Antibiotic-Associated Diarrhea

Overview

Antibiotic-associated diarrhea is a common side effect that occurs when someone takes antibiotics to treat a bacterial infection. It is characterized by passing loose, watery stools three or more times a day. This condition affects about 1 in 5 people who take antibiotics. In most cases, it is mild and resolves within a few days after the antibiotic is stopped. However, in some instances, it may be more severe and require discontinuing or switching the antibiotic treatment. The risk of developing antibiotic-associated diarrhea is higher for people who have taken antibiotics for an extended time, have a history of the condition, or are taking multiple antibiotics.

Understanding the disease

Symptoms

The symptoms of antibiotic-associated diarrhea include passing loose, watery stools three or more times a day after taking medications used to treat bacterial infections (antibiotics). This may also involve more-frequent bowel movements, loose stools, severe diarrhea and dehydration, lower abdominal pain and cramping, low-grade fever, nausea, and loss of appetite.

Risk Factors

Risk factors for developing antibiotic-associated diarrhea include:

1. Taking antibiotics: The primary risk factor is taking antibiotic medications, as they can disrupt the balance of good and bad bacteria in the digestive system.
2. Having taken antibiotics before: People who have experienced antibiotic-associated diarrhea in the past are more likely to develop it again after taking antibiotics.
3. Long-term antibiotic use: The longer someone takes antibiotics, the higher the risk of developing antibiotic-associated diarrhea.
4. Using multiple antibiotics simultaneously: Taking more than one antibiotic medication at the same time can increase the risk of developing diarrhea.

Development

Antibiotic-associated diarrhea occurs when antibacterial medications (antibiotics) upset the balance of good and bad bacteria in your gastrointestinal tract. The specific mechanism is not entirely understood, but it is believed that antibiotics kill not only the targeted harmful bacteria but also the beneficial bacteria in your gut, leading to an imbalance. This imbalance can result in the overgrowth of certain bacteria, such as C. difficile, which can cause further issues, including diarrhea. Antibiotics can also alter the gut's barrier function, leading to increased permeability and the release of toxins, further contributing to diarrhea.

Assessment and Diagnosis

Triage

You should see a doctor if you have serious signs and symptoms of antibiotic-associated diarrhea. These signs and symptoms include severe diarrhea and dehydration, lower abdominal pain and cramping, low-grade fever, nausea, and loss of appetite. If you experience any of these symptoms, it's important to call your doctor right away for further evaluation and possible testing.

Diagnosis

To diagnose antibiotic-associated diarrhea, your doctor typically assesses your health history, including any recent antibiotic treatments, and may request a stool test to check for C. difficile infection.

Management and Treatment

Complications

The potential complications of antibiotic-associated diarrhea include extreme loss of fluids and electrolytes (dehydration), which can be life-threatening. Signs and symptoms of severe dehydration include a very dry mouth, intense thirst, little or no urination, dizziness, and weakness.

Prevention

Antibiotic-associated diarrhea can be prevented in several ways, such as:

1. Taking antibiotics only when necessary: Antibiotics should only be used when prescribed by a doctor and deemed necessary. They won't help with viral infections like colds and flu.
2. Completing the full course of antibiotics: Finishing the entire prescribed course of antibiotics helps to reduce the risk of diarrhea and other complications.
3. Asking caregivers to wash their hands: If receiving care at home or in a hospital, ensure that caregivers wash their hands or use an alcohol-based hand sanitizer before touching you to prevent the spread of infection.
4. Avoiding the use of antibiotics in children with viral infections: Antibiotics should not be given to children with viral infections like colds or the flu, as they won't help and may cause adverse effects like antibiotic-associated diarrhea.
5. Maintaining good hygiene: Practice good hygiene by washing hands frequently, especially before preparing or consuming food, after using the toilet, and after coming into contact with someone who is sick. It's essential to follow your doctor's instructions and the recommended guidelines for taking antibiotics to minimize the risk of antibiotic-associated diarrhea.

Treatment

To treat antibiotic-associated diarrhea, your doctor may recommend changes to your diet, medication adjustments, and in some cases, specific medications targeting the harmful bacteria. Treatment options may include:

1. Changes to your diet: Your doctor may advise a low-fat, low-fiber diet and suggest discontinuing dairy products, gluten, or both. Avoid caffeine and sugar.
2. Medications: If symptoms persist, your doctor may prescribe anti-diarrheal medications like loperamide (Imodium A-D) or bismuth subsalicylate (Pepto-Bismol), steroids like budesonide (Entocort EC), or medications that block bile acids, such as cholestyramine/aspartame (Prevalite), or cholestyramine (Colestid).
3. Antibiotics: If you have a C. difficile infection, your doctor will likely prescribe antibiotics targeting the specific bacteria causing the diarrhea, and recommend discontinuing stomach-acid-suppressing drugs. Self-care measures include avoiding certain foods, consulting with your doctor before taking anti-diarrheal medications, and allowing your body time to recover. Remember, it's essential to follow your doctor's advice and recommendations to ensure proper treatment and recovery.

Preparing for medical consultation

To prepare for an appointment for antibiotic-associated diarrhea, follow these steps:

1. Gather your medical history: Make a list of your key personal information, including any major stresses or recent life changes, your current medications, vitamins, or supplements you're taking, and dosages. Also, note if you have recently taken an antibiotic, including the name, dosage, and when you stopped taking it.
2. Prepare a symptom history: Write down the details of your diarrhea symptoms, when they began, and any other associated symptoms such as abdominal pain, nausea, or fever.
3. Note any recent travel: If you have recently traveled abroad, inform your healthcare professional about your trip, as this information may be relevant to your diagnosis.
4. Prepare a list of questions: Write down any questions you have for your doctor, such as the best course of action, alternative treatments, restrictions you should follow, and foods and drinks to avoid.
5. Follow pre-appointment instructions: When you make the appointment, ask if there are any immediate self-care steps you can take to help recover more quickly. Remember to bring your list of symptoms, medical history, and questions to your appointment. This will help ensure that you cover all the necessary information and get the most out of your appointment.