Antibiotic-associated diarrhea

Description

Antibiotic-associated diarrhea refers to the passage of loose, watery stools three or more times a day after taking medications used to treat bacterial infections (antibiotics).

Approximately 1 out of every 5 people who take antibiotics will develop diarrhea associated with antibiotics. Most often, antibiotic-associated diarrhea is mild and requires no treatment. The diarrhea usually goes away within a couple of days after you stop taking the antibiotic. More serious antibiotic-associated diarrhea requires to stop or, at times, the switching of the antibiotics.

Symptoms

For most people, the antibiotic-associated diarrhea causes mild signs and symptoms, such as:

  • Loose stools
  • More frequent bowel movements

Antibiotic-associated diarrhea is likely to begin a week after you start taking an antibiotic. Sometimes, however, the diarrhea, and other symptoms do not appear until days or even weeks after completion of antibiotic treatment.

Clostridioides difficile (formerly Clostridium difficile) infection

C. difficile is a toxin-producing bacterium that can cause a more severe antibiotic-associated diarrhea. In addition to causing loose stools and more frequent bowel movements, infection by C. difficile can cause:

  • Severe diarrhea and dehydration
  • Abdominal pain and cramps
  • Low-grade fever
  • Nausea
  • Loss of appetite

When to see a doctor

Call your doctor right away if you have severe signs and symptoms of antibiotic-associated diarrhea. These signs and symptoms are common to a number of conditions, so your doctor may recommend tests such as stool or blood tests to determine the cause.

Causes

Why is antibiotic-associated diarrhea occurs is not fully understood. It is commonly believed that develop when antibacterial medicines (antibiotics) to alter the balance of good and bad bacteria in your gastrointestinal tract.

The antibiotics most likely to cause diarrhea

Almost all antibiotics can cause antibiotic-associated diarrhea. The antibiotics most commonly involved are:

  • Macrolides, such as clarithromycin
  • Cephalosporins such as cefdinir and cefpodoxime
  • The fluoroquinolones, such as ciprofloxacin and levofloxacin
  • Penicillins, such as amoxicillin and ampicillin

C. difficile infection

When antibiotics alter the balance of bacteria in your digestive system, the bacteria C. difficile can grow quickly 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 — in spite of taking virtually any antibiotic can put you at risk.

Risk factors

Antibiotic-associated diarrhea may occur in any person who takes an antibiotic. But you are more prone to developing antibiotic-associated diarrhea if you:

  • Has had antibiotic-associated diarrhea in the past
  • Have taken antibiotics for a long time
  • You are taking more than one medicine antibiotic

Complications

One of the most common complications of any type of diarrhea is the excessive loss of fluids and electrolytes (dehydration). Severe dehydration can be life-threatening. Signs and symptoms include a very dry mouth, extreme thirst, little or no urine, dizziness, and weakness.

Prevention

To help prevent antibiotic-associated diarrhea, try the following:

  • Take antibiotics only when necessary. Do not use antibiotics unless your doctor feels necessary. Antibiotics can treat bacterial infections, but will not help viral infections, such as colds and the flu.
  • Ask the doctors to wash their hands. If you are receiving care at home or in the hospital, ask everyone to wash their hands or use an alcohol-based hand sanitizer before touching you.
  • Tell your doctor if you have had antibiotic-associated diarrhea or C. difficile before. To have antibiotic-associated diarrhea once or C. difficile in the past increases the likelihood that the antibiotics can cause the same reaction again. Your doctor may be able to select a different antibiotic for you.

Antibiotic-associated diarrhea

Diagnosis

For the diagnosis of antibiotic-associated diarrhea, your doctor is likely to question you about your health history, including if you have had recent treatment with antibiotics. If your doctor suspects that you have C. difficile infection, a sample of your stool might be to test the bacteria.

Treatment

The treatment for antibiotic-associated diarrhea depends on the severity of your signs and symptoms.

