How can parents prevent and treat diaper rash caused by antibiotics. What are the most effective methods to combat antibiotic-induced diaper rash in babies and toddlers. Why do antibiotics sometimes lead to severe diaper rash in infants.

Understanding the Link Between Antibiotics and Diaper Rash

Antibiotics are often necessary for treating bacterial infections in infants and toddlers. However, they can sometimes lead to an unexpected and uncomfortable side effect: severe diaper rash. This occurs because antibiotics don’t discriminate between harmful and beneficial bacteria in the body. They eliminate both, disrupting the delicate balance of microorganisms in a child’s digestive system.

When the good bacteria in a baby’s intestines are depleted, it can result in changes to stool composition and frequency, potentially leading to irritation and inflammation of the sensitive skin in the diaper area. This is why many parents observe an increase in diaper rash severity or frequency when their child is on antibiotics.

Why is a baby’s skin more susceptible to irritation?

A baby’s skin is approximately five times thinner than an adult’s, making it exceptionally sensitive to irritants and environmental factors. This heightened sensitivity is particularly noticeable in the diaper area, where moisture, friction, and exposure to waste products create an ideal environment for skin irritation. When antibiotics alter the baby’s digestive processes, the resulting changes in stool can exacerbate these existing challenges, leading to more severe and persistent diaper rashes.

Proactive Measures to Prevent Antibiotic-Induced Diaper Rash

Taking a proactive approach is crucial when it comes to preventing antibiotic-induced diaper rash. By implementing preventive strategies from the moment antibiotic treatment begins, parents can significantly reduce the risk of severe diaper rash developing. Here are some effective measures:

• Introduce probiotics to restore beneficial bacteria
• Increase yogurt consumption for natural probiotics
• Apply diaper cream consistently as a protective barrier
• Allow for diaper-free time to promote air circulation
• Maintain proper hygiene and frequent diaper changes

The Role of Probiotics in Preventing Diaper Rash

Probiotics play a crucial role in maintaining a healthy balance of gut bacteria. When antibiotics disrupt this balance, introducing probiotics can help restore it. Parents can find probiotic supplements specifically formulated for infants and toddlers at health food stores or pharmacies. These often come in powder form, making them easy to mix into food or drinks.

When administering probiotics, it’s important to space them at least two hours apart from antibiotic doses. This separation ensures that the beneficial bacteria from the probiotics aren’t immediately destroyed by the antibiotics. Ideally, give probiotics twice daily, mixed into foods like applesauce, yogurt, or even breast milk for younger infants.

The Benefits of Yogurt in Combating Antibiotic-Induced Diaper Rash

Yogurt is a natural source of probiotics and can be an excellent addition to a child’s diet during antibiotic treatment. For infants old enough to consume dairy products, offering two servings of yogurt per day can help replenish beneficial bacteria in the gut. This not only aids in preventing diaper rash but also supports overall digestive health.

For breastfeeding mothers, increasing their own intake of yogurt and probiotics may potentially benefit the baby through breast milk. While research in this area is ongoing, many healthcare professionals believe that some of the beneficial bacteria from the mother’s diet can be passed to the infant through breast milk.

Choosing the Right Yogurt for Your Child

When selecting yogurt for your child, opt for plain, unsweetened varieties with live and active cultures. Greek yogurt is often a good choice due to its higher protein content and thicker consistency. For younger infants, you may need to thin the yogurt with a bit of breast milk or formula to achieve the right texture.

The Importance of Diaper Cream in Preventing and Treating Rash

Applying a high-quality diaper cream is one of the most effective ways to prevent and treat antibiotic-induced diaper rash. A good diaper cream creates a protective barrier between the baby’s skin and potential irritants, including moisture and waste products. It’s essential to start using diaper cream preventively as soon as antibiotic treatment begins, rather than waiting for signs of irritation to appear.

One recommended product is the Weleda Calendula Diaper Rash Cream. This cream is formulated with natural ingredients and is free from synthetic preservatives, fragrances, and petroleum-based substances. It contains pharmaceutical-grade zinc oxide, which is known for its skin-protective properties, and organic calendula extract, which has anti-inflammatory benefits.

How to Apply Diaper Cream Effectively

To maximize the benefits of diaper cream, follow these steps:

1. Thoroughly clean and dry the diaper area during each change
2. Apply a thick layer of cream to all areas that come into contact with the diaper
3. Pay special attention to skin folds and creases
4. Reapply cream after each diaper change, especially after bowel movements
5. If using cloth diapers, check that the cream is compatible to avoid affecting absorbency

The Benefits of Diaper-Free Time in Rash Prevention and Treatment

Allowing your baby to spend some time without a diaper, often referred to as “nakey time” or diaper-free time, can be incredibly beneficial in preventing and treating diaper rash. This practice allows air to circulate freely around the diaper area, helping to keep the skin dry and reducing the risk of irritation.

Diaper-free time is particularly important after baths or when changing a wet or soiled diaper. Place your baby on a waterproof mat or towel and allow them to enjoy some unrestricted movement. This not only helps prevent diaper rash but can also be a fun and liberating experience for your little one.

When is the best time for diaper-free sessions?

The ideal times for diaper-free sessions include:

• After bath time, before putting on a fresh diaper
• During a diaper change, especially if there are signs of irritation
• Before bedtime, to ensure the skin is completely dry
• On warm days when your baby can comfortably be without clothing

Aim for at least 10-15 minutes of diaper-free time, 2-3 times a day. If your baby is prone to diaper rash or is currently on antibiotics, you may want to increase the frequency and duration of these sessions.

Maintaining Proper Hygiene to Prevent Diaper Rash

Proper hygiene practices are crucial in preventing and managing diaper rash, especially when a child is on antibiotics. Regular diaper changes, gentle cleaning, and thorough drying of the diaper area can significantly reduce the risk of skin irritation and infection.

How often should diapers be changed?

