Antibiotic Associated Diarrhea

Mindy Perkins is 48 year old woman who presents to the ED with 10- 15 loose, liquid stools daily for the past 2 days. She completed a course of oral Amoxicillin seven days ago for a dental infection. In addition to loose stools, she complains of lower abdominal pain that began 2 days ago as well. She has not noted any blood in the stool. She denies vomiting, fever, or chills. She is on Prednisone for Crohn’s disease as well as Pantoprazole (Protonix) for severe GERD.

Nausea, vomiting, and oral thrush can occur with repeated or prolonged usage. Other side effects of antibiotics can be diarrhea. The diarrhea may also be a sign of a new infection such as, clostridium difficile. Anti-diarrheal medications are not indicated unless instructed by your provider (rxlist, n.d.).

Health experts know that most antibiotic products interfere with the immune system and the digestive system. Most of these products quell probiotic bacteria

Clostridium difficile was discovered and isolated from neonates in 1935. It was initially considered a component of the fecal flora of newborns and not thought to be pathogenic (Keessen, Gaastra, & Lipman, 2010). The history of C. diff and other antibiotic resistant pathogens are closely related with the history of antibiotics. The first antibiotic discovered was penicillin by Alexander Fleming while working with Staphylococcus. With this discovery, a surge of natural and synthetic drugs was discovered to treat bacterial infections. During the 1970s, clindamycin and cephalosporins were highly used as an effective antibiotic against bacterial infection but at the same time disrupted the normal, healthy bowel flora, allowing C.

Dr. Gumma mentioned that in prescribing antibiotic, it is very important to determine the patient’s allergy to

Bousvaros, & E. (2005). A Randomized, Double-blind Trial of Lactobacillus GG Versus Placebo in Addition to Standard Maintenance Therapy for Children with Crohn’s Disease. http://www.hmphanmi.com.cn/hmp/upload/event/study_4/9.pdf

BACKGROUND – E. coli is a food-borne bacterium that inhabits the bowels of warm blooded creatures such as humans and animals. If the individual is infected by E. coli, some symptoms can be “diarrhea, gas, abdominal cramping, fatigue, fever and vomiting.” (Pietrangelo”) If someone is infected with this bacterium, anti-biotics, which is explained by Oxford Dictionaries as “A medicine (such as penicillin or its derivatives) that inhibits the growth of or destroys microorganisms” can successfully treat the disease if it is outside of the digestive tract.

In the last decade, the number of prescriptions for antibiotics has increases. Even though, antibiotics are helpful, an excess amount of antibiotics can be dangerous. Quite often antibiotics are wrongly prescribed to cure viruses when they are meant to target bacteria. Antibiotics are a type of medicine that is prone to kill microorganisms, or bacteria. By examining the PBS documentary Hunting the Nightmare Bacteria and the article “U.S. government taps GlaxoSmithKline for New Antibiotics” by Ben Hirschler as well as a few other articles can help depict the problem that is of doctors prescribing antibiotics wrongly or excessively, which can led to becoming harmful to the body.

Meanwhile, the quality improvement team selected potential subjects and added their medical record numbers to the database. The team decided to utilize a quality improvement toolbox technique to create surveys for physicians to complete on a daily basis. The survey form requested patient demographics along with the patient’s medical history. The physicians were asked to estimate the patient’s risk of ARTI complications due to chronic illnesses such as diabetes or cardiovascular disease. Finally, the physician recorded the patient’s final diagnosis and the type of antibiotic prescribed. The data collected from the physician forms was entered into a database (REDCaps) for statistical analysis. The working hypothesis stated that the overall antibiotic prescription rate would be reduced by 5% through education and intervention. Overall, their final results support their hypothesis, all of their stated goals met expectations. The overall prescription rate was reduced from 69% to 55%, and broad spectrum antibiotic prescriptions fell from 68% to 59%. The interventions also reduced antibiotic use in otherwise healthy patients and delayed treatment with antibiotics from a baseline of 8.3 days to 9.7 days (Grover DO, et al.,

A young male patient used the fixed dose combinations with of different fluoroquinolones and nitroimidazoles several times in the last few years for self-treating repeated episodes of diarrhoea and loose motion, and each time experienced fixed drug eruptions that increased in number and severity on subsequent occasions. Suspecting association between the drug and the rashes, the patient each time discontinued the treatment prematurely, and preferred to switch to a similar formulation but with different molecules of fluoroquinolone (ciprofloxacin or ofloxacin) and nitroimidazole (tinidazole or ornidazole) next time. The patient presented with multiple, round-to-oval, well-defined, hyperpigmented cutaneous patches of different dimensions, present all over the body. He appeared to have run out of options and therefore consulted us seeking advice how he should treat himself next time he suffered from diarrhoea. Causality assessment by Naranjo’s algorithm revealed a definite relationship between the cutaneous adverse reaction and the offending drug. He was counselled regarding medication in general and advised, in particular, to avoid the tendency to self-treat any future episode of diarrhoea.

A couple times a year local and national mass media put the spotlight on problems connected to antibiotic overuse. Some people consider those problems to be real and serious, and others think that the discussed topics are nothing more than new “fashionable” subjects to talk about, distracting people from “real” problems, such as climbing gas prices or war expenses. Meanwhile, antibiotic overuse continues as a common practice among US doctors and agribusinesses for the last 20 years. The practice of antibiotic overuse has put patient’s health at risk, contributed to antibiotic resistance and increased bacterial mutation to a new, stronger level; as well as it hitting the economy with new costly expenses in health care. It is time to stop

I agree that antibiotic is going to cause diarrhea and yeast infection as a possible side effect because it kills all bacteria including the good bacteria. This is something that the patient will need to know about Keflex and breastfeeding, If the infant develop diarrhea, no treatment is required and it should resolve after completion of the antibiotics. She can include probiotic in her diet in the form of yoghurt or as supplement which can offer some protection from harmful bacteria while on Keflex (Hantoushzadeh et al., 2012). She needs to be encouraged to complete the full course of antibiotics and not to stop as soon as she begins to feel better. She need to call the office if she does not see improvement within 24hours.

Gold standard procedures should be implemented with the aim of providing timely and accurate results. (Schentag) The culture result should be accompanied by its clinical significance, selective reporting of susceptibility testing results in accordance with hospital antimicrobial therapy guidelines and suggested management. (Schentag) This encourages appropriate prescribing and minimises unnecessary use of antimicrobials. The clinical microbiology team should also provide reports to AMS regarding resistant organisms.

bacterial urinary tract infection, which is the most common side effect, may occur.21 Other patients

In this section of the project, we examined five random studies that were selected from CHINAL database. These studies provided information on the over-prescription of antibiotics in LTCF and the possible changes in practice that could be done to decrease antibiotic resistance. Most of these selected studies focused on providing providers and nurses with education to reinforce the education of antibiotic use in patients that present with ASB to reduce antibiotic resistance.