What antibiotics increase the risk of C. difficile infection. How does antibiotic use contribute to C. diff development. Can certain antibiotics help prevent C. diff infection. What are the symptoms and treatment options for C. diff colitis.

Understanding C. Difficile Infection: Causes and Symptoms

Clostridioides difficile, commonly known as C. diff, is a bacterium that can cause severe diarrhea and other gastrointestinal issues. This potentially life-threatening infection often occurs as a result of antibiotic use, which disrupts the normal balance of bacteria in the gut.

C. diff infection (CDI) is a significant healthcare concern, with the Centers for Disease Control and Prevention (CDC) estimating nearly 500,000 cases and 15,000 deaths annually in the United States. The CDC has classified C. diff as an “Urgent Threat” to human health due to its increasing prevalence and severity.

Common Symptoms of C. Diff Infection

• Severe diarrhea
• Fever
• Nausea
• Loss of appetite
• Abdominal pain

Is C. diff infection always caused by antibiotic use? While antibiotics are a primary risk factor, not all cases of CDI are directly linked to antibiotic use. Other factors, such as advanced age, weakened immune system, and prolonged hospital stays, can also contribute to the development of C. diff infection.

Antibiotics That Increase the Risk of C. Diff Infection

While all antibiotics have the potential to disrupt the gut microbiome and increase the risk of C. diff infection, certain classes of antibiotics are more commonly associated with CDI. Understanding which antibiotics pose a higher risk can help healthcare providers make informed decisions when prescribing treatment.

High-Risk Antibiotics for C. Diff

1. Fluoroquinolones (e.g., ciprofloxacin, levofloxacin)
2. Clindamycin
3. Broad-spectrum penicillins (e.g., amoxicillin, ampicillin)
4. Cephalosporins (particularly third and fourth generations)
5. Carbapenems (e.g., meropenem, imipenem)

Why are these antibiotics more likely to cause C. diff infection? These high-risk antibiotics often have a broader spectrum of activity, meaning they target a wide range of bacteria. This broad action can significantly disrupt the normal gut flora, creating an environment where C. diff can thrive.

Antibiotics with Lower Risk of C. Diff Infection

While no antibiotic is entirely risk-free when it comes to C. diff, some antibiotics are associated with a lower risk of CDI. These antibiotics tend to have a narrower spectrum of activity, causing less disruption to the gut microbiome.

Lower-Risk Antibiotics for C. Diff

• Tetracyclines (e.g., doxycycline)
• Trimethoprim-sulfamethoxazole
• Macrolides (e.g., azithromycin)
• Aminoglycosides (e.g., gentamicin)
• Metronidazole (when used for non-C. diff indications)

How can healthcare providers minimize the risk of C. diff when prescribing antibiotics? Physicians should consider using narrower-spectrum antibiotics when appropriate, limiting the duration of antibiotic therapy, and implementing antibiotic stewardship programs to reduce unnecessary antibiotic use.

The Role of Antibiotic Stewardship in Preventing C. Diff Infections

Antibiotic stewardship programs play a crucial role in reducing the incidence of C. diff infections. These programs aim to optimize antibiotic use, improve patient outcomes, and reduce antibiotic resistance and adverse events such as CDI.

Key Components of Antibiotic Stewardship

1. Appropriate antibiotic selection
2. Optimizing antibiotic dosing
3. Minimizing treatment duration
4. Regular review and de-escalation of therapy
5. Education for healthcare providers and patients

How effective are antibiotic stewardship programs in reducing C. diff infections? Studies have shown that implementing comprehensive antibiotic stewardship programs can lead to significant reductions in CDI rates, with some hospitals reporting decreases of up to 50% in C. diff cases.

Diagnosis and Treatment of C. Diff Infections

Prompt and accurate diagnosis of C. diff infection is crucial for effective treatment and prevention of complications. Healthcare providers use various diagnostic tests to confirm CDI, including stool toxin tests and polymerase chain reaction (PCR) assays.

Treatment Options for C. Diff Infections

• Discontinuation of the offending antibiotic (when possible)
• Oral vancomycin or fidaxomicin
• Metronidazole (for mild cases)
• Bezlotoxumab (to prevent recurrence)
• Fecal microbiota transplantation (for recurrent cases)

What is the success rate of fecal microbiota transplantation (FMT) in treating recurrent C. diff infections? FMT has shown impressive results in treating recurrent CDI, with success rates ranging from 80% to 90% in various studies. This treatment option involves transferring healthy donor stool to restore the balance of gut bacteria in patients with recurrent C. diff infections.

Prevention Strategies for C. Diff Infections

Preventing C. diff infections requires a multi-faceted approach that involves healthcare providers, patients, and healthcare facilities. Implementing comprehensive prevention strategies can significantly reduce the incidence of CDI and improve patient outcomes.

Key Prevention Strategies

1. Judicious use of antibiotics
2. Hand hygiene with soap and water
3. Contact precautions for infected patients
4. Environmental cleaning and disinfection
5. Patient and family education

Are there any emerging prevention strategies for C. diff infections? Researchers are exploring the use of probiotics and vaccines as potential preventive measures against CDI. While results are promising, more studies are needed to establish their effectiveness and safety in preventing C. diff infections.

The Economic Impact of C. Diff Infections

C. diff infections pose a significant economic burden on healthcare systems and society as a whole. The costs associated with CDI include direct medical expenses, increased length of hospital stays, and productivity losses due to illness and mortality.

Factors Contributing to the Economic Burden of CDI

• Prolonged hospitalization
• Increased healthcare resource utilization
• Cost of treatment and management
• Loss of productivity for patients and caregivers
• Long-term health consequences and disability

What is the estimated annual cost of C. diff infections in the United States? Studies suggest that the economic burden of CDI in the U.S. ranges from $1 billion to $4.8 billion annually, highlighting the significant financial impact of this healthcare-associated infection.

Future Directions in C. Diff Prevention and Treatment

As the medical community continues to grapple with the challenges posed by C. diff infections, researchers are exploring innovative approaches to prevention, diagnosis, and treatment. These advancements aim to reduce the incidence of CDI, improve patient outcomes, and decrease the economic burden associated with this infection.

Emerging Areas of Research

1. Novel antibiotics with minimal impact on gut microbiome
2. Microbiome-based therapies
3. Improved diagnostic techniques
4. Vaccines against C. diff
5. Targeted antimicrobial peptides

How might microbiome-based therapies revolutionize the treatment of C. diff infections? Microbiome-based therapies, such as next-generation probiotics and engineered bacterial consortia, hold promise for restoring the balance of gut bacteria and providing long-term protection against CDI. These approaches could potentially offer more targeted and sustainable solutions compared to traditional antibiotic treatments.

In conclusion, understanding the relationship between antibiotic use and C. diff infections is crucial for healthcare providers and patients alike. By implementing appropriate antibiotic stewardship programs, adhering to prevention strategies, and staying informed about emerging treatments, we can work towards reducing the incidence and impact of this challenging healthcare-associated infection. As research continues to advance our knowledge of C. diff and the gut microbiome, we can look forward to more effective prevention and treatment options in the future.

C. difficile infection – Care at Mayo Clinic

C. difficile infection care at Mayo Clinic

Mayo Clinic specializes in treating people with difficult cases of C. difficile who haven’t responded to standard medical treatments or who have developed complications such as an inflamed colon. The Division of Gastroenterology and Hepatology at Mayo Clinic has a C. difficile clinic that specializes in treating people with C. difficile infection.

