What is the relationship between diarrhea and the use of antibiotics (Antibacterial medications)?

From the Guidelines

Antibiotics can cause diarrhea as a common side effect, and if you develop diarrhea while on antibiotics, you should continue taking your prescribed medication unless the diarrhea is severe or contains blood. To manage antibiotic-associated diarrhea, it is essential to stay hydrated with water, clear broths, and electrolyte solutions, and eat bland foods like bananas, rice, toast, while avoiding dairy, caffeine, and high-fiber foods temporarily 1.

Managing Diarrhea

• Stay hydrated with water, clear broths, and electrolyte solutions
• Eat bland foods like bananas, rice, toast
• Avoid dairy, caffeine, and high-fiber foods temporarily
• Consider taking probiotics such as Lactobacillus GG or Saccharomyces boulardii (typically 1-2 capsules daily) during and after antibiotic treatment to help prevent or reduce diarrhea by restoring beneficial gut bacteria 1

When to Seek Medical Attention

• Severe diarrhea (more than 6 loose stools per day)
• Fever above 101°F
• Severe abdominal pain
• Blood in stool
• Diarrhea persists more than 2 days, as these could indicate Clostridioides difficile infection, a serious complication requiring specific treatment 1

Prevention of Clostridioides difficile Infection

• Discontinue antibiotic agents if possible, especially in cases of suspected severe CDI 1
• Use antimicrobial therapy with agents that are less frequently implicated with antibiotic-associated CDI, such as parenteral aminoglycosides, sulfonamides, macrolides, vancomycin, or tetracycline/tigecycline 1
• Hand hygiene with soap and water and the use of contact precautions along with a good cleaning and disinfection of the environment and patient equipment should be used by all healthcare workers contacting any patient with known or suspected CDI 1

From the Research

Diarrhea and Antibiotics

• Diarrhea is a common complication of antibiotic use, but it can be prevented with administration of probiotics 2
• The risk of antibiotic-associated diarrhea can be reduced by administering Saccharomyces boulardii, with a risk ratio of 0.47 and a number needed to treat of 10 2
• Loperamide is an effective therapy for a variety of diarrheal syndromes, including acute, nonspecific diarrhea, and is generally well tolerated at recommended nonprescription doses 3, 4
• Loperamide works by decreasing peristalsis and fluid secretion, resulting in longer gastrointestinal transit time and increased absorption of fluids and electrolytes from the gastrointestinal tract 4

Treatment Options

• Loperamide-simeticone and Saccharomyces boulardii are two treatment options for acute diarrhea in adults, with loperamide-simeticone being more effective in reducing the number of unformed stools and time to last unformed stool 5
• Probiotics, such as Lactobacillus rhamnosus GG and Saccharomyces boulardii, have been shown to be effective in preventing antibiotic-associated diarrhea and reducing the duration of acute gastroenteritis 2, 6
• The choice of treatment depends on the individual patient's needs and the severity of their symptoms, with loperamide-simeticone being a good option for rapid relief of symptoms and probiotics being a good option for prevention and treatment of antibiotic-associated diarrhea 5

Prevention of Antibiotic-Associated Diarrhea

• Saccharomyces boulardii has been shown to be effective in reducing the risk of antibiotic-associated diarrhea in both children and adults, with a risk ratio of 0.47 and a number needed to treat of 10 2
• Lactobacillus rhamnosus GG has also been shown to be effective in preventing antibiotic-associated diarrhea, with a reduction in the risk of diarrhea of 43% 6
• Probiotics can be used to prevent antibiotic-associated diarrhea, especially in patients who are at high risk of developing diarrhea, such as those taking broad-spectrum antibiotics 2, 6