Antibiotic-associated diarrhea in clinical practice: preventive and therapeutic approaches
DOI: 10.32364/2587-6821-2022-6-5-259-265
M.A. Livzan, M.M. Fedorin
Omsk State Medical University, Omsk, Russian Federation
Antibiotic-associated diarrhea (AAD) is one of the most common adverse effects of antimicrobial therapy. This paper discusses AAD pathogenesis related to the direct effect of an antibiotic on the intestinal wall and modulation of gut microbiocenosis composition (including idiopathic and Clostridioides difficile-associated AAD). Searching the keywords "antibiotic-associated diarrhea", "microbiota", "intestinal motor activity", "prebiotics", "probiotics", "diarrheal syndrome" for publications indexed in the PubMed and Google Scholar databases was per-formed. Mechanisms of the effect of microbiota composition on intestinal motility and mechanisms of action of probiotics are systematized. Pathogenic mechanisms of AAD are heterogeneous, thereby requiring a differentiated approach to its prevention and management strategy. Among the etiological agents of AAD, Clostridioides difficile, a grampositive aerobic spore-forming bacillus that is resistant to most antibiotics, is of particular importance. To prevent idiopathic and Clostridioides difficile-associated AAD and recover healthy gut microflora, high-risk patients are recommended with probiotics. Among probiotics, Saccharomyces boulardii that is used as monotherapy or in combination therapy is one of the most effective ones.
Keywords: antibiotic-associated diarrhea, microbiota, probiotics, diarrheal syndrome, Saccharomyces.
For citation: Livzan M.A., Fedorin M.M. Antibiotic-associated diarrhea in clinical practice: preventive and therapeutic approaches. Russian Medical Inquiry. 2022;6(5):259–265 (in Russ.). DOI: 10.32364/2587-6821-2022-6-5-259-265.
About the authors:
Maria A. Livzan — Dr. Sc. (Med.), Professor, Corresponding Member of the RAS, Head of the Department of Faculty Therapy and Gastroenterology, Chancellor Omsk State Medical University; 12, Lenin str., Omsk, 644099, Russian Federation; ORCID iD 0000-0002-6581-7017.
Maxim M. Fedorin — Resident of the Department of Faculty Therapy and Gastroenterology, Omsk State Medical University; 12, Lenin str., Omsk, 644099, Russian Federation;
ORCID iD 0000-0002-0238-466. Contact information: Maxim M. Fedorin, e-mail: maxim.f@gmail.com.
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interests.
Received 04.04.2022.
Revised 27.04.2022.
Accepted 26.05.2022
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2. Nasiri M.J., Goudarzi M., Hajikhani B. et al. Clostridioides (Clostridium) difficile infection in hospitalized patients with antibiotic-associated diarrhea: A systematic review and meta-analysis. Anaerobe. 2018;50:32–37. DOI: 10.1016/j.anaerobe.2018.01.011.
3. Краткие алгоритмы ведения пациентов на этапе оказания первичной медико-санитарной помощи: Пособие для врачей-терапевтов. Под ред. Драпкиной О.М. М.: Видокс; 2019. [Brief algorithms for managing patients at the stage of providing primary health care: A manual for general practitioners. Ed. Drapkina O.M. M.: Vidox; 2019 (in Russ.)].
4. Gomez R., Fernandez S., Aspirot A. et al. Effect of amoxicillin/clavulanate on gastrointestinal motility in children. J Pediatr Gastroenterol Nutr. 2012;54(6):780–784. DOI: 10.1097/MPG.0b013e31824204e4.
5. Peeters T., Matthijs G., Depoortere I. et al. Erythromycin is a motilin receptor agonist. Am J Physiol. 1989;257(3 Pt 1):G470–G474. DOI: 10.1152/ajpgi.1989.257.3.G470.
6. Högenauer C., Hammer H.F., Krejs G.J., Reisinger E.C. Mechanisms and management of antibiotic-associated diarrhea. Clin Infect Dis. 1998;27(4):702–710. DOI: 10.1086/514958.
7. Dobbins W.O. 3rd, Herrero B.A., Mansbach C.M. Morphologic alterations associated with neomycin induced malabsorption. Am J Med Sci. 1968;255:63–77. DOI: 10.1097/00000441-196801000-00011.