Your Mayo Clinic care team

Mayo Clinic uses a multidisciplinary team approach to evaluation and management of C. difficile infection with a team that includes doctors, nurses, study coordinators and laboratory personnel. Doctors who specialize in digestive and infectious diseases work closely with laboratory medicine specialists and scientists specializing in the gut microbiome and individualized medicine to diagnose and treat your condition.

Advanced diagnosis and treatment

Mayo Clinic uses the polymerase chain reaction (PCR) test, the most accurate diagnostic test available to confirm C. difficile infection. The high sensitivity of PCR, together with its rapid turnaround time, allows prompt treatment of people with C. difficile infection, likely reducing opportunity for spreading infection and improving outcomes.

For recurrent or stubborn C. difficile infections, fecal microbiota transplant (FMT) has been performed at Mayo Clinic with an overall high success rate. FMT therapy involves infusing healthy donor stools into people with C. difficile infections. Mayo Clinic performs extensive testing of donors and recipients before performing the procedure and offers the choice of related (family) or standard donors. Because donor testing typically isn’t covered by insurance, Mayo Clinic has a standard donor pool to help reduce the cost to potential recipients. Mayo Clinic also participates in clinical trials that are studying enema and capsule formulations for FMT.

Expertise and rankings

Mayo Clinic has about 140 digestive disease specialists (gastroenterologists) on staff, one of the largest such groups in the world. Because of the complexity of digestive diseases, the specialty is divided into nine specialty groups.

Mayo Clinic resources include the latest in endoscopic equipment and techniques. Using these minimally invasive procedures, doctors insert tubes through the mouth, nose or rectum to examine and treat problems of the digestive tract.

Locations, travel and lodging

Mayo Clinic has major campuses in Phoenix and Scottsdale, Arizona; Jacksonville, Florida; and Rochester, Minnesota. The Mayo Clinic Health System has dozens of locations in several states.

For more information on visiting Mayo Clinic, choose your location below:

Costs and insurance

Mayo Clinic works with hundreds of insurance companies and is an in-network provider for millions of people.

In most cases, Mayo Clinic doesn’t require a physician referral. Some insurers require referrals, or may have additional requirements for certain medical care. All appointments are prioritized on the basis of medical need.

Learn more about appointments at Mayo Clinic.

Please contact your insurance company to verify medical coverage and to obtain any needed authorization prior to your visit. Often, your insurer’s customer service number is printed on the back of your insurance card.

More information about billing and insurance:

Mayo Clinic in Arizona, Florida and Minnesota

Mayo Clinic Health System

Jan. 04, 2020

Antibiotics that cause C.Diff (and which ones probably don’t)

The introduction of antibiotics to cure infections undoubtedly revolutionized medicine over the past century. But some of these “wonder drugs,” as they were once called, can also leave the body vulnerable to an infectious disease called C.Difficile. 

What is C.Diff?

Clostridioides difficile, formerly known as Clostridium difficile, or C.Diff, is a contagious bacteria that can cause severe diarrhea. Other common C.Diff symptoms include fever, nausea, loss of appetite, and abdominal pain.

It’s estimated to cause almost 500,000 illnesses in the United States and 15,000 deaths each year, according to the Centers for Disease Control and Prevention. It is currently classified by the CDC as an “Urgent Threat”—the Centers’ highest threat level—to human health from an infectious pathogen in the U.S. (The CDC plans to release an updated report regarding this data in fall 2019.) 

Which antibiotics cause C.Diff?

So how exactly does antibiotic usage make one susceptible to a life-threatening disease like C.Diff? When you take an antibiotic, it works to kill a bacterial infection in your body. In the process, these drugs can also destroy the healthy bacteria that keep invaders like C.Diff in check. It’s important to note, not all antibiotics cause C.Diff, and not everyone has the same risk. Although almost any antibiotic can cause it, the worst culprit, in this case, is often broad-spectrum antibiotics. Those most at risk are patients 65 or older who have been in a healthcare setting, such as a hospital or nursing home. 

“Broad-spectrum antibiotics have activity against a [large] range of bacteria that reside in the gut,” explains Dr. Hana Akselrod, assistant professor of medicine in the Division of Infectious Disease at the George Washington School of Medicine and Health Sciences. “It’s very important to have a healthy and diverse population of these bacteria. ” When people are given broad-spectrum antibiotics, “their gut bacteria are depleted,” thereby allowing for a “pathogenic species,” such as C.Diff, to “essentially create overgrowth of aggressive bacteria that produce toxins that damage the bowel and create very severe illness.”

Erika Prouty, Pharm.D., former adjunct professor at Western New England University College of Pharmacy in Springfield, Massachusetts, breaks it down further: Broad-spectrum antibiotics can be potentially threatening for patients because they “not only target the bad bacteria we’re trying to eradicate, but they also kill a lot of the good bacteria that’s in our digestive system.” 

Both Dr. Akselrod and Dr. Prouty identify clindamycin and fluoroquinolones as some of the worst offenders. The list of antibiotics that could cause C.Diff includes:

“It’s unfortunate,” says Dr. Akselrod, “because those antibiotics are in wide use for everything from pneumonia to urinary tract infections.” The other issue is the necessity of certain IV antibiotics regularly used by physicians in hospital emergency rooms, which also fall under the “broad-spectrum” umbrella. These drugs include:

IV antibiotics are routine in an ER setting because they’re used as a “first-line therapy when patients come in sick and they’re not sure what’s causing the infection,” explains Dr. Akselrod. But as a medical professional immersed in this field, she is well-aware of the fine line physicians must walk in terms of both treating the illness at hand, while not introducing additional infection. “Over time we’ve become cognizant of the risks versus the benefits of this kind of broad-standard therapy,” she says. “It can be a tough call whether or not to start IV antibiotics. What helps us make the right decision is a judicious approach and trying to have a specific reason for giving antibiotics.”

Which antibiotics are less likely to cause C.Diff?

If you are at high risk for C. Diff, it’s worth talking to your doctor about choosing a lower-risk treatment. The antibiotics that are less likely to cause C.Diff include:

What antibiotics treat C.Diff?

Although broad-spectrum meds are at the top of the list of C.Diff causes, there are only a few types of C.Diff antibiotics capable of curing this particular infection. Vancomycin is the most frequently used antibiotic for C.Diff, says Dr. Prouty, citing the importance of oral, as opposed to IV, treatment: “The IV doesn’t actually penetrate the gastro-intestinal system, so it’s pretty much useless.” And since all infections are caused by different microbes (a bacterium that causes disease), “not all antibiotics are going to target those microbes and kill them,” she says. Therefore,specific drugs must be used in C.Diff treatment. 

It has been suggested that rates of C.diff have fallen in recent years at least partially due to antibiotic stewardship programs in hospitals, which seek to reduce the prescribing of unnecessary antibiotics. But when it comes to patients being proactive over C.Diff prevention, Dr. Akselrod says the number one thing they can do is have a frank conversation with their medical provider about whether or not they “really need that antibiotic, and to minimize the time spent on it.” 

Which Antibiotics Are Most Associated with Causing Clostridium difficile Diarrhea?

The Infectious Diseases Society of America (IDSA) guidelines clearly outline that the most significant risk factor for C difficile infection is older age, particularly in those 65 years of age and older.¹ In addition, hospitalization and duration of hospitalization are also 2 significant risk factors for C difficile infection. While it is important to recognize that age and hospitalization are risk factors, these cannot be modified to reduce a patient’s risk of infection.

