From the Guidelines
Loose stools with antibiotics should be managed by continuing the prescribed antibiotic, staying hydrated, and considering probiotic supplements, while monitoring for severe symptoms that may indicate Clostridioides difficile infection, which requires specific treatment. This approach is based on the understanding that antibiotics can disrupt the normal gut microbiome, leading to diarrhea in 5-30% of patients taking these medications 1. The exact mechanism by which antibiotics cause diarrhea is unclear, but it is known that the disruption of the gut microbiota can lead to an overgrowth of harmful bacteria, including Clostridium difficile 1.
To manage loose stools with antibiotics, patients should:
- Continue taking their prescribed antibiotic as directed, unless the diarrhea is severe or contains blood
- Stay well-hydrated by drinking plenty of water
- Consider consuming probiotic-rich foods like yogurt with live cultures or taking a probiotic supplement (containing Lactobacillus or Saccharomyces boulardii) during and after their antibiotic course
- Avoid high-fiber foods temporarily and opt for bland, easy-to-digest foods such as bananas, rice, applesauce, and toast (the BRAT diet)
- Use over-the-counter medications like loperamide (Imodium) at a dose of 2mg after each loose stool (maximum 8mg per day) to help reduce diarrhea symptoms
It is essential to monitor for severe symptoms, such as:
- Diarrhea that is severe (more than 6 loose stools per day)
- Diarrhea that contains blood
- Diarrhea that is accompanied by fever above 101°F
- Diarrhea that persists more than 2 days after finishing antibiotics If any of these symptoms occur, patients should contact their healthcare provider immediately, as they may indicate a more serious condition like Clostridioides difficile infection, which requires specific treatment 1.
From the Research
Loose Stools with Antibiotics
- Loose stools are a common side effect of antibiotic use, particularly with broad-spectrum antibiotics that disrupt the balance of gut flora 2, 3, 4, 5, 6
- The use of concomitant antibiotics during treatment for Clostridioides difficile infection (CDI) can compromise the initial response to therapy and the durability of response 2
- Fidaxomicin has been shown to be more effective than vancomycin in achieving clinical cure in the presence of concomitant antibiotic therapy and in preventing recurrence regardless of concomitant antibiotic use 2, 5, 6
Treatment Options
- Fidaxomicin and vancomycin are commonly used to treat CDI, with fidaxomicin being recommended as first-line therapy for all patients with CDI 5
- The choice of treatment may depend on the severity of the infection, the presence of concomitant antibiotics, and the patient's medical history 4, 6
- Metronidazole is also used to treat CDI, but it has been shown to be less effective than fidaxomicin and vancomycin in some studies 6
Clinical Effectiveness
- Fidaxomicin has been shown to be associated with a lower risk of treatment failure and recurrence compared to vancomycin in some studies 5, 6
- The clinical effectiveness of fidaxomicin and vancomycin may vary depending on the patient population and the specific clinical context 4, 5, 6
- Further research is needed to fully understand the clinical effectiveness of different treatment options for CDI and to inform treatment guidelines 2, 3, 4, 5, 6