8. Park H.Z., Lee S.P., Schy A.L. Ceftriaxone-associated gallbladder sludge. Identification of calcium-ceftriaxone salt as a major component of gallbladder precipitate. Gastroenterology. 1991;100(6):1665–1670. DOI: 10.1016/0016-5085(91)90667-a.
9. Lange K., Buerger M., Stallmach A., Bruns T. Effects of Antibiotics on Gut Microbiota. Dig Dis. 2016;34(3):260–268. DOI: 10.1159/000443360.
10. Jakobsson H.E., Jernberg C., Andersson A.F. et al. Short-term antibiotic treatment has differing long-term impacts on the human throat and gut microbiome. PLoS One. 2010;5(3):e9836. DOI: 10.1371/journal.pone.0009836.
11. Yin J., Prabhakar M., Wang S. et al. Different Dynamic Patterns of β-Lactams, Quinolones, Glycopeptides and Macrolides on Mouse Gut Microbial Diversity. PLoS One. 2015;10(5):e0126712. DOI: 10.1371/journal.pone.0126712.
12. Schubert A.M., Sinani H., Schloss P.D. Antibiotic-Induced Alterations of the Murine Gut Microbiota and Subsequent Effects on Colonization Resistance against Clostridium difficile. mBio. 2015;6(4):e00974. DOI: 10.1128/mBio.00974-15.
13. Fukuda S., Toh H., Hase K. et al. Bifidobacteria can protect from enteropathogenic infection through production of acetate. Nature. 2011;469(7331):543–547. DOI: 10.1038/nature09646.
14. Федорин М.М., Гаус О.В., Ливзан М.А., Суханова С.А. Лица с избыточной массой тела и СРК имеют характерные пищевые привычки и повышенный уровень кишечной проницаемости. Экспериментальная и клиническая гастроэнтерология. 2021;6(190):50–56. DOI: 10.31146/1682-8658-ecg-190-6-50-56. [Fedorin М.М., Gaus O.V., Livzan M.A., Sukhanova S.A. Typical dietary habits and elevated intestinal permeability in people with excess body weight and IBS. Experimental and Clinical Gastroenterology. 2021;6(190):50–56 (in Russ.)]. DOI: 10.31146/1682-8658-ecg-190-6-50-56.
15. Бикбавова Г.Р., Ливзан М.А., Федорин М.М. Профилактика колоректального рака у больных воспалительными заболеваниями кишечника. Фарматека. 2021;28(7):8–14. DOI: 10.18565/pharmateca.2021.7.8-14. [Bikbavova G.R., Livzan M.A., Fedorin M.M. Prevention of colorectal cancer in patients with inflammatory bowel disease. Farmateka. 2021;28(7):8–14 (in Russ.)]. DOI: 10.18565/pharmateca.2021.7.8-14.
16. Borzio M., Salerno F., Piantoni L. et al. Bacterial infection in patients with advanced cirrhosis: a multicentre prospective study. Dig Liver Dis. 2001;33(1):41–48. DOI: 10.1016/s1590-8658(01)80134-1.
17. Sullivan A., Edlund C., Nord C.E. Effect of antimicrobial agents on the ecological balance of human microflora. Lancet Infect Dis. 2001;1(2):101–114. DOI: 10.1016/S1473-3099(01)00066-4.
18. Nyberg S.D., Osterblad M., Hakanen A.J. et al. Long-term antimicrobial resistance in Escherichia coli from human intestinal microbiota after administration of clindamycin. Scand J Infect Dis. 2007;39(6–7):514–520. DOI: 10.1080/00365540701199790.
19. McFarland L.V., Ozen M., Dinleyici E.C., Goh S. Comparison of pediatric and adult antibiotic-associated diarrhea and Clostridium difficile infections. World J Gastroenterol. 2016;22(11):3078–3104. DOI: 10.3748/wjg.v22.i11.3078.
20. Rupnik M., Wilcox M.H., Gerding D.N. Clostridium difficile infection: new developments in epidemiology and pathogenesis. Nat Rev Microbiol. 2009;7(7):526–536. DOI: 10.1038/nrmicro2164.