Treatments for dealing with mild antibiotic-associated diarrhea

If you have diarrhea that is mild, the symptoms are likely to resolve within a couple of days after the antibiotic treatment ends. In some cases, your doctor may advise you to stop your therapy with antibiotics until the diarrhea stops.

The treatment to combat the harmful bacteria that cause infection by C. difficile

If you have C. difficile infection, your doctor will probably leave the antibiotic that you are taking currently, and may prescribe antibiotics specifically targeted to kill the C. difficile bacteria that cause diarrhea. You may also be asked to stop taking stomach acid-suppressing drugs. For people with this type of infection, the symptoms of diarrhea can return and require repeated treatment.

Self-care

To cope with diarrhea:

  • Drink sufficient amount of liquid.To offset a slight loss of fluids from diarrhea, drink more water or drinks that contain electrolytes. To a greater loss, and drinking liquids that contain water, sugar and salt, such as the oral rehydration solution. Taste the broth or juice of fruits that are not high in sugar. Avoid drinks with high sugar content, or that contain alcohol or caffeine, such as coffee, tea and cola drinks, which can make your symptoms worse. For infants and children with diarrhea, talk to your doctor about the use of an oral rehydration solution such as Pedialyte, to replenish fluids and electrolytes.
  • Avoid certain foods. It is a good idea to avoid dairy products, as well as fatty and spicy foods while you have diarrhea. You can usually return to a normal diet soon after their symptoms have gone away.
  • Ask about anti-diarrheal medications. In some mild cases of antibiotic-associated diarrhea, the 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 the body's ability to eliminate toxins and lead to serious complications. These medications should not be used in case of developing C. difficile infection.

Drink sufficient amount of liquid. To offset a slight loss of fluids from diarrhea, drink more water or drinks that contain electrolytes. To a greater loss, and drinking liquids that contain water, sugar and salt, such as the oral rehydration solution. Taste the broth or juice of fruits that are not high in sugar. Avoid drinks with high sugar content, or that contain alcohol or caffeine, such as coffee, tea and cola drinks, which can make your symptoms worse.

For infants and children with diarrhea, talk to your doctor about the use of an oral rehydration solution such as Pedialyte, to replenish fluids and electrolytes.

People can turn to probiotics, which are found in foods such as yogurt — with the hope that they can re-balance the healthy bacteria in your digestive tract. But, there is no consensus on whether or not over-the-counter probiotics can help reduce symptoms of antibiotic-associated diarrhea. Probiotics do not seem to be harmful, however, unless you have a weakened immune system.

Preparing for your appointment

Make an appointment with the doctor who prescribed an antibiotic. Here's some information to help you prepare for your appointment.

What you can do

Make a list of:

  • Your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Key personal information, including any major stresses or recent life changes, for example, if you have recently been in the hospital or in a nursing home.
  • The medications, vitamins, or supplements you are taking, including dosage. If you've recently taken an antibiotic, include the name, dose, and when she stopped taking it.
  • Questions to ask your doctor.

For antibiotic-associated diarrhea, some basic questions to ask your doctor include:

  • What tests do I need?
  • Is my condition likely temporary or chronic?
  • What is the best course of action?
  • What are the alternatives to the primary approach you're suggesting?
  • There are restrictions that I should follow?
  • Are there foods and drinks should I avoid?

Do not hesitate to ask other questions.

What to expect from your doctor

Your doctor may ask you a series of questions. Be ready to answer them may allow more time to cover other points you want to address. Your doctor may ask:

  • When did your symptoms begin?
  • Can you describe your bowel movements? How frequent are they?
  • Do you have a history of intestinal problems, such as ulcerative colitis, Crohn's disease or other inflammatory bowel disease?
  • Has been near someone with diarrhea recently?

What you can do in the meantime

Keep taking the antibiotics as directed by your doctor.

To cope with diarrhea until your appointment, you can:

  • Drink more water and other fluids to replace the fluids lost due to diarrhea
  • Eat soft foods and avoid spicy or greasy foods that may aggravate the diarrhea
Symptoms and treatment of Antibiotic-associated diarrhea