Antibiotics: the Most Important Modifiable Risk Factors for Infection

Nearly any antibiotic is capable of disrupting the normal gut microflora, which can allow for C difficile to flourish and produce toxin. ¹ Surprisingly, even single doses of antibiotics for surgical prophylaxis have been associated with an increased risk of C difficile infection. In general, a longer antibiotic duration and multiple antibiotics (versus a single antibiotic) are 2 risk factors that increase the risk of antibiotic-associated C difficile diarrhea. Aside from these 2 standard antimicrobial stewardship principles, the IDSA guidelines are relatively silent regarding specific antibiotic drugs or drug classes that may carry a higher risk of C difficile infection.

Multiple studies have been conducted to assess the comparative risk of different antibiotics for C difficile infection.^3-5 Although there is heterogeneity in the studies available, multiple meta-analyses have concluded similar findings regarding which antibiotic classes are at the highest risk for C difficile infection.

Antibiotic Classes with Highest Risk of C difficile (odds ratio 5 or more)

Without a doubt, clindamycin carries the highest risk of C difficile infection with an odds ratio of about 17-20 compared to no antibiotic exposure.^3-5 Fluoroquinolones, cephalosporins, aztreonam, and carbapenems carry a fairly high risk, all of which being associated with an odds ratio of approximately 5 compared to no antibiotic exposure.

Antibiotic Classes with Moderate Risk of C difficile (odds ratio 1 to 5)

Macrolides, sulfonamides/trimethoprim, and penicillins are associated with a moderate risk of C difficile infection with odds ratios between about 1.8 and 3.3.^3-5 Within this group, penicillins are generally associated with a slightly higher risk (odds ratio about 50% higher) compared to macrolides and sulfonamides/trimethoprim.

Clinical Implications of C difficile Risk Data

On the basis of the available data, clindamycin should absolutely be avoided among patients who are at risk for C difficile infection, particularly in elderly patients and those with frequent antibiotic exposure or hospitalizations. Given the available data, it’s clear that clindamycin is a well-deserving candidate of its boxed warning specifically for C difficile risk.⁶

For community-acquired pneumonia, it has been suggested that a tetracycline may be substituted in place of azithromycin (or another macrolide) among elderly patients at higher risk for C difficile infection.⁷ In fact, data suggests that tetracyclines may NOT increased risk of C difficile infection at all, with a non-significant odd ratio of 0.9 versus no antibiotic exposure.^3,4

In patients hospitalized with severe infections who require anti-Pseudomonal coverage, the available data suggests that penicillins (such as piperacillin/tazobactam) may have a lower risk of C difficile infection versus cephalosporins (such as cefepime) or carbapenems (such as meropenem). While this risk is certainly relevant to the selection of antimicrobials, local resistance patterns should also be considered when selecting an agent.

Knowledge of high-risk and lower-risk antibiotics for C difficile infection is important, particularly in patients who are already at a higher risk for C difficile infection, such as elderly patients. Avoidance of these high-risk antibiotics when other first-line alternatives exist in certain patient populations should be an antimicrobial stewardship intervention for pharmacists to reduce the risk of C difficile infection both in the inpatient and outpatient settings.

References

• Cohen SH, Gerding DN, Johnson S, et al. Clinical Practice Guidelines for Clostridium difficile Infection in Adults: 2010 Update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol. 2010;31(5):431-455. doi:10.1086/651706.
• Collins CE, Ayturk MD, Flahive JM, Emhoff TA, Anderson FA, Santry HP. Epidemiology and outcomes of community-acquired Clostridium difficile infections in Medicare beneficiaries. J Am Coll Surg. 2014;218(6):1141-1147.e1. doi:10.1016/j.jamcollsurg.2014.01.053.
• Deshpande A, Pasupuleti V, Thota P, et al. Community-associated Clostridium difficile infection and antibiotics: a meta-analysis. J Antimicrob Chemother. 2013;68(9):1951-1961. doi:10.1093/jac/dkt129.
• Brown KA, Khanafer N, Daneman N, Fisman DN. Meta-Analysis of Antibiotics and the Risk of Community-Associated Clostridium difficile Infection. Antimicrob Agents Chemother. 2013;57(5):2326-2332. doi:10.1128/AAC.02176-12.
• Vardakas KZ, Trigkidis KK, Boukouvala E, Falagas ME. Clostridium difficile infection following systemic antibiotic administration in randomised controlled trials: a systematic review and meta-analysis. Int J Antimicrob Agents. 2016;48(1):1-10. doi:10.1016/j.ijantimicag.2016.03.008.
• Clindamycin [package insert]. Morgantown, WV: Mylan Pharmaceuticals Inc; 2013.
• Bella SD, Taglietti F, Petrosillo N. Are There Reasons To Prefer Tetracyclines to Macrolides in Older Patients with Community-Acquired Pneumonia? Antimicrobial Agents and Chemother. 2013;57(8):4093. doi:10.1128/AAC.00828-13.

Symptoms, Causes, Diagnosis, Treatment, Prevention

What Is Clostridium Difficile (C. diff)?

Clostridium difficile (C. diff) is a type of bacteria that can cause colitis, a serious inflammation of the colon. Infections from C. diff often start after you’ve been taking antibiotics. It can sometimes be life-threatening.

Clostridium Difficile (C. diff) Symptoms

When you have C. diff, the symptoms can range from mild to severe.

Mild symptoms can include problems like:

• Watery diarrhea that happens three to four times a day for several days
• Stomach pain, cramping, or tenderness

In more serious infections, there may be blood or pus in the stool. This can happen because C. diff can cause the colon — also called the large intestine — to get inflamed. When this happens, tissue in the colon can bleed or make pus. Other symptoms of a serious infection include:

If your C. diff infection is severe, you could get severe intestinal inflammation. Your colon could also get enlarged and you could develop an extreme response to infection called sepsis. All of these problems are serious and could send you to the hospital.

If your diarrhea from C. diff is very severe, get medical help quickly. Severe diarrhea can lead to life-threatening dehydration.

Clostridium Difficile (C. diff) Causes and Risk Factors

C. diff exists all around us. It’s in the air, water, soil, and in the feces of humans and animals.

C. diff bacteria that are outside the body turn into spores that can live on surfaces for weeks or months. These spores are not “active,” but they can turn active after you swallow them and they get into your intestines. Some people have the bacteria in their intestines and never have any symptoms. But for others, the bacteria make toxins that attack the intestines.

A new strain of C. diff bacteria makes larger amounts of toxins. These types are hard to treat with medications.

C. diff bacteria spread in health care facilities, like hospitals or nursing homes, where workers are more likely to come into contact with it and then with patients or residents.

Continued

You can also become infected if you touch clothing, sheets, or other surfaces that have come in contact with feces and then touch your mouth or nose.

Continued

Older adults in health care facilities are most at risk, especially if they’re taking antibiotics. That’s because the human body contains thousands of different types of bacteria — some good, some bad. If the antibiotics kill enough healthy bacteria, the ones that cause C. diff could grow unchecked and make you sick.

The antibiotics that are most linked to a risk of C. diff infection are:

An increasing number of younger people also develop C. diff infections, even without taking antibiotics or being in a hospital. Failure to wash your hands thoroughly after being exposed to the bacteria can lead to infection.

You also have higher odds of getting C. diff if you have:

Women have higher chances of getting C. diff than men. You’re also more at risk for the disease if you’re 65 or older. And your odds of C. diff go up the more times you’ve had the disease before.