21. Mullish B.H., Williams H.R. Clostridium difficile infection and antibiotic-associated diarrhoea. Clin Med (Lond). 2018;18(3):237–241. DOI: 10.7861/clinmedicine.18-3-237.
22. Davies K.A., Longshaw C.M., Davis G.L. et al. Underdiagnosis of Clostridium difficile across Europe: the European, multicentre, prospective, biannual, point-prevalence study of Clostridium difficile infection in hospitalised patients with diarrhoea (EUCLID). Lancet Infect Dis. 2014;14(12):1208–1219. DOI: 10.1016/S1473-3099(14)70991-0.
23. De Roo A.C., Regenbogen S.E. Clostridium difficile Infection: An Epidemiology Update. Clin Colon Rectal Surg. 2020;33(2):49–57. DOI: 10.1055/s-0040-1701229.
24. Sun X., Savidge T., Feng H. The enterotoxicity of Clostridium difficile toxins. Toxins (Basel). 2010;2(7):1848–1880. DOI: 10.3390/toxins2071848.
25. Ивашкин В.Т., Ющук Н.Д., Маев И.В. и др. Рекомендации Российской гастроэнтерологической ассоциации по диагностике и лечению Clostridium difficile-ассоциированной болезни. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2016;26(5):56–65. DOI: 10.22416/1382-4376-2016-26-5-56-65. [Ivashkin V.T., Yushchuk N.D., Mayev I.V. et al. Diagnostics and treatment of Clostridium difficile-associated disease: Guidelines of the Russian gastroenterological association. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2016;26(5):56–65 (in Russ.)]. DOI: 10.22416/1382-4376- 2016-26-5-56-65. 26. Crobach M.J., Planche T., Eckert C. et al. European Society of Clinical Microbiology and Infectious Diseases: update of the diagnostic guidance document for Clostridium difficile infection. Clin Microbiol Infect. 2016;22 Suppl 4:S63–S81. DOI: 10.1016/j.cmi.2016.03.010.
27. Cerilli L.A., Greenson J.K. The differential diagnosis of colitis in endoscopic biopsy specimens: a review article. Arch Pathol Lab Med. 2012;136(8):854–864. DOI: 10.5858/arpa.2012-0205-RA.
28. Culligan E.P., Sleator R.D. Advances in the Microbiome: Applications to Clostridium difficile Infection. J Clin Med. 2016;5(9):83. DOI: 10.3390/jcm5090083.
29. Kieffer D.A., Martin R.J., Adams S.H. Impact of Dietary Fibers on Nutrient Management and Detoxification Organs: Gut, Liver, and Kidneys. Adv Nutr. 2016;7(6):1111–1121. DOI: 10.3945/an.116.013219.
30. Fukumoto S., Tatewaki M., Yamada T. et al. Short-chain fatty acids stimulate colonic transit via intraluminal 5-HT release in rats. Am J Physiol Regul Integr Comp Physiol. 2003;284(5):R1269–R1276. DOI: 10.1152/ajpregu.00442.2002.
31. Dimidi E., Christodoulides S., Scott S.M., Whelan K. Mechanisms of Action of Probiotics and the Gastrointestinal Microbiota on Gut Motility and Constipation. Adv Nutr. 2017;8(3):484–494. DOI: 10.3945/an.116.014407.
32. Triantafyllou K., Chang C., Pimentel M. Methanogens, methane and gastrointestinal motility. J Neurogastroenterol Motil. 2014;20(1):31–40. DOI: 10.5056/jnm.2014.20.1.31.
33. Markowiak P., Śliżewska K. Effects of Probiotics, Prebiotics, and Synbiotics on Human Health. Nutrients. 2017;9(9):1021. DOI: 10.3390/nu9091021.
34. Гаус О.В., Ливзан М.А. Про- и синбиотики в лечении заболеваний кишечника: на какие эффекты мы можем рассчитывать? Consilium medicum. 2020;22(12):37–43. DOI: 10.26442/20751753.2020.12.200309. [Gaus O.V., Livzan M.A. Pro and synbiotics in the treatment of intestinal diseases: what effects can we expect? Consilium medicum. 2020;22(12):37–43 (in Russ).]. DOI: 10.26442/20751753.2020.12.200309.
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