During antibiotic treatment, it’s advisable to change diapers more frequently than usual. Aim to check and change diapers:

• Every 2-3 hours during the day
• Immediately after bowel movements
• At least once during the night, if your baby is prone to rash

When changing diapers, use gentle, fragrance-free wipes or warm water with a soft cloth. Pat the area dry instead of rubbing, and allow the skin to air dry completely before applying diaper cream and putting on a fresh diaper.

Alternative Treatments for Severe Antibiotic-Induced Diaper Rash

In some cases, despite preventive measures, a severe diaper rash may still develop. When this occurs, additional treatments may be necessary. It’s important to consult with your pediatrician if the rash persists or worsens, as they may recommend specific treatments based on the severity and nature of the rash.

What are some alternative treatments for severe diaper rash?

For severe cases of antibiotic-induced diaper rash, your doctor might suggest:

• Antifungal creams, if a yeast infection is suspected
• Mild hydrocortisone cream for inflammation (only as directed by a doctor)
• Barrier ointments containing zinc oxide or petrolatum
• Sitz baths with baking soda to soothe the affected area
• Switching to super-absorbent diapers or cloth diapers temporarily

Remember, these treatments should only be used under medical supervision, especially for infants and young toddlers. Always follow your healthcare provider’s instructions carefully when treating severe diaper rash.

Long-Term Strategies for Maintaining Healthy Skin in the Diaper Area

While addressing antibiotic-induced diaper rash is crucial, it’s equally important to develop long-term strategies for maintaining healthy skin in the diaper area. These practices can help prevent future occurrences of diaper rash and promote overall skin health for your baby.

What are some effective long-term strategies for diaper area skin health?

Consider incorporating these practices into your regular routine:

• Use gentle, fragrance-free products for bathing and diaper changes
• Avoid tight-fitting diapers or clothing that can trap moisture
• Change wet or soiled diapers promptly, even during the night
• Consider using cloth diapers, which may be less irritating for some babies
• Regularly moisturize your baby’s skin with gentle, hypoallergenic lotions
• Introduce solid foods gradually to minimize digestive upset
• Continue to include probiotic-rich foods in your child’s diet

By maintaining these practices, you can help ensure that your baby’s skin remains healthy and resistant to irritation, even when faced with challenges like antibiotic treatments.

The Role of Diet in Preventing Antibiotic-Induced Diaper Rash

While topical treatments and hygiene practices are crucial in preventing and managing antibiotic-induced diaper rash, diet also plays a significant role. The foods your child consumes can impact their digestive health and, consequently, the likelihood of developing diaper rash during antibiotic treatment.

How can diet help prevent antibiotic-induced diaper rash?

Consider these dietary strategies to support your child’s digestive health and reduce the risk of diaper rash:

• Incorporate probiotic-rich foods like yogurt, kefir, and fermented vegetables (for older children)
• Offer plenty of fruits and vegetables to provide essential nutrients and fiber
• Limit sugary and processed foods, which can exacerbate digestive issues
• Ensure adequate hydration to support healthy digestion and regular bowel movements
• For breastfed infants, consider the mother’s diet and its potential impact on breast milk composition

Remember that dietary changes should be introduced gradually and in consultation with your pediatrician, especially for younger infants or children with existing health conditions.

Understanding When to Seek Medical Attention for Diaper Rash

While many cases of antibiotic-induced diaper rash can be managed at home, there are instances where professional medical attention is necessary. Recognizing the signs that indicate a need for medical intervention is crucial for ensuring your child’s health and comfort.

When should you consult a doctor about diaper rash?

Seek medical attention if you observe any of the following:

• The rash persists or worsens despite home treatment for 3-4 days
• The rash is accompanied by a fever or seems to be causing significant pain
• You notice signs of infection, such as oozing, pus, or increased redness
• The rash spreads beyond the diaper area
• Your child becomes lethargic or refuses to eat
• You observe blood in the stool or urine

A healthcare professional can assess the severity of the rash, rule out any complications, and prescribe appropriate treatments if necessary. They may also provide guidance on adjusting your child’s antibiotic regimen if it’s contributing significantly to the diaper rash.

The Importance of Consistency in Diaper Rash Prevention

Consistency is key when it comes to preventing and managing antibiotic-induced diaper rash. Establishing a regular routine for diaper changes, skincare, and preventive measures can significantly reduce the risk of severe rash development and promote faster healing when irritation does occur.

How can parents maintain consistency in diaper rash prevention?

Consider these strategies to ensure consistent care:

• Create a diaper changing schedule and stick to it as much as possible
• Keep diaper cream and other necessary supplies easily accessible in multiple locations
• Educate all caregivers about your prevention and treatment routines
• Set reminders for administering probiotics or other preventive measures
• Regularly assess your child’s skin condition to catch any issues early
• Maintain a log of diaper changes, treatments applied, and any observed skin changes

By maintaining a consistent approach, you can create an environment that supports your child’s skin health and minimizes the risk of severe diaper rash, even during antibiotic treatment.

HOW TO COMBAT DIAPER RASH CAUSED BY ANTIBIOTICS

I participated in an Influencer Activation on behalf of Influence Central for Weleda. I received product samples to facilitate my review and a promotional item to thank me for my participation.

We’ve had a rough week in the Larsen household. For some reason, my little lad, who is two weeks shy of three years old, has decided to bite his baby sister – twice.

I don’t think he did it to be mean or malicious, and to be fair, my nine month old is at a phase in her life where she thinks it’s super fun to put her little baby fingers in somebody’s mouth….so I think my toddler thought she was asking for it.

One time it just seemed to hurt her. She cried out in pain, and I rushed to her side.

The second time, however, skin was actually broken. She wasn’t bleeding, but I was still a little nervous, as I recalled hearing once that a human’s mouth is wrought with germs and if a child is bitten, they often need to go on antibiotics.

Sure enough, our pediatrician put our little lass on a 10 day dose of amoxicillin.

