In the summer, diarrhea is a common occurrence, and many people have the habit of taking antibiotics when they have diarrhea. However, this is a very wrong habit. Most cases of diarrhea are self-limiting diseases and do not require the use of antibiotics. Blindly using antibiotics can not only cause or worsen gastrointestinal discomfort and induce bacterial resistance, but some people may also experience a sudden worsening of diarrhea after a few days of improvement, even more severe than before. Switching to other antibiotics does not work, and the diarrhea becomes increasingly severe. In fact, these patients have developed a special type of infectious diarrhea called antibiotic-associated diarrhea.
Antibiotic-associated diarrhea refers to medically-induced diarrhea caused by the disruption of intestinal flora following the use of antibiotics. The main symptoms include abdominal pain and diarrhea. Mild cases may present with a large amount of watery stools, while severe cases may have bloody stools or pseudo-membranes resembling egg drop soup in the stool. If left untreated or not stopping the medication in time, it can lead to dehydration, electrolyte imbalance, metabolic acidosis, shock, circulatory failure, and more.
The normal intestinal flora can consist of over 500 different species, and the flora balance is maintained between the intestinal flora and the host, which is essential for maintaining overall health. When someone has an infectious disease and uses antibiotics, or when antibiotics are used for a prolonged period for prophylactic purposes during surgery, it can disrupt this balance and cause an imbalance in the intestinal flora. The result is a weakened intestinal barrier function, allowing certain foreign or transient bacteria to colonize and proliferate in the intestines, becoming dominant flora and leading to diarrhea or enteritis.
Antibiotic-associated diarrhea can occur at any age, but it is particularly common in infants, young children, the elderly, and those with a history of prolonged antibiotic use. Almost all antibiotics can cause diarrhea, with the highest incidence seen with lincomycin and clindamycin, accounting for about 20%. Penicillin class antibiotics also have a high proportion of inducing pseudomembranous enteritis, with reports stating that about 11% of patients taking oral ampicillin develop diarrhea after a week. Cephalosporins are also frequently associated with diarrhea, especially second and third-generation cephalosporins. Tetracyclines can also cause difficult-to-distinguish Clostridium difficile-associated pseudomembranous enteritis. Macrolides and sulfonamide drugs can induce difficult-to-distinguish Clostridium difficile enteritis. Clinical data shows that the broader the spectrum of the antibiotic, the greater the likelihood of causing diarrhea.
For antibiotic-associated diarrhea, early diagnosis and treatment are crucial. Anyone who experiences diarrhea during the use of antibiotics or within a few weeks after stopping the medication should highly suspect this condition. The final diagnosis should rely on pathogen examination and relevant toxin tests. Mild patients only exhibit diarrhea, and stopping the use of antibiotics can lead to improvement. Severe patients may experience severe fever, diarrhea, the passage of pseudo-membranes in the stool, systemic toxic symptoms, and even death. At this point, there are not many antibiotics available for the treatment of this condition, with metronidazole and vancomycin being the main options.
To prevent antibiotic-associated diarrhea, doctors should strictly adhere to the indications for antibiotic use, avoid the misuse of antibiotics, especially broad-spectrum antibiotics, and strictly control the duration of treatment and timely cessation of medication. Elderly and frail patients, especially those with peritoneal infections, malnutrition, and immunodeficiency, should try to avoid the use of antibiotics that are prone to induce diarrhea. Patients on long-term antibiotic therapy should also be familiar with the pharmacological effects and adverse reactions. During the course of treatment, close observation for any toxic side effects is necessary. If antibiotic-associated diarrhea occurs, the causative antibiotic should be stopped, and mucosal protectants, intestinal microecological preparations, antidiarrheal drugs, and nutritional support should be used for symptomatic treatment.