Clostridium Difficile (C. Diff) Complications

If a C. diff infection isn’t treated quickly, you could become dehydrated due to severe diarrhea. This loss of fluids might also affect your:

A C. diff infection also can lead to rare problems such as:

• Toxic megacolon. Your colon dilates and can’t release gas or stool. This could cause it to swell and rupture. It can be life-threatening without emergency surgery.

• Bowel perforation. This is a hole in your large intestines that allows dangerous bacteria to escape. It can lead to a dangerous infection called peritonitis.

Clostridium Difficile (C. Diff) Diagnosis

If your doctor suspects you have this infection, they’ll probably order one or more stool tests. They include:

• Enzyme immunoassay
• Polymerase chain reaction
• GDH/EIA
• Cell cytotoxicity assay

If your doctor suspects serious problems with your colon, they might order X-rays or a CT scan of your intestines. In rare cases, your doctor may examine your colon with procedures such as a flexible sigmoidoscopy or colonoscopy.

Clostridium Difficile (C. Diff) Treatment

Antibiotics may have triggered your infection, but some types of these drugs target C. diff. They include:

Talk with your doctor about the side effects of these antibiotics.

It’s important to replace fluids that you lost from diarrhea. Drink plenty of fluids that have water, salt, and sugar, such as broth and fruit juices.

If there’s been damage to your intestines, you may need surgery to remove the affected areas.

Sometimes, a C. diff infection can come back. Doctors sometimes recommend a treatment to help repopulate the colon with healthy bacteria. It’s often done by putting another person’s stool in your colon using a device called a colonoscope. The procedure is called fecal microbiota transplant (FMT).

Donors are screened carefully to make sure they’re not passing along infections or parasites.

Clostridium Difficile (C. Diff) Prevention

If you’re in a hospital or long-term health care facility, you can do several things to protect yourself from C. diff. For example:

• Ask your health care professionals to wash their hands thoroughly before and after caring for you.
• Request that all medical equipment be sanitized before being brought into your room.
• Wash your hands with soap and water after using the bathroom and before eating.

Continued

Another way to help prevent C. diff is to not take unnecessary antibiotics. Talk this over with your doctor and see if there are other treatment options. And don’t take antibiotics without a doctor’s OK.

Many C. diff infections are mild and short-lived, but others can be quite serious. Take precautions, and don’t hesitate to seek medical help if you have symptoms.

C. Difficile Infection – American College of Gastroenterology

Overview

Diarrhea is a frequent side effect of antibiotics, occurring 10–20% of the time. It usually gets better when the antibiotics are stopped. Clostridium difficile infection (CDI) is due to a toxin-producing bacteria that causes a more severe form of antibiotic associated diarrhea. The disease ranges from mild diarrhea to severe colon inflammation that can even be fatal. CDI usually occurs when people have taken antibiotics that change the normal colon bacteria allowing the C. difficile bacteria to grow and produce its toxins. Since 2000, there has been a dramatic increase in the number and severity of cases of C. difficile infection (CDI) in the US, Canada and other countries. C. difficile is a gram positive bacterium. This bacterium is everywhere in the environment, and produces spores that are hard to get rid of. C. difficile produces two main toxins – toxins A and B – that cause inflammation in the colon.

Risk Factors

The major risk factor for CDI is taking antibiotics in the previous several weeks, but sometimes it occurs even without prior antibiotic use. High-risk antibiotics are clindamycin, cephalosporins, and quinolones (i.e. ciprofloxaxin, levofloxacin). Major risk factors are older age, weakened immune system, having other illnesses, and being in a hospital or a long-term care facility. However, even healthy individuals who have not had antibiotics can develop CDI. Patients with inflammatory bowel disease (Crohn’s disease or ulcerative colitis) are more likely to get CDI, and may be sicker than patients with IBD alone or CDI alone. Many studies have also suggested that use of acid suppressive medications (proton pump inhibitors) may increase the risk of CDI. Individuals can pick up C. difficile by ingesting spores that are all around in the environment, especially in hospitals. Infected individuals excrete spores, and transmission among patients in hospital has been well documented.

Symptoms

Symptoms of CDI can vary. Diarrhea is the most common symptom; it is usually watery and, rarely, bloody, and may be associated with crampy abdominal pain. Associated symptoms are feeling poorly, fever, nausea, and vomiting. Signs of severe disease include fever and abdominal distension and/or tenderness.

Screening/Diagnosis

C. difficile infection requires documenting the presence of toxin in the stools, usually by testing for the gene that produces toxin B, using a method called PCR. It is very sensitive, so it should not be used to test solid stools since that is likely a carrier state. An older test is an enzyme immunoassay test for toxin A and B, but it is less sensitive.

Treatment

First, it would be ideal to stop the antibiotic that led to the infection in the first place. This may not always be possible, however, as some infections, like severe bone or heart infections, need long-term antibiotics. If the symptoms are mild, metronidazole 500 mg, three times a day for ten days is recommended. If one cannot tolerate metronidazole’s side effects, or early in pregnancy when it is not recommended, alternate treatment is vancomycin 125 mg, four times a day for ten days. If the patient does not get better after several days on metronidazole, a switch to vancomycin is recommended. Fidaxomicin is a new antibiotic that appears equivalent to vancomycin, but is much more expensive. Antidiarrheal drugs should never be used for CDI, as slowing down an inflamed colon may result in a severe complication called toxic megacolon.

Patients with severe disease may not have diarrhea if their colon is very inflamed. They are usually very sick, with fever, severe abdominal pain, and tenderness. In such cases, oral vancomycin is the best choice. Sometimes intravenous metronidazole is added as well. In some patients, CDI is so severe that antibiotics do not work. When this happens, surgery to remove the colon may be needed to save the person’s life.

While antibiotics are effective in treating most cases of CDI, the symptoms recur after the end of treatment in 10-20% of cases. This is called recurrent CDI and usually occurs 1–2 weeks after stopping treatment. After a recurrence, the chance of further recurrences goes up to 40-60%, perhaps because one is using an antibiotic to treat a disease caused by antibiotics. We presume that the normal colonic bacteria have not had a chance to recolonize. A common treatment is to give vancomycin in a pulsed regimen – taking it one day but then skipping a day, and increasing the number of days between doses. Perhaps this allows the normal bacteria to return on the “off antibiotic” days. The most effective treatment, however, is fecal microbiota transplant (FMT), also known as stool transplant. In studies, it has been effective in over 90% of patients who received the treatment, and has been proven effective with several randomized controlled trials.

Prevention

Wise antibiotic policies, by using narrow-spectrum agents when directed and avoiding unnecessary use of broad-spectrum antibiotics, are key in the prevention of CDI. Environmental cleaning is important – especially hand washing with soap and water, since alcohol gels do not inactivate spores. In hospitals, everyone entering the room of a patient with CDI should wear a gown, gloves, and use disposable equipment.

Author(s) and Publication Date(s)

Christina M. Surawicz, MD, MACG, University of Washington School of Medicine, Seattle, WA – Published December 2012. Updated July 2016

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C. diff Infections | C. difficile

What is C. diff?

C. diff is a bacterium that can cause diarrhea and more serious intestinal conditions such as colitis. You may see it called other names – Clostridioides difficile (the new name), Clostridium difficile (an older name), and C. difficile. It causes close to half a million illnesses each year.

What causes C. diff infections?