I’m not a huge fan of antibiotics, and asked if there was anyway we could wait it out a little bit to see if she really needed the medicine. The doctor said I could wait two days, but if the skin was still broken, that she would need it.

Well, two days later, there was still a cut.

So why do I hate antibiotics? Well, aside from the fact that sometimes I feel like they are given out too frequently, my main concern is actually that it has given my kids some seriously crazy diaper rash.

I’m talking about the most epic, painful, red, swollen, make-me-even-cry-just-looking-at-it kinda diaper rash.  

Yes, I took pictures of it, and, no, I’m not going to post them here because I don’t want you to cry upon seeing it. A baby’s skin is five times thinner than an adult’s, so its super sensitive to irritations and environmental influences – so just imagine how sensitive it must be when things go awry!

Antibiotics can sometimes cause craaaaazy diaper rashes in babies and toddlers because they not only kill the bad bacteria (like the kind we feared entered after my son bit my daughter) but also the GOOD bacteria that live in my children’s intestines.

My little nine month old has now been on the antibiotics for four full days, and (knock on wood) the epic diaper rash has not shown up yet. I honestly think its because I think the best defense in this type of situation is a good offense.

I’ve been prepared – and here’s how I’ve been combating diaper rash.

1. PROBIOTICS

One of the ways to get some good bacteria back into your child is through probiotics. We have picked some powdered ones up from our local health food store, and I add it to applesauce, yogurt, water, and breastmilk – so that my baby gets about two servings a day.

My pediatrician did recommend that we give probiotics two hours away from the antibiotics to avoid interference (antibiotics kill all bacteria — so they would even kill the good ones)

2. YOGURT

Another fantastic source of good bacteria that tastes yummy is yogurt. My nine month old has been having two servings a day since her antibiotics medicine has started, and sometimes I’ve stirred in some of the probiotic. I’ve also been upping my yogurt and probiotic intake – since I’m breastfeeding my daughter. there hasn’t been a ton of research yet on moms passing good bacteria from mom to baby through nursing, but I figure it can’t hurt!

3. DIAPER CREAM

My daughter hasn’t been prone to diaper rashes, but she has had occasional times while teething, just like my son did at her age.  When my son was put on antibiotics, he received that hideous diaper rash that I was talking about before. I had no idea that antibiotics could cause such a reaction until it happened to him, and I had only wished I had known to be proactive with diaper rash cream before things got out of control. His rash honestly was so raw and bad that we had to get yet another prescription for his little bum to help combat the pain.

This time around, I’ve been using Weleda Calendula Diaper Rash Cream from the start. I like it because it is free from synthetic preservatives, fragrances and petroleum – and uses pharmaceutical-grade zinc oxide. This cream is Weleda’s best selling baby product, and uses organic anti-inflammatory calendula extra, and was formulated in collaboration with German midwives. The product is safe for newborns and up and also for use with cloth diapers.

*Read more at the bottom of this post to learn how to possibly win one of 15 Weleda Prize Packs.

4. NAKEY TIME

One of the best things to do when a baby gets diaper rash is to let the area air dry – so after a bath or even just a diaper change, I let my infant spend some time on a towel on the floor, or I fan her little tush with the diaper to make sure it is super dry before adding the Weleda diaper cream.

(It should go without saying, I am not a pediatrician. If you ever have concerns about your baby’s diaper rash, I’d recommend you reach out to your doctor. )

Again, knock on wood, but my darling baby’s bum has been rash free so far, and I really think it’s because I’ve been super careful about what has been going in and on her body.

Now, if you don’t mind, I’m off to read some blog posts about how to stop a toddler from biting!  Any tips would be greatly appreciated, as the only one I’ve gotten from grandma has been to make him bite soap. Yuck!

Talk soon friends,

Mary

You can learn more about Weleda by visiting their Website |  Twitter | Instagram or on Amazon

*I-C will randomly select 15 winners from all program entries and will handle fulfillment of the winning prizes.

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St. Elizabeth Healthcare – Condition

Updated: 2022-07-01

Overview

Diaper rash is a common form of irritated skin (dermatitis) that looks like patches of inflamed skin on your baby’s bottom. It’s often related to wet or infrequently changed diapers, skin sensitivity, and chafing. It usually affects babies, though anyone who wears a diaper regularly can develop the condition.

Diaper rash usually clears up with simple at-home treatments, such as air drying, more-frequent diaper changes and ointment.

Symptoms

Signs and symptoms of diaper rash include:

• Inflamed skin in the diaper area — buttocks, thighs and genitals
• Itchy, tender skin in the diaper area
• Sores in the diaper area
• Discomfort, fussiness or crying, especially during diaper changes

When to see a doctor

If your baby’s skin doesn’t improve after a few days of home treatment, talk with your health care provider. You may need a prescription medication to treat diaper rash, or the rash may have another cause, such as zinc nutritional deficiency.

Take your child to your health care provider for:

• A rash with a fever
• A rash that’s severe or unusual
• A rash that persists or gets worse despite home treatment
• A rash that bleeds, itches or oozes
• A rash that causes burning or pain when your baby urinates or has a bowel movement

Causes

Diaper rash may be caused by:

• Leaving on wet or soiled diapers too long. The tender skin of babies can develop a rash if wet or soiled diapers are left on too long. Babies may be more prone to diaper rash if they’re experiencing frequent bowel movements or diarrhea.
• Chafing or rubbing. Tightfitting diapers or clothing that rubs against the skin can lead to a rash.
• Using a new product. Your baby’s skin may react to a new brand of baby wipes, diapers or a detergent, bleach or fabric softener used to launder cloth diapers. Ingredients in lotions, powders and oils might add to the problem.
• Developing a bacterial or yeast (fungal) infection. What begins as a simple infection may spread to the surrounding skin. The area covered by a diaper is at risk because it’s warm and moist, making a perfect breeding ground for bacteria and yeast. These rashes can be found within the creases of the skin. And you might notice red dots scattered around the creases.
• Introducing new foods. As babies start to eat solid foods, the content of their stool changes. This increases the likelihood of diaper rash. Changes in your baby’s diet can also increase the frequency of stools, which can lead to diaper rash. Breastfed babies might develop diaper rash in response to something the mother has eaten.
• Having sensitive skin. Babies with skin conditions, such as atopic dermatitis (eczema) or seborrheic dermatitis, may be more likely to develop diaper rash. The irritated skin of atopic dermatitis is usually in areas not covered by a diaper.
• Using antibiotics. Antibiotics can contribute to a rash by killing bacteria that keep yeast growth in check. Antibiotic use also increases the risk of diarrhea. Breastfed babies whose mothers take antibiotics are also at increased risk of diaper rash.

