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Managing antibiotic associated diarrhoea

BMJ 2002; 324 doi: (Published 08 June 2002) Cite this as: BMJ 2002;324:1345

Probiotics may help in prevention

  1. Frédéric Barbut (, head of infection control,
  2. Jean Luc Meynard, senior research fellow in infectious diseases
  1. Unité d'Hygiène et de Lutte contre l'Infection Nosocomiale (UHLIN), Hôpital Saint-Antoine, 75 571 Paris cedex 12, France
  2. Service des Maladies Infectieuses et Tropicales

    Papers p 1361

    Diarrhoea is a common adverse effect of antibiotic treatments. Antibiotic associated diarrhoea occurs in about 5-30% of patients either early during antibiotic therapy or up to two months after the end of the treatment.13 The frequency of antibiotic associated diarrhoea depends on the definition of diarrhoea, the inciting antimicrobial agents, and host factors.

    Almost all antibiotics, particularly those that act on anaerobes, can cause diarrhoea, but the risk is higher with aminopenicillins, a combination of aminopenicillins and clavulanate, cephalosporins, and clindamycin. 1 4 5 Host factors for antibiotic associated diarrhoea include age over 65, immunosuppression, being in an intensive care unit, and prolonged hospitalisation.6

    Clinical presentations of antibiotic associated diarrhoea range from mild diarrhoea to fulminant pseudomembranous colitis. The latter is characterised by a watery diarrhoea, fever (in 80% of cases), leucocytosis (80%), and the presence of pseudomembranes on endoscopic examination. Severe complications include toxic megacolon, perforation, and shock.

    Antibiotic associated diarrhoea results from disruption of the normal microflora of the gut by antibiotics. This microflora, composed of 1011 bacteria per gram of intestinal content, forms …

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