C. diff bacteria are commonly found in the environment, but people usually only get C. diff infections when they are taking antibiotics. That’s because antibiotics not only wipe out bad germs, they also kill the good germs that protect your body against infections. The effect of antibiotics can last as long as several months. If you come in contact with C. diff germs during this time, you can get sick. You are more likely to get a C. diff infection if you take antibiotics for more than a week.

C. diff spreads when people touch food, surfaces, or objects that are contaminated with feces (poop) from a person who has C. diff.

Who is at risk for C. diff infections?

You are at more likely to get a C. diff infection if you

• Are taking antibiotics
• Are 65 or older
• Recently stayed in a hospital or nursing home
• Have a weakened immune system
• Have had a previous infection with C. diff or were exposed to it

What are the symptoms of C. diff infections?

The symptoms of C. diff infections include

• Diarrhea (loose, watery stools) or frequent bowel movements for several days
• Fever
• Stomach tenderness or pain
• Loss of appetite
• Nausea

Severe diarrhea causes you to lose a lot of fluids. This can put you at risk for dehydration.

How are C. diff infections diagnosed?

If you have been taking antibiotics recently and have symptoms of a C. diff infection, you should see your health care provider. Your provider will ask about your symptoms and do a lab test of your stool. In some cases, you might also need an imaging test to check for complications.

What are the treatments for C. diff infections?

Certain antibiotics can treat C. diff infections. If you were already taking a different antibiotic when you got C. diff, you provider may ask you to stop taking that one.

If you have a severe case, you may need to stay in the hospital. If you have very severe pain or serious complications, you may need surgery to remove the diseased part of your colon.

About 1 in 5 people who have had a C. diff infection will get it again. It could be that your original infection came back or that you have new infection. Contact your health care provider if your symptoms come back.

Can C. diff infections be prevented?

There are steps you can take to try to prevent getting or spreading C. diff:

• Wash your hands with soap and water after you use the bathroom and before you eat
• If you have diarrhea, clean the bathroom that you used before anyone else uses it. Use bleach mixed with water or another disinfectant to clean the toilet seat, handle, and lid.

Health care providers can also help prevent C. diff infections by taking infection control precautions and improving how they prescribe antibiotics.

Centers for Disease Control and Prevention

Symptoms, Causes, Treatment & Prevention

Overview

What is pseudomembranous colitis?

Pseudomembranous colitis is inflammation (swelling, irritation) of the large intestine. In many cases, it occurs after taking antibiotics. Using antibiotics can cause the bacterium Clostridium difficile (C. diff) to grow and infect the lining of the intestine, which produces the inflammation. Certain antibiotics, like penicillin, clindamycin (Cleocin®), the cephalosporins and the fluoroquinolones, make C. diff overgrowth more likely.

Who is at risk for getting pseudomembranous colitis?

People who have the greatest risk for developing pseudomembranous colitis include:

• Residents of nursing homes
• People who have been in the hospital for a long time
• People living with another, severe medical condition

Symptoms and Causes

What causes pseudomembranous colitis?

For some people, C. diff is part of the normal bacterial flora, or the collection of bacteria, in the gastrointestinal tract. Pseudomembranous colitis results from changes to the bacterial flora after you use antibiotics.

In some cases, taking antibiotics can cause C. diff to grow out of control and release toxins (poisons) into intestinal tissues. These toxins attack the lining of the intestine and cause pseudomembranous colitis symptoms.

What are the symptoms of pseudomembranous colitis?

Symptoms of pseudomembranous colitis include:

• Frequent watery diarrhea that is sometimes bloody
• Pain and tenderness in the stomach
• Cramping
• Nausea
• Fever
• Loss of appetite

In more severe cases, sepsis (the body’s potentially dangerous overreaction to an infection) can occur.

Most people who have pseudomembranous colitis notice symptoms 5 to 10 days after starting treatment with antibiotics.

Diagnosis and Tests

How is pseudomembranous colitis diagnosed?

Pseudomembranous colitis is diagnosed by examining a sample of feces (stool) in a laboratory to identify toxins produced by C. diff.

Doctors may diagnose pseudomembranous colitis with a sigmoidoscopy. This procedure uses a thin, flexible tube (sigmoidoscope) that enables your doctor to view the interior of your large intestine.

Management and Treatment

How is pseudomembranous colitis treated?

The first thing your doctor may recommend is that you stop taking the antibiotic that led to the pseudomembranous colitis infection.

Pseudomembranous colitis is treated with antibiotics that target this infection. In most cases, doctors prescribe metronidazole (Flagyl®), vancomycin (Vancocin®) or fidaxomicin (Dificid®) for up to 14 days.

Pseudomembranous colitis recurs (comes back) in as many as 20% of people who have been treated. If this occurs, your doctor will prescribe another dose of an antibiotic.

A newer treatment known as a fecal transplant uses stool from a healthy donor to help restore normal bacterial flora to your intestine, especially if the infection has returned after the first treatment.

What complications are associated with pseudomembranous colitis?

Complications of pseudomembranous colitis include the following:

• Some people suffer reinfections with C. diff, which can cause pseudomembranous colitis to recur many times.
• If your C. diff infection worsens, you may become dehydrated (lose a great deal of fluid) from frequent diarrhea. You may also temporarily lose the ability to pass stool.
• In rare cases, pseudomembranous colitis causes toxic megacolon (severe intestinal distention, or swelling), intestinal perforation (puncture) or sepsis. These conditions are medical emergencies that must be treated immediately.

Call 911 or go to an emergency room if you have signs of these complications, including:

• Severe abdominal distention (bloating) and pain
• Rapid heartbeat (tachycardia)
• Abdominal tenderness

Prevention

Can pseudomembranous colitis be prevented?

Pseudomembranous colitis from out-of-control growth of C. diff bacteria can be prevented by following basic sanitation practices:

• Wash your hands often with soap and water.
• Wash your hands after visiting anyone in a nursing home or hospital.
• Disinfect surfaces with chlorine bleach-based cleaning products.
• Don’t use antibiotics except those prescribed by your doctor.
• If caring for someone with C. diff, wear disposable gloves and wash your hands after all contact.
• If your clothing becomes soiled with stool from someone infected with C. diff, wash your clothing with soap and chlorine bleach.

Outlook / Prognosis

What is the outlook for people who have pseudomembranous colitis?

With treatment, most people recover fully from pseudomembranous colitis. For a small number of people, reinfection with C. diff can lead to repeated bouts of the illness.

Living With

When should I call my doctor about pseudomembranous colitis?

If you develop symptoms of pseudomembranous colitis, especially if you’ve recently taken antibiotics, contact your doctor for evaluation and treatment.

A popular antibiotic can be fatal in the treatment of COVID-19

Health

15:05 09/18/2020 (updated 09:33 09/18/2020) Get a short link

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Taking some drugs together with an antibiotic can cause fainting, heart palpitations and even cardiac arrest

NUR-SULTAN, Sep 18 – Sputnik. The antibiotic azithromycin, which is used to combat the complications of COVID-19, can cause heart attacks when used with a number of other drugs. This conclusion was made by scientists from the University of Illinois at Chicago, according to the journal JAMA Network Open.

The protocol for treating children from coronavirus was developed in Kazakhstan

Dangerous interaction data based on studies of over 44 million patients. At the same time, doctors compared the results of the groups taking amoxicillin and azithromycin, respectively, RIA Novosti reports, citing scientific information.