Complications

• Changes in skin color. In babies with brown and Black skin, diaper rash might cause the affected area to lighten (post-inflammatory hypopigmentation). Mild hypopigmentation usually clears up in a few weeks. Severe cases might take months or years to return to the usual skin color.
• Infection. Diaper rash can develop into a severe infection that doesn’t respond to treatment.

Prevention

The best way to prevent diaper rash is to keep the diaper area clean and dry. A few simple strategies can help decrease the likelihood of diaper rash developing on your baby’s skin.

• Change diapers often. Remove wet or dirty diapers promptly. If your child is in child care, ask staff members to do the same. Disposable diapers that contain an absorbent gel are effective because they draw wetness away from the skin.
• Rinse your baby’s bottom with warm water as part of each diaper change. You can use a sink, tub or water bottle for this purpose. Moist washcloths, cotton balls and baby wipes can aid in cleaning the skin. Be gentle. Use wipes that don’t contain alcohol or fragrance. Or use a mild soap or a gentle nonsoap cleanser.
• Gently pat the skin dry with a clean towel or let it air dry. Don’t scrub your baby’s bottom. Don’t use talcum powder.
• Apply cream, paste or ointment regularly. If your baby gets rashes often, apply a cream, paste or ointment during each diaper change. Petroleum jelly and zinc oxide are the time-proven ingredients in many diaper rash products. If the product you applied at the previous diaper change is clean, leave it in place and add another layer on top of it.
• After changing diapers, wash your hands well. Hand-washing can prevent the spread of bacteria or yeast to other parts of your baby’s body, to you or to other children.
• Fasten diapers securely but not too tight. A diaper that allows some airflow helps prevent diaper rashes. Too-tight diapers can rub the skin. Take a break from plastic or tightfitting diaper covers.
• Give your baby’s bottom more time without a diaper. When possible, let your baby go without a diaper. Exposing skin to air is a natural and gentle way to let it dry. To avoid messy accidents, try laying your bare-bottomed baby on a large towel and engage in some playtime.

Treatment

The best treatment for diaper rash is to keep your baby’s skin as clean and dry as possible. If the rash doesn’t go away with home treatment, your health care provider might suggest:

• A mild (0.5% to 1%) hydrocortisone (steroid) cream twice a day for 3 to 5 days
• An antifungal cream, if your baby has a fungal infection
• Antibiotic medicine taken by mouth, if your baby has a bacterial infection

A diaper rash might take several days to improve, depending on how severe it is. A rash may come back again and again. If a rash persists even with prescription products, your health care provider may recommend that your baby see a specialist in skin conditions (dermatologist).

Lifestyle and home remedies

Generally, a diaper rash can be treated successfully at home with these practices:

• Keep the diaper area clean and dry. The best way to keep your baby’s diaper area clean and dry is by changing diapers promptly after they are wet or soiled. Until the rash is better, this may mean getting up during the night to change the diaper. Try using disposable diapers that contain an absorbent gel. They draw wetness away from the skin.
• Rinse your baby’s bottom with warm water as part of each diaper change. You can use a sink, tub or water bottle for this purpose. Moist washcloths, cotton balls and baby wipes can aid in cleaning the skin. Be gentle. Use wipes that don’t contain alcohol or fragrance. Or use a mild soap or a gentle nonsoap cleanser.
• Gently pat the skin dry with a clean towel or let it air dry. Don’t scrub your baby’s bottom. Don’t use talcum powder.

• Apply cream, paste or ointment. After you’ve gently cleaned and dried the skin, apply a cream, paste or ointment. If the product you applied at the previous diaper change is clean, leave it in place and add another layer on top of it. If you do want to remove it, try using mineral oil on a cotton ball.

  Products with a high percentage of zinc oxide or petroleum jelly work well to protect the skin from moisture. Various diaper rash medications are available without a prescription. Talk to your health care provider or pharmacist for specific recommendations. Some popular products include A + D, Balmex, Desitin, Triple Paste and Lotrimin (for yeast infections).

  Zinc oxide is the active ingredient in many diaper rash products. Such products are usually applied to the rash throughout the day to soothe and protect babies’ skin. It doesn’t take much – a thin covering will do. The product can be applied over medicated creams, such as an antifungal or a steroid, when needed. You could also apply petroleum jelly on top, which helps keep the diaper from sticking to the paste, ointment or cream.

  Ointments, pastes or creams may be less irritating than lotions. But ointments and pastes create a barrier over the skin and don’t allow it to receive air. Creams dry on the skin and allow air through.

  As a general rule, stick with products designed for babies. Avoid items containing baking soda, boric acid, camphor, phenol, benzocaine, diphenhydramine or salicylates. These ingredients can be toxic for babies.

• Increase airflow. To aid the healing of diaper rash, do what you can to increase air exposure to the diaper region. These tips may help:
  • Let your baby go without a diaper and ointment for short periods of time, such as during naps.
  • Take a break from plastic or tightfitting diaper covers.
  • Use diapers that are larger than usual until the rash goes away.
• Bathe your baby daily. Until the rash clears up, give your baby a bath each day. Use warm water with mild, fragrance-free soap or a gentle nonsoap cleanser.
• Stop using products that seem to trigger your baby’s rash. Try a different brand of baby wipe, disposable diaper, laundry soap or whatever other product you suspect.

