Incidence Of Antibiotic-associated Diarrhea Research Articles

Incidence and risk factors of oral antibiotic-associated diarrhea in an outpatient pediatric population.

Little information is available on the epidemiologic characteristics of antibiotic-associated diarrhea (AAD) in children. The authors' aim was to evaluate the incidence of AAD in an outpatient pediatric population and to identify risk factors. Children aged 1 month to 15.4 years treated with oral antibiotics for a proven or suspected infection were enrolled from an ambulatory pediatric practice during an 11-month period. Parents recorded the daily frequency and characteristics of stools using a diary during the antibiotic treatment and for 1 week after it was stopped. An episode of diarrhea was defined by at least 3 soft or liquid stools/d for at least 2 consecutive days. Risk factors for AAD-age, type of antibiotic treatment, type of combined treatment, and site of infection-were analyzed. Of 650 children included, 11% had an episode of AAD, lasting a mean of 4.0 +/- 3.0 days, beginning a mean of 5.3 +/- 3.5 days after the start of antibiotic treatment. No child was hospitalized because of AAD. The incidence of AAD was higher in children less than 2 years (18%) than in those more than 2 years (3%; P < 0.0001). The incidence of AAD was particularly high after administration of certain antibiotics (amoxicillin/clavulanate, 23%; P = 0.003 compared with other antibiotics). The type of combined treatment and site of infection did not influence the onset of AAD. Antibiotic-associated diarrhea was common in these outpatient children, especially for those aged less than 2 years and after the prescription of certain antibiotics, particularly, the combination of amoxicillin/clavulanate.

Incidence and Risk Factors of Oral Antibiotic‐Associated Diarrhea in an Outpatient Pediatric Population

ABSTRACTBackground:Little information is available on the epidemiologic characteristics of antibiotic‐associated diarrhea (AAD) in children. The authors' aim was to evaluate the incidence of AAD in an outpatient pediatric population and to identify risk factors.Methods:Children aged 1 month to 15.4 years treated with oral antibiotics for a proven or suspected infection were enrolled from an ambulatory pediatric practice during an 11‐month period. Parents recorded the daily frequency and characteristics of stools using a diary during the antibiotic treatment and for 1 week after it was stopped. An episode of diarrhea was defined by at least 3 soft or liquid stools/d for at least 2 consecutive days. Risk factors for AAD—age, type of antibiotic treatment, type of combined treatment, and site of infection— were analyzed.Results:Of 650 children included, 11% had an episode of AAD, lasting a mean of 4.0 ± 3.0 days, beginning a mean of 5.3 ± 3.5 days after the start of antibiotic treatment. No child was hospitalized because of AAD. The incidence of AAD was higher in children less than 2 years (18%) than in those more than 2 years (3%; P &lt; 0.0001). The incidence of AAD was particularly high after administration of certain antibiotics (amoxicillin/clavulanate, 23%; P = 0.003 compared with other antibiotics). The type of combined treatment and site of infection did not influence the onset of AAD.Conclusions:Antibiotic‐associated diarrhea was common in these outpatient children, especially for those aged less than 2 years and after the prescription of certain antibiotics, particularly, the combination of amoxicillin/clavulanate. JPGN 37:22‐26, 2003.

Antibiotic use, gastroenteritis and respiratory illness in South Australian children.

This study examines the incidence of antibiotic-associated diarrhoea (AAD) in children in the community setting. Parents of 965 children aged 4-6 years and resident in rural/semi-rural South Australia completed a questionnaire on socio-demographic factors, and a 6-week daily diary detailing symptoms of gastroenteritis, antibiotic use, respiratory illness, and contact with someone with gastroenteritis. The incidence of AAD was 32.3 %, falling to 23.5% when episodes associated with a respiratory illness were excluded. Respiratory illness in the previous 3 days (OR 6.76, 95% CI 4.87, 9.38), and contact with someone with gastroenteritis in the previous 14 days (OR 1.8, 95% CI 1.48, 2.19), were both associated with gastroenteritis. After adjusting for these, only the first day of antibiotic use was associated with gastroenteritis (OR 3.8, 95% CI 1.8, 8.06). Potential confounding factors, in particular inter-current respiratory illness, need to be considered when examining AAD.

Treatment and prevention of antibiotic associated diarrhea

Mild or severe episodes of antibiotic-associated diarrhea (AAD) are common side effects of antibiotic therapy. The incidence of AAD differs with the antibiotic and varies from 5 to 25%. The major form of intestinal disorders is the pseudomembranous colitis associated with Clostridium difficile which occurs in 10–20% of all AAD. In most cases of AAD discontinuation or replacement of the inciting antibiotic by another drug with lower AAD risk can be effective. For more severe cases involving C. difficile, the treatment of diarrhea requires an antibiotic treatment, with glycopeptides (vancomycin) or metronidazole. Another approach to AAD treatment or prevention is based on the use of non-pathogenic living organisms, capable of re-establishing the equilibrium of the intestinal ecosystem. Several organisms have been used in treatment or prophylaxis of AAD such as selected strains of Lactobacillus acidophilus, L. bulgaricus, Bifidobacterium longum, and Enterococcus faecium. Another biotherapeutic agent, a non-pathogenic yeast, Saccharomyces boulardii has been used. In animal models of C. difficile colitis initiated by clindamycin, animals treated with S. boulardii (at end of vancomycin therapy) had a significant decrease in C. difficile colony-forming units, and of toxin B production. In several clinical randomised trials (versus placebo), S. boulardii has demonstrated its effectiveness by decreasing significantly the occurrence of C. difficile colitis and preventing the pathogenic effects of toxins A and B of C. difficile. It has been shown to be a safe and effective therapy in relapses of C. difficile colitis. A good response has been seen in children with AAD, treated by S. boulardii only. In ICUs prevention of AAD remains based on limitation of antibiotic overuse and spread of C. difficile or other agents of AAD should be prevented by improved hygiene measures (single rooms, private bathrooms for patients, use of gloves and hand washing for personnel). In addition the increasing use of biotherapeutic agents such as S. boulardii should permit the prevention of the major side effect of antibiotics, i.e. AAD in at risk patients.

A randomized controlledtrial comparing Lactobacillus combined with Bifidobacterium bifidum against fructo-oligosaccharides in reducing the incidence of antibiotic-associated diarrhoea: a preliminary investigation

A double-blind randomized controlled trial was conducted to investigate thetherapeutic efficacy by comparing Lactobacillus combined with Bifidobacterium bifidum against fructo-oligosaccharides in ameliorating antibiotic-associated diarrhoea in an inpatient clinical population. No evidence was found to support the notion that Lactobacillus combined with B. bifidum decreases the incidence of antibiotic-associated diarrhoea. Patients taking fructo-oligosacchrides without the addition of bacteria were observed to be less likely to develop diarrhoea when taking antibiotics. This pilot investigation suggests that further studies in this area are indicated.