From the Guidelines
To treat diarrhea from antibiotics, the most effective approach is to take probiotics containing Lactobacillus or Saccharomyces boulardii, which can help restore beneficial gut bacteria disrupted by antibiotics, as supported by the most recent and highest quality study 1. This approach can be combined with staying well-hydrated by drinking plenty of water and electrolyte solutions like Pedialyte or Gatorade to replace lost fluids. Following the BRAT diet (bananas, rice, applesauce, toast) temporarily can also help firm up stools. Over-the-counter medications like loperamide (Imodium, 2mg after each loose stool, not exceeding 8mg per day) can provide symptomatic relief. It is essential to continue the prescribed antibiotic unless directed otherwise by a healthcare provider, as stopping prematurely can leave the original infection untreated. Antibiotic-associated diarrhea occurs because antibiotics kill both harmful and beneficial gut bacteria, disrupting the normal intestinal balance. If diarrhea is severe, contains blood, is accompanied by fever above 101°F, or persists beyond 2-3 days, it is crucial to contact a healthcare provider immediately, as this could indicate a more serious condition like Clostridioides difficile infection 1. Some key points to consider include:
- The use of probiotics has been shown to be effective in preventing and treating antibiotic-associated diarrhea 1.
- Loperamide can be used to provide symptomatic relief, but it is essential to follow the recommended dosage and not exceed 8mg per day 1.
- Staying hydrated and following the BRAT diet can help manage symptoms and support recovery.
- If symptoms persist or worsen, it is crucial to seek medical attention to rule out more serious conditions like Clostridioides difficile infection 1.
From the FDA Drug Label
VANCOMYCIN HYDROCHLORIDE capsules, for oral use ... C. difficile-associated diarrhea ... DOSAGE AND ADMINISTRATION C difficile-associated diarrhea: Adult Patients (18 years of age or greater): 125 mg orally 4 times daily for 10 days. Pediatric Patients (less than 18 years of age): 40 mg/kg in 3 or 4 divided doses for 7 to 10 days.
Treatment for Diarrhea from Antibiotics: The treatment for C. difficile-associated diarrhea is vancomycin hydrochloride capsules.
- For adult patients (18 years of age or greater): 125 mg orally 4 times daily for 10 days.
- For pediatric patients (less than 18 years of age): 40 mg/kg in 3 or 4 divided doses for 7 to 10 days, with a total daily dosage not exceeding 2 g. 2
From the Research
Treatment Options for Diarrhea from Antibiotics
- Discontinuation or replacement of the inciting antibiotic can be effective in most cases of antibiotic-associated diarrhea (AAD) 3
- For more severe cases involving C. difficile, treatment with antibiotics such as vancomycin or metronidazole may be necessary 3, 4
- Biotherapeutic agents, such as Saccharomyces boulardii, Lactobacillus acidophilus, and Bifidobacterium longum, can help re-establish the equilibrium of the intestinal ecosystem and prevent or treat AAD 3, 5
- Loperamide can be used to treat diarrhea, but its use should be limited to cases where the benefits outweigh the risks, as it can cause constipation and other side effects 6
Prevention of Antibiotic-Associated Diarrhea
- Limitation of antibiotic overuse and improved hygiene measures, such as single rooms and hand washing, can help prevent the spread of C. difficile and other agents of AAD 3
- The use of poorly absorbed antimicrobials may decrease the risk of AAD and C. difficile-associated disease 5
- Probiotics may be a useful adjunct to antibiotics to minimize the risk of diarrhea associated with antibiotics 3, 5