I believe that many Bao Bao parents have such experience, children because of bacterial infection to the hospital after antibiotic treatment, some babies take antibiotics after a period of time will appear diarrhea and other symptoms, then if the exclusion of food or other external reasons, Bao Bao parents need to be alert to antibiotic-related diarrhea.
Antibiotic Associated Diarrhea (ADD) is refers to after the use of antibiotics can not be explained by other reasons for Diarrhea, is the most common adverse reaction of antibiotics, especially in children, 10% of children will have Diarrhea after taking antibiotics,
The incidence is up to 18 percent in children under 2 years of age.
Figure 1 The incidence of antibiotic-associated diarrhea in children
What are the specific causes of ADD
At present, the etiology and specific pathogenesis of ADD have not been clearly studied, which is usually believed to be related to intestinal flora disorder.
Under normal circumstances, probiotics and opportunistic pathogens in the human gut are in a balanced state. Probiotics can improve the intestinal environment, regulate the intestinal flora, inhibit the growth of harmful bacteria, and also help with normal digestion and absorption.
Contingent pathogens are too few in number to cause disease.
After the use of antibiotics, on the one hand, the number of probiotics is significantly reduced, and the digestion and absorption function supported by the probiotics is impaired, resulting in insufficient metabolism of some sugars, which stay in the intestines, increase osmotic pressure and change pH value, and stimulate the increase of substances secreted by the intestines, leading to diarrhea.
On the other hand, antibiotics disrupt the balance of flora, allowing opportunistic pathogens, such as Clostridium difficile, to flourish, leading to intestinal inflammation and diarrhea.
Because the bacterium is well studied, ADD is sometimes referred to specifically as diarrhea caused by Clostridium difficile.
Of course, there are also studies that the allergic reaction and toxic effect caused by antibiotics can directly cause intestinal mucosa damage, leading to absorptive diarrhea;
Some antibiotics, such as erythromycin, can stimulate the contraction of the gastric antrum and duodenum, causing symptoms such as diarrhea and vomiting.
Common antibiotics that cause ADD
In general, broad-spectrum antibiotics are more likely to induce ADD than narrow-spectrum antibiotics.
It has been reported that the incidence of ADD caused by broad-spectrum antibiotics is 10-70 times that of narrow-spectrum antibiotics.
The most common include: lincomycin, second and third generation cephalosporins, broad-spectrum penicillins (amoxicillin and potassium clavulanate);
Less relevant ones include first-generation cephalosporins, other penicillins, macrolides;
Few associated drugs include aminoglycosides, rifampicin, and sulfonamides.
Current treatments
- Antibiotics
Discontinuation and adjustment of antibiotics are recommended.
For most ADD, stopping the use of antibiotics is effective, even if Clostridium difficile infection, some patients only stopping the use of antibiotics is effective.
Therefore, for all ADD patients, if it does not affect the recovery of the primary disease, antibiotics should be considered to stop immediately.
In clinical practice, if it is mild to moderate diarrhea that does not lead to abdominal pain, dehydration and other problems of the child, there is no need to stop using antibiotics temporarily, or to use the full course of treatment;
In general, diarrhea can be relieved automatically a few days after the antibiotics are stopped after the full course of treatment.
If during the course of antibiotic treatment, diarrhea gradually gets worse, or the symptoms are serious, such as fever, obvious abdominal pain, bloody stool, dehydration or even shock, antibiotics should be stopped immediately and corresponding symptomatic treatment should be given.
2, supplement probiotics
Probiotic supplements are recommended to restore the balance of normal intestinal flora.
At present, it is believed that probiotics may have a moderate protective effect on the prevention of ADD and can shorten the duration of diarrhea by 1 day.
There are no specific recommendations for specific strains, preparations and dosages. Lactobacillus rhamnosus or Saccharomyces braglii are commonly used in clinical practice, with a daily frequency of 10-20 billion CFUs.