Abx effects on gut

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Hi all,

Just found this (looking for something else) but have had lots diarrhoea in the past, I suspect often due to abx, which at the time docs refused to acknowledge: but, so’s you know – fyi:

Look up this site on http://medind.nic.in/iau/t03/i1/iaut03i1p6.pdf

ANTIBIOTIC ASSOCIATED DIARRHOEA: INFECTIOUS CAUSES

*A Ayyagari, J Agarwal, A Garg

Diarrhoea is a frequent adverse effect of antibiotic

therapy; incidence varying between 5-25%, differing

with the antibiotic used.1 Antibiotic associated diarrhoea

(AAD) is considered clinically significant when there are

three mushy or watery stools per day.2 Diarrhoea is

reported to develop from within a few hours up to 2

months after antibiotic intake.3 Various mechanisms

have been attributed to development of diarrhoea

following antibiotic therapy. Disturbed composition and

function of normal intestinal flora leads to decreased

metabolism of carbohydrates, which in turn causes

osmotic diarrhoea. Reduced break down of primary bile

acids further adds on as these are potent colonic

secretory agents. Other mechanisms include lower

concentrations of faecal anaerobes thus decrease in

colonization resistance, overgrowth of pathogenic

microbes which may produce toxins; allergic or toxic

effects of antibiotic on intestinal mucosa and

pharmacological effect on gut motility.4,5 Nearly 25%

of AAD cases are caused by Clostridium difficile and it

is the most commonly identified and treatable pathogen.6

Other pathogens that have been linked with AAD

include Clostridium perfringens, Staphylococcus aureus,

Klebsiella oxytoca, Candida spp. and Salmonella spp.4,5

Clostridium difficile

Clostridium difficile is an anaerobic, gram-positive

spore forming bacillus first isolated in 1935 from faecal

flora of healthy neonates. It was not until 1978 that its

association with antibiotic induced pseudomembranous

colitis (PMC) was established.7 Isolation rate of C.

difficile varies from 90% in PMC to 20-25% in AAD.6

Major risk factors include advanced age, duration of

hospitalization, severity of underlying disease and

exposure to antibiotics. The antibiotics most frequently

associated are clindamycin, cephalosporin, ampicillin

and amoxicillin. In a multivariate analysis, after making

adjustments for other risk factors, these agents were

found to be associated with highest risk of C. difficile

diarrhoea.8 Almost all antibiotics have been linked with

C. difficile diarrhoea and colitis, including vancomycin

and metronidazole (which are used for its treatment) and

cancer chemotherapy.9,10 The frequency of association

is related to frequency of use, the route of administration

and the impact of that antibiotic on the colonic

microflora (Figure). Other reported risk factors include

presence of nasogastric tube and gastrointestinal

procedures.8

Just something to be aware of... Doesn’t necessarily mean you have dx b/c on abx...

Cheers,

joy