides difficile , which causes pseudomembranous colitis , is particularly feared . In addition, infections with Salmonella can be favored by certain antibiotics. Other germs such as Staphylococcus aureus or fungi such as Candida albicans are also suspected to be the cause of the diarrhea.
  • Diarrhea rarely occurs as part of an allergic or toxic reaction of the intestine to the antibiotics. The death of the intestinal cells causes severe diarrhea. In the allergic reaction, however, the whole body anaphylactic shock is usually the more dangerous complication .

clinic

The extent and course of the diarrhea depend on its cause. While excited peristalsis is harmless, an infection or allergy can be life-threatening. In addition to a massive loss of fluids and salts through the intestines, bacteria can also penetrate the blood, where they can multiply quickly. In this case, one speaks of sepsis .

Therapy (treatment)

  • The loss of fluids and salts must be compensated for. This often requires an infusion .
  • In addition, pseudomembranous colitis (overgrowth with Clostridioides difficile) must be treated with antibiotics - despite the risks of renewed antibiotic therapy. The following active ingredients are used here:
    • First choice: Metronidazole (3 × 500 mg) orally for 10 days
    • Second choice: Vancomycin (4 × 125 mg) orally for 10 days (more preferred for severe courses)
  • In the event of allergic reactions as well as infections, the offending antibiotic must be discontinued. In the event of allergic reactions, the excessive immune system must be quickly suppressed with immunomodulators such as steroids .

prophylaxis

Several studies have shown that probiotics can prevent the occurrence of antibiotic-associated diarrhea by being administered prophylactically or at the same time as necessary antibiotic therapy. For example, a controlled, randomized, double-blind study from 1999 that was carried out with 202 children aged 6 months to 10 years (188 of which were included in the analysis) showed that 25 of 95 children in the placebo group , but only 7 of 93 children of the children treated with Lactobacillus rhamnosus GG (= verum group ) developed diarrhea after the necessary antibiotic therapy. In another controlled, randomized, double-blind study from 2005, which was carried out with 269 children between the ages of 6 months and 14 years (of which 246 were included in the analysis), it was shown that the risk of antibiotic-associated diarrhea was increased by the simultaneous intake of Saccharomyces boulardii significantly decreased. In the placebo group, 22 of 127 children developed antibiotic-associated diarrhea, whereas the intake of Saccharomyces boulardii only caused this type of diarrhea in 4 of 119 children. Another study used a defined amount of yoghurt (227 g) as a dietary supplement in parallel with antibiotics. Result: The administration of yoghurt halved the number of patients with diarrhea and even more significantly reduced the total number of days with diarrhea: Only 12% (compared to 24%) in the yoghurt group complained of diarrhea; and 23 days of diarrhea in the yogurt group were compared to 60 days of diarrhea in the non-yogurt group.

A meta-analysis in which nine randomized controlled studies were evaluated comes to the conclusion that probiotics are helpful in the prevention of antibiotic-associated diarrhea. Saccharomyces boulardii and Lactobacillus are most effective in this indication. It should be noted, however, that bacteria (such as lactobacilli) are attacked by antibiotics and therefore the antibiotic must be taken with a delay. The simultaneous intake of dairy products is also not possible with antibiotics of the tetracycline group and so-called gyrase inhibitors , as otherwise the effectiveness of the antibiotics is lost; These antibiotics should therefore always be taken at least two to three hours after the consumption of dairy products.

See also

literature

  • WL George, RD Rolfe, VL Sutter, SM Finegold : Diarrhea and colitis associated with antimicrobial therapy in man and animals . In: Am J Clin Nutr. , Jan. 1979, 32 (1), pp. 251-257
  • AH Lishman, IJ Al-Jumaili, CO Record: Spectrum of antibiotic-associated diarrhea . Well. Jan. 1981, 22 (1), pp. 34-37
  • E. Mylonakis, ET Ryan, SB Calderwood: Clostridium difficile-associated diarrhea: a review . In: Arch Intern Med , 2000, 161, pp. 525-533
  • C. Van Dessel, J. Flamaing, M. Hiele: Antibiotic associated diarrhea and Clostridium difficile associated diarrhea in the elderly . In: Tijdschr Gerontol Geriatr. Dec. 2005, 36 (6), pp. 247-50
  • JA Vanderhoof, DB Whitney, DL Antonson, TL Hanner, JV Lupo, RJ Young: Lactobacillus GG in the prevention of antibiotic-associated diarrhea in children . In: J Pediatr . 1999 Nov, 135 (5), pp. 535-537, PMID 10547243 .
  • RS Beniwal, VC Arena, L. Thomas et al .: A randomized trial of yoghurt for prevention of antibiotic-associated diarrhea . In: Dig Dis Sci 2003, 48, pp. 2077-2082
  • Burkhard Göke, Frank Kolligs, Christian Rust: Internal Clinic Guide . Munich 2005, ISBN 3-00-017647-0

Web links

Individual evidence

  1. ↑ a b L.V. McFarland: Antibiotic-associated diarrhea: epidemiology, trends and treatment. In: Future microbiology. Volume 3, Number 5, October 2008, pp. 563-578, doi : 10.2217 / 17460913.3.5.563 , PMID 18811240 (review).
  2. ↑ Joël Doré: The effect of intestinal bacteria goes beyond the digestive tract . ( Memento of June 18, 2012 in the Internet Archive ) June 11, 2012, accessed June 16, 2012 ( INSA )
  3. ↑ JA Vanderhoof et al.
  4. ↑ M. Kotowska, P. Albrecht, H. Szajewska: Saccharomyces boulardii in the prevention of antibiotic-associated diarrhea in children: a randomized double-blind placebo-controlled trial. In: Alimentary pharmacology & therapeutics. Volume 21, Number 5, March 2005, pp. 583-590, doi : 10.1111 / j.1365-2036.2005.02356.x , PMID 15740542 .
  5. ↑ RS Beniwal et al., 2003.
  6. ^ AL D'Souza, C. Rajkumar, J. Cooke, CJ Bulpitt: Probiotics in prevention of antibiotic associated diarrhea: meta-analysis. In: BMJ (Clinical research ed.). Volume 324, number 7350, June 2002, p. 1361, PMID 12052801 , PMC 115209 (free full text) (review).
  7. ↑ Interactions with antibiotics . Focus.