Choosing right drug, probiotic supplementation effective in prevention of antibiotic-associated diarrhea

NEW YORK — Choosing an antibiotic with a narrow spectrum can help cut the risk of antibiotic-asociated diarrhea, according to a presentation during the 23rd Annual Infectious Diseases in Children Symposium held here recently.

Andi L. Shane, MD, MPH, MSc, assistant professor of pediatrics, division of pediatric infectious diseases at Emory University School of Medicine, in Atlanta, presented an overview of issues related to antibiotic-associated diarrheas.

Shane discussed the definition and physiology of antibiotic-associated diarrhea; different strategies for prevention and treatment, including judicious use of antibiotics; and the differences in nutritional supplementation and therapeutic applications of probiotics for antibiotic-associated diarrhea.

Andi L. Shane

“My interest in antibiotic-associated diarrhea began during my training as an infectious diseases fellow, when I noticed that there was a high incidence of diarrhea among the patients who acquired antimicrobial therapy for infections that we were treating,” Shane said during the presentation.

“This resulted in a lot of changes in therapy … and also resulted in a lot of difficulty from the children tolerating the antibiotic therapy and from the parents being dissatisfied with the discomfort their children were undergoing,” she said.

She presented four cases (pharyngitis, otitis media, Clostridium difficile and recurrent C. difficile) and challenged participants to appropriately diagnose and treat each patient.

“The first principle for managing antibiotic-associated diarrhea is to select an antimicrobial with a narrow spectrum for the implicated or suspected organism,” she said.

The second principle of management of antibiotic-associated diarrhea is to consider supplementation with a probiotic. It is important to decide whether to administer the probiotic as prevention or treatment, according to Shane. One should approach the selection of a probiotic in the same way that an antibiotic is chosen; by selecting the group, species and strain of a probiotic considering the indication and host factors. Although regarded as safe, probiotic products are live organisms with the potential for adverse effects in persons with certain underlying conditions.

In general, Shane said that antibiotics should be used judiciously and that probiotics can be beneficial for both prevention and treatment. In addition, administration of probiotics in food products or as a supplement should be considered, along with the importance of selection of the probiotic and the indication. – by Christen Cona, MA

For more information:

Shane AL. Antibiotic-associated diarrheas in office practice. Presented at: the 23rd Annual Infectious Diseases in Children Symposium; Nov. 20-21, 2010; New York.

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