It was found that the combined use of azithromycin and drugs that affect the electrical impulses of the heart is associated with a 40 percent increase in the frequency of cardiac abnormalities, such as fainting, heart palpitations and even cardiac arrest.These drugs include blood pressure medications, antidepressants, antimalarial drugs, and opioids.

Named diseases incompatible with COVID-19 vaccine

Earlier, American cardiologists published recommendations for the careful prescription of drugs that cause cardiac arrhythmias as a side effect. The list also includes some drugs for COVID-19.

Among these drugs, the authors named chloroquine, hydroxychloroquine and azithromycin – all of them, according to doctors’ conclusions, can cause heart rhythm disturbances.

Azithromycin is a semi-synthetic broad-spectrum antibiotic used in the treatment of many diseases, primarily respiratory, as well as otitis media, streptococcal pharyngitis, chlamydia, gonorrhea, malaria and others.

The bride died on her wedding day after taking a sedative

Note that Kazakh doctors do not recommend taking antibiotics without a doctor’s prescription, since these drugs can only complicate the patient’s further treatment.

How to drink them correctly, when it is useless, and when it is dangerous

Antibacterial drugs are divided into groups, differ in their effects and undesirable effects. The severity of side effects and the likelihood of an antibiotic allergy is what influences the choice of antibacterial drug in each case. The reaction to the drug depends not only on the drug itself, but also on the patient’s body. If a person has a chronic illness, their course may worsen while taking the prescribed antibiotic.Therefore, it is so important to tell the doctor about concomitant diseases and the presence of allergies, even if it was a very long time ago. Symptoms of the latter are skin itching, swelling of the respiratory tract, or even anaphylactic shock (usually after an injection of an antibiotic), when the pressure drops sharply, a semi-fainting state occurs and the person needs urgent resuscitation.

Dizziness, headache, nausea, vomiting, bloating, loose stools are frequent manifestations in response to antibiotic therapy. But this is not the whole list of toxic reactions.Some antibiotics are hepatotoxic (amphotericin, erythromycin) – they worsen liver function and increase the risk of jaundice, and in the 60s, taking antibiotics could even result in hearing loss. This is due to the substances of the aminoglycoside group: neomycin, streptomycin, kanamycin, gentamicin, amikacin. Previously, they treated intestinal infections (today they have learned to solve this problem in a different way – as a rule, without antibiotics). Currently, old aminoglycosides are used extremely rarely and only for strict indications (for example, for purulent infections of the abdominal cavity and small pelvis in combination with other drugs) – they were replaced by more modern and safe drugs.

A common complication of antibiotic therapy is the development of so-called antibiotic-associated diarrhea. Usually it does not need to be treated additionally, but if the ailments persist two to three days after the course of antibiotics, you should see a doctor. “The reason for such diarrhea may be the activated Clostridium difficile, a bacterium of the large intestine, which under certain conditions (under the influence of an antibiotic) can actively multiply and become pathogenic microbes,” explains Marina Laur. “To solve the problem, you need to drink other antimicrobial drugs (metronidazole, vancomycin) that inhibit the growth of bacteria.”

A rare but very serious complication of antibiotic therapy is hematopoiesis disorder. It is caused by the antibiotic Levomycetin, which, due to its high toxicity, is not produced in tablets and capsules in a number of countries, but Russia is not one of them. “Previously, Levomycetin was a great help in the fight against meningococcal infection, but now it has given way to more modern and less toxic antibiotics (cephalosporins of the third and fourth generations, carbapenems),” notes Ekaterina Stepanova.- Sometimes, in the old fashioned way, people drink “Levomycetin” in the treatment of diarrhea, but this is not justified by anything. There are also eye drops with this antibiotic, the effectiveness of which is also low. ” In pharmacies, “Levomycetin” is dispensed by prescription, but even if the drug was prescribed by a doctor, then before taking it, you should see another specialist and look for an alternative remedy.

A fairly large group of antibacterial drugs is used in pediatrics. But there are antibiotics that are contraindicated in childhood due to their ability to influence growth and the lack of data on their safety.For example, tetracycline antibiotics should not be taken until the age of nine, fluoroquinolones – until the age of 15. When prescribing an antibiotic, the dose of the drug should be calculated taking into account the age and weight of the child.

Pregnant women should take antibiotics with great caution, unless such treatment is really necessary (for example, in the case of pneumonia, pyelonephritis, cholecystitis). They are especially dangerous in the first trimester of pregnancy, when the main organs and systems of the future organism are being laid.During pregnancy, tetracyclines are absolutely contraindicated (can lead to a violation of the formation of bones, teeth in the fetus), aminoglycosides (can cause oto- and nephrotoxicity), as well as chloramphenicol, sulfonamides and nitrofurans. Pregnant women are prescribed only relatively safe antibiotics that are officially approved during pregnancy: penicillins, cephalosporins, macrolides.

A new program will tell doctors how different drugs are combined – Rossiyskaya Gazeta

A computer program will soon appear in the arsenal of doctors, suggesting the correct combinations of drugs when prescribing.

When preparing to write a prescription, the doctor will “type” into the computer the name of the medicine needed by a particular patient, and the program will “issue” recommendations taking into account the entire “bouquet” of human diseases. The new software product, they say in the Ministry of Health, should be ready by the end of the year.

Good business. We have a system of treating a person “in parts”, when each specialist doctor is responsible for his “part” of the body. This leads to the fact that chronic patients, especially older ones, have to take literally handfuls of pills.It is the responsibility of the therapist to “revise” the medical history, monitor all drug therapy prescribed by a cardiologist, rheumatologist, gastroenterologist, ophthalmologist (and further down the list …), to ensure that the patient does not take incompatible medications. But in reality the situation is complicated. First, not all precinct officers consider it necessary to “interfere” with the appointments of their colleagues – narrow specialists. Secondly, we, patients, bring in our share of the medication mess, and a lot. We do not like going to doctors, but just a little – we “grab” the pills on the advice of relatives, acquaintances, neighbors.

Medication polypharmacy (as experts call excessive prescription of drugs, when the harm from their use exceeds the positive effect) is characteristic not only for Russia. We do not have such statistics, but in the United States, for example, they do not hide the fact that hundreds of thousands of deaths in the country occur due to medical errors and improper treatment, including medication.

Whitney Houston died of a wrong combination of drugs last year. It is clear that the best doctors in Hollywood were at the service of the actress.Nevertheless, after her death, it turned out that she was taking high doses of the antidepressant Xanax, pain relievers ibuprofen and midol, and the antibiotic amoxicillin. All drugs, by the way, are forbidden to be taken simultaneously with alcohol, but the actress did not know about this or neglected and paid with her life.

“Combinations” of drugs are not always evil. For example, when “fighting” hypertension, a competent doctor, as a rule, selects a combination of different antihypertensive (pressure lowering) drugs for daily use, supplements the scheme with diuretics if necessary, “describes” to the patient how to behave and what to take additionally during a crisis.Different drugs act on different causes of hypertension, and a skillfully selected complex works much more efficiently than single drugs.

Another example of “correct” combinations is when one drug neutralizes the negative properties of another. Since the side effects inherent in certain drugs are known, these undesirable effects of treatment can be prevented if a “protection” drug is prescribed in addition to the main drug. For example, antimicrobial drugs, antibiotics, due to the threat of dysbiosis, are combined with nystatin or other antifungal drugs.

Pharmacologists are constantly studying the “combinations” and interactions of various drugs. The “data bank” about what can and cannot be treated at the same time is constantly replenished. One of the latest news: it is undesirable for elderly patients to take statins and antibiotics clarithromycin and erythromycin. This can lead to life-threatening complications.