Alternative medicine

The following alternative treatments have worked for some people:

• Witch hazel (winter bloom), a flowering plant. A study showed that applying an ointment made with witch hazel to diaper rash helped. The study included 309 children.

• Human breast milk. Results are mixed on whether human breast milk applied to diaper rash is better than other treatments. One study showed that applying breast milk to diaper rash is an effective and safe treatment. Infants with diaper rash were treated with either 1% hydrocortisone ointment or breast milk. The study included 141 infants. Treatment with breast milk was as effective as the ointment alone.

  Another study compared human breast milk with a cream made from zinc oxide and cod liver oil. Newborns with diaper rash were treated with the cream or the breast milk. The study included 63 babies. Treatment with the cream was more effective.

• Shampoo clay (bentonite). A study showed that shampoo clay was effective in healing diaper rash and that it worked faster than calendula. The study included 60 infants.
• Other substances. Other natural remedies have been tried, including aloe vera, calendula, bee pollen, beeswax and cod liver oil. Further study is needed to prove their effectiveness for treating diaper rash. Some of these substances may promote bacterial growth.

Preparing for an appointment

Generally, diaper rash can be treated successfully at home. Make an appointment with your baby’s health care provider if the rash gets worse despite several days of home treatment, is severe or occurs along with a fever.

Here’s some information to help you get ready for your appointment.

What you can do

• List your baby’s signs and symptoms, and for how long your baby has had them.
• List key information about your baby’s medical conditions and food intake. For example, has your baby been treated for any illness or given any medications recently? Has the baby’s diet changed? If your baby is breastfed also note any medications that might reach the baby through breast milk. Also note changes in the mother’s diet, such as an increase in tomato-based foods.
• List all products that come into contact with your baby’s skin. Your baby’s health care provider will want to know what brand of wipes, diapers, laundry detergent, soaps, lotions, powders and oils you use for your baby. If you suspect that one or more products may be causing your baby’s diaper rash, you may wish to bring them to the appointment so your health care provider can read the label.
• List questions to ask your health care provider. Creating your list of questions in advance can help you make the most of your time with your health care provider.

Below are some basic questions to ask your health care provider about diaper rash.

• What is the most likely cause of my baby’s rash?
• What are other possible causes?
• What can I do to help my baby’s skin heal?
• What diaper ointments, pastes, creams or lotions would you recommend for my baby?
• When should I use an ointment or paste instead of a cream or lotion?
• Do you suggest any other treatments?
• What products or ingredients should I avoid using with my baby?
• Should I avoid exposing my baby to certain foods, either through breast milk or through my baby’s diet?
• How soon do you expect my baby’s symptoms to improve?
• What can I do to prevent this condition from recurring?
• Is the rash a sign of some other internal problem?

What to expect from your doctor

Your health care provider is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to talk about in-depth. Your health care provider may ask:

• When did you first notice your baby’s signs and symptoms?
• What type of diaper does your baby typically wear?
• How often do you or your baby’s child care provider change your baby’s diaper?
• What types of soap and wipes do you use to clean your baby?
• Do you apply any skin care products to your baby, such as lotions, powders, creams and oils?
• Is the baby breastfed? If so, is the mother taking antibiotics? Are there any changes to the mother’s own diet?
• Have you introduced your baby to solid foods?
• What treatments have you tried so far for your baby’s rash? Has anything helped?
• Has your baby recently had any other medical conditions, including any illness that caused diarrhea?
• Has your baby recently taken any new medications?

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Use of amoxicillin/clavulanate in the treatment of children with cancer

Antibiotic

Trademarks:

Augmentin®

Other names:

Amoxicillin and Clavulanic Acid

Often used for:

Infections

Amoxicillin/clavulanate (Augmentin®) is an antibiotic. Its action is aimed at the destruction of bacteria that cause infections. This drug belongs to the antibiotics of the penicillin group.

Oral chewable tablets

Oral tablet

Oral liquid form

• Diarrhea
• Diaper rash
• Nausea and vomiting
• Headache
• Abdominal pain
• Loss of appetite
• Skin rash
• Vaginal irritation and itching or vaginal discharge

Symptoms of an allergic reaction may occur: rash, hives, itching, chills, fever, headache, muscle pain, shortness of breath, cough, tightness in the throat, swelling of the face or neck

Amoxicillin/clavulanate was prescribed. The most common side effects are highlighted in bold, but others are not excluded. Report all possible side effects to your doctor or pharmacist.

Be sure to discuss these and other recommendations with your doctor or pharmacist.

• Tell your doctor if you have severe diarrhea while taking this drug.
• This drug may interfere with some lab tests, especially in people with high blood sugar (diabetes). Ask your doctor or pharmacist how to properly use the urine glucose test strips and how to interpret the results.
• The drug may reduce or increase the effectiveness of other drugs. Tell your doctor or pharmacist about all medicines you are taking, especially if it is methotrexate or probenecid.
• Pregnant or breastfeeding patients should notify their physician.
• Therapy with this drug may reduce the effectiveness of birth control pills and other hormonal methods of contraception. During therapy, patients who are sexually active should use other methods of contraception, such as condoms.
• The course of taking the drug must be completed completely in accordance with the recommendations of the attending physician or pharmacist.

Amoxicillin/clavulanate at home:

• It should be taken at the same time each day.
• Long-acting tablets: must be swallowed whole. Do not crush or chew before taking. The extended-release tablets should be taken with food.
• Other formulations may be taken with or without food. If the drug causes stomach upset, it must be taken with food.
• In liquid form: shake well before use, use the measuring device provided to measure the dosage. The drug in liquid form can be mixed with milk, infant formula or juice immediately before taking.
• Chewable tablets: Chew or crush before taking.
• Take your dose as soon as possible if you miss it. Do not do this only if there is little time left until the next appointment. In no case do not double the dose at the next dose!
• Tablets should be stored at room temperature.
• Liquid formulation should be stored in the refrigerator. After opening, store no more than 10 days.
• Do not use an expired drug.
• Follow instructions for safe storage and disposal of the drug.

