| ORIGINAL ARTICLE |
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| Year : 2016 | Volume
: 1
| Issue : 1 | Page : 27-33 |
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Antibiotic-associated diarrhea: a systematic review with two decades of experience
Suraj Gupte
Professor and Head, Postgraduate Department of Pediatrics, Mamata Medical College/Mamata General and Super speciality Hospitals, Khammam, Telangana, India
Correspondence Address:
Suraj Gupte
Professor and Head, Postgraduate Department of Pediatrics, Mamata Medical College/Mamata General and Super speciality Hospitals, Khammam, Telangana
India
 Source of Support: None, Conflict of Interest: None
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Objective: To put in perspectives the scattered information in the literature with inputs from our 2 decades of experience on antibiotic-associated diarrhea (AAD)- a by and large neglected condition.
Resource and Design: Systematic review of literature together with our own experience spread over 2 decades.
Salient Features: AAD is defined as the diarrhea that has no known cause other than an antibiotic therapy given concurrently or discontinued at the most 4 weeks preceding it. By and large, each and every antibiotic, though some are decidedly high-risk, is capable of causing diarrhea. No doubt, C. difficile is responsible for most cases of severe AID (i.e. colitis), in some cases S. aureus and C. perfringens may well be the causative agents. Diagnosis is by and large clinical. Most important first-aid measure in AAD is withdrawal of the offending antibiotic and offering supportive measures to maintain fluid and electrolyte balance and nutrition. As a therapeutic measure (as and when considered warranted), metronidazole (preferably oral) should be considered the drug of first choice.Alternatively, ornidazole or nitazoxanide may be given. The somewhat superior in efficacy, though expensive, alternative is vancomycin. At times, the two drugs may be given simultaneously. Good food and water hygiene, meticulous hand-washing, and proper environmental cleaning are helpful. Incorporation of probiotics may have both a preventive and therapeutic role.
Conclusion: Judicious use of antibiotics is the most important preventive measure in AAD. Treatment modalities include withdrawal of the offending agent and administration of metronidazole, ornidazole or nitazoxanide. In case of poor response, vancomycin yieds gratifying response. Administration of probiotics may be helpful. A vaccine against C. difficile may well be around the corner.
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