It is important to know this, since statins – drugs that lower cholesterol levels – are widely prescribed today for hypertensive patients.

They are also received by patients over 50 years of age for the prevention of coronary heart disease and blood vessels. They are taken in long courses. It turned out that if, without abolishing statins, the patient is prescribed some antibiotics (clarithromycin, erythromycin), there is an effect of increasing their concentration in the blood and the same consequences as in an acute overdose. These patients were more likely to develop rhabdomylosis, a serious complication characterized by acute renal failure and destruction of muscle fiber cells, in some cases resulting in death (according to the journal Annals of Internal Medicine).

Of course, the patient himself cannot evaluate how to correctly combine the drugs he needs.This is the doctor’s business. But everyone can take care of their health.

1. It is necessary to carefully read the instructions for use – there is necessarily a section on the combination of drugs, restrictions and prohibitions on their use.
2. If you have any questions or doubts – bring this to the attention of your doctor.
3. To consult not only on the interaction of different drugs with each other. But also on the correct intake of the prescribed pills.
4. It is necessary to strictly follow the doctor’s prescriptions and treatment regimen.If the medicine should be taken half an hour before meals, it should be done so without violating the appointment.

Here are the most popular warnings for combining drugs with food:

Antibiotics are the most “conflicting” drugs. For the course of treatment, it is necessary to give up alcohol. Milk and dairy products weaken their effects.

Antidepressants – a categorical ban on alcohol.

Anticoagulants (thinning the blood) cannot be combined with cranberry juice, fruit drink and cranberries itself.This combination can cause internal bleeding.

Aspirin – the widespread opinion that it should be washed down with milk is mistaken. In general, the vast majority of medicines are taken with pure water, not tea or juice. When taking aspirin, it is generally better to refuse juices – an additional portion of acid provokes irritation of the gastric mucosa.

Diuretics – remove potassium, magnesium and other useful microelements from the body.Usually doctors take this into account and prescribe “compensating” drugs. However, a diet rich in potassium and magnesium will not hurt: dried apricots, spinach, baked potatoes.

Iron-containing preparations – while taking them, give up coffee, tea, flour and sweets, dairy products and nuts. All of these foods make it difficult for the body to absorb iron.

Drugs that lower blood pressure must not be combined with alcohol. Alcoholic drinks neutralize the effect of the drug, which can cause a sharp jump in pressure.You can lose consciousness.

A pulmonologist declared the inadmissibility of antibiotics for the prevention of COVID :: Society :: RBC

Taking such drugs is pointless and dangerous for future health.Earlier, the Ministry of Health repeatedly urged Russians not to get carried away with antibiotics for coronavirus infection

Photo: Anton Vaganov / Reuters

It is unacceptable to take antibiotics to prevent coronavirus infection. This was told by the chief freelance pulmonologist of the Ministry of Health of Russia Sergey Avdeev, reports TASS.

“Antibiotics do not work on any viruses, including the new coronavirus. They are prescribed only in case of development of bacterial complications of a new coronavirus infection, ”the doctor said.

He recalled that uncontrolled intake of antibiotics without medical prescription can cause side reactions, as well as resistance to them in microorganisms. Side effects can range from life-threatening rashes or stool disturbances to anaphylactic shock.

Beglov asked not to buy antibiotics like buckwheat

The Ministry of Health has repeatedly warned that antibiotics cannot be used to prevent COVID-19.The chief freelance microbiologist of the ministry, Professor Roman Kozlov, reported in October that such drugs do not prevent the disease.

Why it is harmful to drink a course of antibiotics to the end – Science

Anyone who has been prescribed antibiotics knows that in no case should they “not finish drinking” – stop treatment earlier than recommended, even if you feel better. Taking antibiotics correctly is your personal contribution to the fight against bacterial resistance.

Or not? Are your irresponsible friends who drop their medications as soon as their fever has subsided actually doing everything right? This is what scientists from the Brighton and Sussex School of Medicine write about in an article for BMJ magazine.

Among the recommendations of physicians on the competent use of antibiotics, the need to always complete the course of antibiotics prescribed by the doctor is often mentioned and in no case should be interrupted earlier, as soon as the state of health has improved.

This clause is in the recommendations of the World Health Organization (WHO), as well as in national campaigns to combat antibiotic resistance in Australia, Canada, the United States and Europe. In the UK, where the authors of the article work, this prescription is taught as a science fact in high school.

On this topic

“However, the idea that stopping antibiotic treatment early is contributing to the emergence of resistance is not supported by evidence, when taking medication longer than necessary increases the risk of it … We urge decision-makers, teachers and doctors to stop talking about the importance of ending antibiotics. and, moreover, publicly and actively declare that this recommendation is not based on facts and is not true, “the scientists write.

They note that the misconception about the need to “drink the whole course” of antibiotics arose at the dawn of their use. In his 1945 Nobel Prize speech, Alexander Fleming described what he saw as a dangerous scenario in which an imaginary patient with streptococcal infection does not take enough penicillin – as a result of which the streptococcus develops antibiotic resistance – and then infects his wife with it, who then dies of an incurable disease and his indiscretions.That is why, according to Fleming, “if you are using penicillin, use enough.”

However, the authors of the article write, the drug resistance that Fleming had in mind occurs, for example, in HIV or tuberculosis, but almost never occurs in bacteria that cause special concern among scientists – for example, Escherichia coli Escherichia coli and the so-called ESKAPE bacteria: enterococci, staphylococci, etc.

These opportunistic bacteria live in our bodies and the environment, usually without causing any problems.But they can cause infections in immunocompromised patients and, in the case of antibiotic resistance, dangerous nosocomial infections.

“When a patient takes antibiotics for any reason, species and strains that are susceptible to them on the skin, in the intestines and in the environment are replaced by resistant and capable of further causing infection.

On this topic

The longer these bacteria are exposed to antibiotics, the stronger the selection in favor of resistant species and strains.For example, it is this resistance to methicillin that developed in Staphylococcus aureus.

In addition, we have very little evidence that the recommended courses of antibiotics (formed in practice and out of fear of under-treatment) are in fact the minimum required time for taking them.

“The very idea of ​​an antibiotic course does not take into account that different patients may react differently to the same antibiotic. Now we ignore this fact and give universal recommendations for the duration of antibiotic use, based on poor data,” the authors of the article emphasize.

In their opinion, the simplicity and unambiguousness of advice about completing a full course of antibiotics may be the reason for the persistence of this myth. To understand how long it takes to take antibiotics, research and careful monitoring of the patient’s condition is needed.

“In the meantime, antibiotic education materials should highlight the fact that antibiotic resistance is a consequence of overuse and cannot be prevented by taking a course of medication. Society needs to be reminded that antibiotics are a valuable and exhaustible resource that must be conserved.” – scientists conclude.

Olga Dobrovidova

Read the full version of the material on the popular science portal “Cherdak”

90,000 Are antibiotics always the right solution? – Baltic Medical Center

Fever, runny nose, cough, general weakness … What will help if the disease begins to progress more rapidly? Most of us still think that when we get sick, antibiotics are most likely to help. But is it? Are antibiotics a cure for all diseases? When should you use them? Let’s talk about this with Inna Akhmetova, a doctor at the Baltic Medical Center.