More about amoxicillin/clavulanate

Clinical features of antibiotic-associated syndrome in children with various antibiotic therapy | Golden L.B., Ploskireva A.A., Kanner E.V., Kanner I.D.

Introduction

At present, the use of antibacterial drugs (ABP) is one of the most frequently recommended methods for the treatment of a large number of infectious diseases. However, like any other type of therapeutic intervention, antibiotics, along with undoubted positive clinical effects, can cause unwanted drug reactions.

The World Health Organization (WHO) divides all unwanted drug reactions into 5 types:

Type A – predictable (predictable) effects:

drug overdose (PM) and primary toxic reactions, for example, when administered in high doses of paracetamol, some patients experience liver failure [1]. The liver, as the main organ in which drugs are metabolized, is particularly susceptible to the damaging effects of drugs and toxins. Hepatotoxicity in the form of cholestasis or hepatitis most often develops while taking oxacillin, amoxicillin / clavulanate, metronidazole, tetracyclines, ceftriaxone [2];

delayed reactions and actual side effects, such as drowsiness, which manifests itself when taking antihistamines;

secondary effects — antibiotic-associated diarrhea [2];

drug interaction, for example, poisoning with the simultaneous use of drugs such as theophylline and erythromycin [3].

Type B – unpredictable (unpredictable) effects:

pseudo-allergic reactions (non-immunological), for example, to radiopaque substances;

allergic reactions, for example, anaphylaxis when taking drugs [4]. Possible with the use of any ABP, but most often develop against the background of the use of β-lactam antibiotics (most often penicillins, to a lesser extent – cephalosporins), sulfonamides, erythromycin, streptomycin, vancomycin, amphotericin B. Unlike β-lactams, macrolides rarely cause allergic reactions;

idiosyncrasy, the cause of which is an insufficient amount or low activity of enzymes. Thus, when treated with quinidine, pyrazolones, or ABP, a lack of the enzyme glucose-6-phosphate dehydrogenase can cause hemolytic anemia [5];

individual intolerance is an undesirable phenomenon caused by the use of drugs in subtherapeutic and therapeutic doses, for example, the appearance of tinnitus after taking acetylsalicylic acid [6].

Type C – phenomena of a “chemical” nature that develop with long-term use of drugs, for example, the manifestation of chronic toxicity in the form of keratopathy when taking chloroquine [7].

Type D is a late (delayed) undesirable effect of the drug, such as withdrawal after opiate use [8].

Type E – treatment failure of an unpredictable nature, for example, a decrease in the effectiveness of perfor-
oral contraceptives with the simultaneous use of inducers of microsomal liver enzymes [9].

One of the common adverse events for all antibiotics, regardless of their characteristics, route of administration and mechanism of action, is antibiotic-associated diarrhea (AAD) [10].

According to the WHO definition, AAD is 3 or more episodes of loose stools, an increase in its volume, a change in consistency, the appearance of pathological impurities, such as mucus, blood while taking ABP or within 2 months. after the end of antibiotic therapy [2].

At the moment, two etiological forms are distinguished in the classification of AAD:

idiopathic AAD, the cause of which is currently considered to be an imbalance in the intestinal microbiocenosis [11];

infectious AAD, in which in most cases (15–30%) the pathological process is caused by the bacterium Clostridium difficile , in more rare cases – by microorganisms Clostridium perfringens , Staphylococcus aureus , Klebsiella oxytoca , Salmonella spp. , Candida spp. and others [12].

Violation of the microbiocenosis of the gastrointestinal tract (GIT) in its significance is considered the leading multifactorial pathogenetic mechanism for the development of AAD (Fig. 1) [13], since the destabilization of the microbiocenosis system of the gastrointestinal tract not only leads to the development of clinical manifestations of digestive disorders, but also triggers a cascade of pathological reactions leading to vitamin and mineral deficiency, immunological destabilization, as well as the risk of developing AAD associated with C. difficile [14], linking both types of AAD into one pathogenetic process.

Taking into account the above, as well as modern ideas about the role of microbiocenosis in the human body, it can be assumed [15-18] that the clinical manifestations associated with antibacterial therapy are not limited only to diarrheal syndrome, but include a much wider range of disorders.

The purpose of the study: to identify the features of the clinical manifestations of the syndrome associated with the use of various antibacterial drugs (antibiotic-associated syndrome, AAS).

Material and methods

In 2017–2019 Prospective clinical observation of 231 patients aged 3 months and older was conducted on the basis of GBUZ ICH No. up to 13 years old, hospitalized in a hospital with a diagnosis of “community-acquired pneumonia” and treated with various anti-inflammatory drugs. Of these, 165 patients received β-lactam antibiotics (ampicillin (n=50), amoxicillin with clavulanic acid (n=37), cephalosporins (n=52), combined antibiotic therapy (n=26)), and 66 patients received macrolides ( clarithromycin (n=34), azithromycin (n=32)). Patients were included in the observation if there were indications for prescribing antibiotic therapy and receiving a full course of treatment. In addition, the absence in ananmnesis vitae data on diseases and / or complaints of digestive disorders. The legal representatives of the patients signed the informed consent.

The selection of patients for clinical observation was carried out by the method of continuous screening. The follow-up period for each patient was 1 month. The observation included a general clinical examination in dynamics, a laboratory examination (clinical blood test, general urinalysis, determination of the etiology of community-acquired pneumonia by bacteriological and serological methods, chest x-ray, biochemical blood test, ultrasound examination of the abdominal organs and other studies according to indications).

The establishment of AAS was carried out during a clinical examination and by questioning the parents or legal representatives of the patient using a specially designed questionnaire. The condition of the digestive organs (development of diarrhea, vomiting, dyspepsia, stomatitis), skin and skin appendages (appearance of dry skin, diaper rash, brittle nails, hair, etc.), nervous system (development of sleep disorders, psycho-emotional sphere), inflammatory changes in the external genitalia, exacerbation of allergic diseases, the development of repeated episodes of acute respiratory infections within a month after antibiotic therapy were taken into account.

