Antibiotic-associated diarrhea

Antibiotic-associated diarrhea (AAD) results from an imbalance in the colonic microbiota caused by antibiotic therapy. Microbiota alteration changes carbohydrate metabolism with decreased short-chain fatty acid absorption and an osmotic diarrhea as a result. Another consequence of antibiotic therapy leading to diarrhea is overgrowth of potentially pathogenic organisms such as Clostridium difficile. It is defined as frequent loose and watery stools with no other complications.^[1]

Several meta-analyses have concluded that probiotics may protect against AAD.^{[2][3][4][5][6][7]} However, citing conflicting data in the studies, other sources claim that the use of probiotics has failed thus far to meet the standard of medical care required for evidence-based medicine.^{[8][9][10][11]} Demonstration of the efficacy of probiotics is needed by randomized, double blind, placebo-controlled trials.

Efficacy of probiotic AAD prevention is dependent on the probiotic strain(s) used and on the dosage.^[12][13] Up to a 50% reduction of AAD occurrence has been found.^[7] No side-effects have been reported in any of these studies. Caution should, however, be exercised when administering probiotic supplements to immunocompromised individuals or patients who have a compromised intestinal barrier.

Clostridium difficile, also known more commonly as C. diff, is known to account for 10 to 20 percent of antibiotic-associated diarrhea cases. The reasoning for this, is that the antibiotics administered for the treatment of certain diseases processes such as inflammatory colitis also inadvertently kills a large portion of the gut flora, the normal flora that is usually present within the bowel. With this lower amount of "healthy" bacteria present, the overgrowth of C. diff is then responsible "for elaborating the enterotoxin." ^[1]

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