1. What are antibiotics?

Antibiotics are medicines that act against bacteria that have entered the body. Bacterial infections are caused by various bacteria, therefore, there are different antibiotics. Different antibiotics act differently on microbes. Some destroy microbes, while others stop their growth and reproduction.

2. When should you use them?

Antibiotics are not a cure for all diseases, although many people mistakenly think otherwise.

Antibiotics are not recommended for the treatment of colds and viral diseases, since they do not affect viruses.

Ideally, antibiotics are given after the infectious agent and antibiotic sensitivity have been identified.

To determine the causative agent of the disease, material is taken from the source of inflammation for inoculation and antibiogram. But you need to wait for the answer within 3-4 days. Therefore, most often antibiotics are prescribed with the assumption of a possible pathogen and its sensitivity.

3. Why can only a doctor prescribe antibiotics?

There are many reasons why only a doctor can prescribe antibiotics.

Since an antibiotic only destroys bacteria, it is necessary to know the exact cause of the disease before prescribing them. Antibiotics do not fight infections caused by viruses, such as colds, flu, sore throat, bronchitis, and many ear infections. Therefore, antibiotics are not always suitable for treatment.

Only a doctor can properly assess the characteristics of the patient and the disease, changes in the state of health and decide which medicine to prescribe and how long to take it. Different antibiotics have different effects on the body. Some are more effective in the intestines, others in the bones, and still others in other organs. Therefore, it is not recommended to take antibiotics without a doctor’s prescription.

4. Is it true that the use of antibiotics unnecessarily not only does not help, but can even harm health?

The use of antibiotics unnecessarily can cause allergic reactions, changes in the intestinal microflora, abdominal pain and diarrhea. When using antibiotics that are ineffective against pathogens, bacterial resistance, in other words, antibiotic resistance, can develop.

5. What rules should be followed when using antibiotics?

Antibiotics should be used only in the prescribed doses and for the prescribed time. If the dose is lower than the prescribed dose, antibiotic resistance can also develop. If, when using the prescribed dose, there are side reactions, you must inform your doctor about this.In no case should you reduce the dose yourself or interrupt the treatment. Stopping treatment prematurely may re-cause infection because not all pathogens have been eradicated. It is important to know that an incomplete course of antibiotic treatment and a reduced dose of antibiotics on your own will stimulate the emergence of drug resistance in bacteria.

6. Is it always necessary to immediately consult a doctor when the first symptoms of the disease appear?

People often rush to see a doctor unnecessarily when the first symptoms of a cold appear.When a cold appears, the main signs of which are sneezing, runny nose, sore throat, you can heal yourself within 2-3 days. Only if the temperature rises above 39 degrees, other symptoms appear – rash, vomiting, etc., in this case, you just need to see a doctor. It is necessary to immediately consult a doctor if a child under 2 years of age falls ill, as well as in case of a strong manifestation of symptoms of the disease.

7. How to distinguish

Only an objective examination will help to establish the true causative agent of the disease – a cold, a virus or an infection.Most often, a cold manifests itself in the form of a runny nose, sneezing, headache and sore throat. Even with a cold, the temperature can rise to 38 degrees and higher. The disease caused by the virus is characterized by severe weakness, fever, severe muscle pain, severe headache, and eye pain. A viral disease is characterized by an abrupt onset, dry cough.

8. How to treat viral infections?

Symptomatic treatment is recommended for viral infections.You need to drink plenty of fluids, vitamin C, at temperatures above 38 degrees, use antipyretic drugs. But if the temperature persists for more than 3 days or other symptoms appear (rash, vomiting), you should consult a doctor.

90,000 Do probiotics help restore the intestinal microflora?

• Marta Henriquez
• BBC Future

January 28, 2019

Photo by, Unsplash

Antibiotic treatment can destroy not only harmful bacteria, but also beneficial ones.However, do probiotics help restore the gut microflora, as their ubiquitous advertising insists?

Probiotics are heavily advertised as a remedy for problems ranging from obesity to mental health problems. But most often they are recommended to restore the intestinal microflora after a course of antibiotics.

The logic is simple: during the treatment of infection, antibiotics destroy all bacteria, both harmful and beneficial, and therefore the intestines must be repopulated with new bacteria.

However, the effectiveness of this method has not been practically proven. What’s more, the researchers found that consuming probiotics after antibiotics actually delayed the restoration of gut flora.

The problem is that there is not enough research on any particular probiotic. Even when scientists use strains of live bacteria, the composition of the cocktail can vary greatly from laboratory to laboratory.

This is the opinion of Sidney Newberry of the Rand Corporation, who analyzed a large database of probiotic use in the treatment of antibiotic-induced diarrhea in 2012.

Newberry reviewed 82 studies with a total of 12,000 patients. He concluded that probiotic supplementation did help reduce the risk of digestive upset, but it was impossible to figure out which probiotic or probiotic blend was effective.

Photo author, Getty Images

Pidpis to photo,

It is widely believed that antibiotics, along with harmful ones, destroy beneficial bacteria in the intestine.

First of all, there is a lack of research that would prove the safety of taking probiotics.As a rule, probiotics do not harm the body of a healthy person.

But there is also more alarming evidence that probiotics may promote the spread of fungal infections in the bloodstream in more vulnerable patients.

Recently, scientists from the Weizmann Institute of Science in Israel proved that even in healthy people, the use of probiotics after antibiotics was not so safe.

Probiotics, as scientists have found, interfered with the very process of recovery, that is, their action was actually the opposite.

Scientists divided the participants in the experiment, who had just finished taking antibiotics, into three groups.

One group began to take probiotics, the second – the control – did not take anything, and the third received a fecal transplant. The participants in this group received a stool sample taken from them before taking antibiotics.

Photo author, Getty Images

Pidpis to photo,

Probiotics do not have the same effect on everyone, because the intestinal microbiome is different for all people

The result was unexpected.The worst result was for those who took the probiotics, and the best for the group that received the faecal transplant. It took only a few days for the intestinal microflora to fully recover.

There is a growing body of evidence that probiotics can harm unhealthy gut.

One recent study showed that probiotics were of no benefit to children admitted to hospital with gastroenteritis.

However, despite these findings, the demand for probiotics is not only not decreasing, but growing.In 2017, the sales market for probiotics amounted to more than $ 1.8 billion, by 2024 it may grow to $ 66 billion.

“Given this scale of production, it is very important that the benefits of probiotics are properly proven,” notes Eran Elinav of the Weizmann Institute.

“This is also the reason that regulatory bodies such as the US Food and Drug Administration and similar European institutions have not yet approved the clinical use of probiotics,” the scientist adds.

Photo author, Getty Images

Sign up to photo,

Probiotics can harm unhealthy intestines

This, however, does not mean that probiotics should be completely abandoned. The problem is obviously not with the probiotics themselves, but with the way we take them.

Such drugs are often bought without a prescription, and the consumer has no idea what exactly he bought and whether the bacteria in it are alive at all.

Elinav and his colleagues also tried to find out who might benefit from taking probiotics.

By examining the work of genes associated with the immune system, scientists were able to predict whether the patient’s intestines will be susceptible to saturation of beneficial bacteria, or they will just pass by without delay.

“This is an interesting and important study because it also says that our immune system interacts with probiotic bacteria,” explains Elinav.

It paves the way for the development of personalized probiotic therapies based on a person’s genetic profile.

This approach is “absolutely realistic and can be developed relatively quickly,” notes Elinav, but so far this is only a theoretical argument.

Development will require more research on individual probiotic selection and testing of different strains of bacteria in large populations.