Statistical processing of the obtained data was carried out on the basis of GOST R 50779.21-96 using the methods of variation statistics on a computer using Microsoft Excel licensed programs. Statistical analysis included an assessment of qualitative variables, which was carried out by calculating the values ​​of the sample share (W), its standard error (SE). Comparison of the significance of differences in quantitative and ordinal variables between groups was carried out after checking the assumptions for the application of parametric multivariate univariate analysis of variance with the subsequent calculation of the achieved significance levels by t-tests for related and unrelated samples or non-parametric tests. Differences were considered significant at p<0.05, highly significant at p<0.01 and p<0.001, unreliable at p>0.05 [19].

Study results

Of the 231 patients examined, AAS symptoms were found in 149 (64.5%).

The most common manifestations of AAS were gastrointestinal symptoms, among which AAD itself was observed in a quarter of patients. These patients showed a change in character (from liquefied to liquid, watery) and an increase in the frequency of stools. In addition to diarrhea, pain syndrome, development of constipation, and stomatitis associated with antibacterial therapy were noted (Fig. 2).

Among the extraintestinal manifestations of AAS, when assessing the condition of the skin and skin appendages, dry skin or its peeling, the appearance of diaper rash in the perineum, brittle nails, and inflammatory changes in the external genitalia were revealed (Fig. 3).

Among the disorders of the nervous system, only deviations in the psycho-emotional sphere were diagnosed in the form of increased irritability and sleep disturbances, which were not isolated, but were combined with pain (abdominal pain) or diarrhea, which does not allow them to be attributed to the actual manifestations of AAS.

The frequency of development of clinical manifestations of AAS during one or another antibiotic therapy was different.

In patients treated with β-lactam antibiotics, the characteristic manifestations of gastrointestinal lesions were the development of diarrheal syndrome, dyspeptic manifestations, loss of appetite and the development of constipation. A lower frequency of development of clinical manifestations of lesions of the digestive organs was observed in patients treated with ampicillin (Fig. 4).

Extraintestinal manifestations of AAS in patients treated with β-lactam antibiotics were less common than gastrointestinal lesions. Among them, the most common symptom was the appearance of dryness/flaking of the skin. In patients treated with ampicillin or cephalosporins, the incidence of extraintestinal manifestations of AAS was significantly less compared to other observation groups (Fig. 5).

In general, the frequency of clinical manifestations of lesions of the digestive system in AAS in patients treated with macrolides was less than in patients treated with β-lactam antibiotics. At the same time, treatment with clarithromycin, compared with azithromycin, was accompanied by a significantly less frequent development of symptoms of gastrointestinal lesions and extraintestinal manifestations of AAS, in particular, diaper rash was not observed in such patients (Fig. 6 and 7). Moreover, the results of the study make it possible to talk about a higher safety profile of clarithromycin compared to β-lactam antibiotics and azithromycin.

Talk

In modern scientific literature, several of the most common variants of clinical manifestations of AAD are distinguished:

Intestinal dysbiosis (dysbacteriosis) is a complex of any symptoms of diarrhea that does not fit into the classical understanding of AAD; in foreign sources, this pathology is described as “mild illness” [20].

Actually AAD, which is clinically manifested in the form of regular symptoms of diarrhea and fever; at the same time, intoxication, dehydration and pain in the abdomen are extremely rare. Diarrheal syndrome and other symptoms of the disease (if any) disappear spontaneously a few days after drug withdrawal [21].

Pseudomembranous colitis (PMC) is characterized by frequent liquid stools, up to 15 times a day, the patient complains of severe cramping pain in the abdomen, fever up to 40 ° C. Leukocytosis (15 × 10 ⁹ /l and more) is recorded in the blood [22], hypoalbuminemia. An endoscopic examination on the mucous membrane of the large intestine will reveal rounded yellow plaques protruding into the lumen of the organ with a diameter of not more than 15 mm; a more detailed histological examination of the composition of these formations will reveal fibrin, mucus, epithelial detritus, and destroyed neutrophils [23]. Mortality in MVP is 10–35% [24].

Usually, the use of antibiotics such as clindamycin, penicillin, fluoroquinolones, and cephalosporins is associated with infection with C. difficile , but the disease can occur with the use of almost any antibiotic, including vancomycin and metronidazole [25]. The use of ABP contributes to the depletion of the commensal bacterial composition, which leads to a decrease in resistance to colonization, which contributes to the development of C. difficile infection (Fig. 8) [26].

Prevalence of asymptomatic colonization C. difficile varies in different population groups, reaching the highest values ​​in infants and newborns [26]. Asymptomatic colonization of C. difficile is a decisive factor in the progression of the pathological process, since carriers of toxigenic strains are at a higher risk of developing infection compared to non-colonized patients [27].

Antibiotic-associated colitis (AAC) has the same symptoms as MVP, but they are less pronounced: the frequency of loose stools more than 7 times a day, fever, moderate leukocytosis, etc. [28].

Segmental hemorrhagic colitis has all the symptoms of AAK and MVP, therefore it is clinically indistinguishable from them, but endoscopic examination of the intestine shows all signs of hemorrhagic colitis [29]. This disease has attracted attention in recent years due to the overgrowth of cytotoxin -producing K. oxytoca due to the use of antibiotics such as penicillin and amoxicillin [30].

The incidence of AAD, according to different authors, ranges from 18% to 68% [31, 32]. These data coincide with the data on the frequency of development of AAD itself, obtained in the course of our study.

A previously differentiated analysis showed that the incidence of AAD in adults with the use of macrolides is 8-16%, broad-spectrum penicillin antibiotics – 11%, clindamycin – 20-30%, cephalosporins – 9-43%, amoxicillin / clavulanate – 23-30%. 71% [2].

