What measures can be taken to reduce diarrhea in an infant taking antibiotics (antibacterial medications)?

From the Guidelines

To reduce diarrhea in an infant on antibiotics, consider giving probiotic supplements such as Lactobacillus rhamnosus GG or Saccharomyces boulardii, and ensure the infant stays well-hydrated with breast milk, formula, or oral rehydration solutions like Pedialyte. The most recent and highest quality study, 1, recommends reduced osmolarity oral rehydration solution (ORS) as the first-line therapy of mild to moderate dehydration in infants, children, and adults with acute diarrhea from any cause. Some key points to consider:

• Typical dosing for infants is 1-10 billion CFUs daily, divided into 1-2 doses, continued throughout the antibiotic course and for a few days after completion.
• Small, frequent feedings may be better tolerated than large ones.
• Avoid fruit juices, carbonated beverages, and dairy products other than formula or breast milk.
• The BRAT diet (bananas, rice, applesauce, toast) may help firm stools in older infants who have started solids.
• Antibiotic-associated diarrhea occurs because antibiotics kill both harmful and beneficial gut bacteria, disrupting normal digestive processes.
• If diarrhea is severe (more than 6-8 watery stools per day), contains blood or mucus, or if the infant shows signs of dehydration (decreased urination, dry mouth, sunken fontanelle, lethargy), contact a healthcare provider immediately. Additionally, the study 1 suggests that nasogastric administration of ORS may be considered in infants, children, and adults with moderate dehydration, who cannot tolerate oral intake, or in children with normal mental status who are too weak or refuse to drink adequately. It is also important to note that isotonic intravenous fluids such as lactated Ringer’s and normal saline solution should be administered when there is severe dehydration, shock, or altered mental status and failure of ORS therapy 1. In terms of prevention, the study 1 highlights the importance of general measures such as hand hygiene, proper food preparation and storage, avoidance of high-risk foods, and use of infection prevention and control measures in hospitals, childcare, and nursing home settings. Overall, the management of diarrhea in infants on antibiotics requires a comprehensive approach that includes probiotic supplements, oral rehydration solutions, and careful monitoring for signs of dehydration and other complications.

From the Research

Reducing Diarrhea in Infants on Antibiotics

To reduce diarrhea in an infant who is on antibiotics, several strategies can be considered:

• Probiotics: The use of probiotics, particularly Lactobacillus rhamnosus GG (LGG) and Saccharomyces boulardii, has been shown to be effective in reducing the duration of diarrhea in children, including those with antibiotic-associated diarrhea (AAD) 2.
• Discontinuation of Antibiotics: In cases where antibiotic-associated bloody diarrhea is suspected, discontinuation of antibiotics may be beneficial, especially if facilities for bacterial culture with cytotoxin assays are limited 3.
• Probiotic Strains: Certain probiotic strains, such as Lactobacillus acidophilus and Bifidobacterium bifidum, have been found to be effective in reducing the duration of diarrhea and frequency of watery stools, even when stored at ambient temperature 4.
• Rehydration and Dietary Management: Following guidelines for rehydration and dietary management, such as those recommended by the American Academy of Pediatrics, can also be beneficial in managing diarrhea in infants 5.

Key Considerations

When managing diarrhea in infants on antibiotics, it is essential to consider the following:

• The potential benefits and risks of antibiotic use
• The effectiveness of different probiotic strains
• The importance of proper rehydration and dietary management
• The need for careful consideration of antibiotic use, particularly in cases of watery diarrhea, which is often of viral origin 6, 3