In the course of this study, it was shown that the maximum incidence of AAS was observed with the combined administration of ABP, which is explained by a greater effect on the microbiocenosis of the gastrointestinal tract. It was also shown that the development of AAS was observed with a greater frequency when using clavulanic acid, this is consistent with previous studies abroad. So, in the study of M.M. Aspin et al. [33], which included 180 children aged 6 months and older. up to 12 years of age, adverse events occurred more frequently with amoxicillin/clavulanate than with clarithromycin (51% vs. 32%, respectively, p=0.015). Diarrhea was the most common adverse event and was observed in 40% and 12% of patients in the amoxicillin/clavulanate and clarithromycin groups, respectively (p<0.001). Also, in patients from the amoxicillin/clavulanate group, diaper rash developed more often than in patients from the clarithromycin group (12% vs. 1%, respectively, p = 0.004).

In the course of this study, it was found that in pediatric practice, the development of AAS with the use of clarithromycin was recorded much less frequently than in the adult population.

Also, in the course of this study, extraintestinal manifestations of AAD were analyzed, which in most cases are not taken into account in clinical practice. It is necessary to pay serious attention to such manifestations, including them in the concept of “antibiotic-associated syndrome”, which implies the development of a wider range of clinical manifestations associated with the use of ABP than the development of AAD alone.

Conclusion

The most common clinical manifestations of AAS in pediatric practice were observed with combined antibiotic therapy, as well as with the use of amoxicillin with clavulanic acid and cephalosporins, less often with clarithromycin therapy. Adverse events associated with taking ABP are not limited to the development of diarrheal syndrome, but are characterized by the development of a symptom complex, including extraintestinal manifestations.

Clarithromycin remains of great importance in pediatric practice due to its high efficacy in many infectious diseases and a favorable safety profile. The original drug clarithromycin is registered in the Russian Federation for use in children in the form of film-coated tablets (250 mg and 500 mg) and granules for oral suspension (125 mg (5 ml) and 250 mg (5 ml)). Oral use of these drugs has no age restrictions, while children under 12 years of age are recommended to use a suspension, tablets are allowed for use from the age of 12 [34]. Clarithromycin has advantages over other macrolides. So, according to a number of authors, clarithromycin is superior to other macrolides in terms of antibacterial activity against the main pathogens of respiratory tract infections: Streptococcus spp., Staphylococcus aureus, Chlamydia pneumoniae, Mycoplasma pneumoniae, Legionella pneumophila [35, 36]. The minimum inhibitory concentrations of clarithromycin against the main pathogens of respiratory tract infections are several times lower than those of azithromycin and other macrolides [35, 36]. Due to the peculiarities of pharmacokinetics, a short half-life, clarithromycin, unlike azithromycin, does not stimulate the growth of resistance to the macrolide class in bacteria at the end of the course of therapy and reduces the risk of recurrence of the infectious process [37-39]. According to the Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy, in the Russian Federation, bacterial resistance to clarithromycin is lower than to azithromycin, which is an important advantage when choosing antibiotic therapy in modern medical practice [40].

Information about authors:

Golden Lika Borisovna – doctor of GBUZ IKB No. 2 DZM; 105275, Russia, Moscow, 8th st. Sokolina Gora, 15.

Ploskireva Antonina Alexandrovna – Doctor of Medical Sciences, Deputy Director for Clinical Work of the Central Research Institute of Epidemiology of Rospotrebnadzor; 111123, Russia, Moscow, st. Novogireevskaya, 3A; Professor of the Department of Pediatrics with Infectious Diseases in Children, Faculty of Additional Professional Education N.I. Pirogov of the Ministry of Health of Russia; 117997, Russia, Moscow, st. Ostrovityanova, 1; ORCID ID 0000-0002-3612-1889.

Ekaterina Valerievna Kanner — Candidate of Medical Sciences, Senior Researcher, Clinical Department of Infectious Pathology, Central Research Institute of Epidemiology of Rospotrebnadzor; 111123, Russia, Moscow, st. Novogireevskaya, 3A; ORCID ID 0000-0003-3204-1846.

Kanner Ilya Dmitrievich – 4th year student of Moscow State University named after M. V. Lomonosov; 119991, Russia, Moscow, Leninskiye Gory, 1; ORCID iD 0000-0003-4632-0547.

Contact information: Ploskireva Antonina Alexandrovna, e-mail: [email protected].

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Transparency of financial activities: none of the authors has a financial interest in the submitted materials and methods.

No conflict of interest.

Article received on 07/14/2021.

Received after review on 08/06/2021.

Accepted for publication on August 31, 2021.

About the authors:

Lika B. Golden—doctor, Infectious Clinical Hospital No. 2, 8th str. of Sokolinoy Gory, Moscow, 105275, Russian Federation.

Antonina A. Ploskireva—Dr. Sc. (Med.), Deputy Director for Clinical Work, Central Research Institute of Epidemiology of the Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being; 3A, Novogireevskaya str. , Moscow, 111123, Russian Federation; professor of the Department of Pediatrics with Infectious Diseases in Children of the Faculty of the Additional Professional Education, Pirogov Russian National Research Medical University; 1, Ostrovityanov str., Moscow, 117437, Russian Federation; ORCID iD iD 0000-0002-3612-1889.

Ekaterina V. Kanner – C. Sc. (Med.), senior researcher of the Clinical Division of Infective Disorders, Central Research Institute of Epidemiology of the Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being; 3A, Novogireevskaya str., Moscow, 111123, Russian Federation; ORCID ID 0000-0003-3204-1846.

Iliya D. Kanner — student of the 4 ^th course, Lomonosov Moscow State University; 1, Leninskie Gory, Moscow, 119991, Russian Federation; ORCID iD 0000-0003-4632-0547.

Contact information: Antonina A. Ploskireva, e-mail: [email protected].

Financial Disclosure: no authors have a financial or property

interest in any material or method mentioned.