Antibiotic associated diarrhea. Treatment of antibiotic-associated diarrhea

The concept of recovery after antibiotics appeared when the era of widespread use of antibiotics began. Antibiotics not only saved the lives of millions of people, but also began to have undesirable side effects, such as diarrhea (diarrhea) and colitis (intestinal inflammation) associated with changes in the intestinal microflora.

Fig. 1. The total intestinal area (its inner surface) in adults is approximately 200 m 2.

Diarrhea and colitis after antibiotics

When treatment with antibiotics, the number of microbes sensitive to them is reduced and the growth of normal is depress. The amount of strains resistant to antibiotics increases. Poverty bacteria reproduced intensively and begin to acquire property damaging macroorganism.

Klostridia, staphylococci, protea, enterococci, Klebsiella and yeast-like mushrooms are the most famous representatives of the intestinal pathogenic flora. In most cases, Diarmen, arising after antibiotics, a leading place occupy Klostridia ( Clostridium Difficile.). The frequency of damage is:

• from 15 to 30% of cases with antibiotic-associated diarrhea (ADA);
• from 50 to 75% of cases with antibiotic-associated colitis;
• until 90% of cases with pseudommabranous colitis.

Fig. 2. In the photo of Klostridia, the diffraction under the microscope.

Fig. 3. In the photo of the colony of clostridium diffraction.

The cause of diarrhea (diarrhea) and colitis is a disorder of intestinal microbiocenosis (intestinal dysbiosis). The growth of pathogenic bacteria leads to damage to the intestinal wall and strengthening the secretion of electrolytes and water.

Intestinal microflora participates in fiber utilization. As a result of such a process, short-chain fatty acids are formed - the energy source for the intestinal mucosa.

With an insufficient amount of fiber in a human diet, Troof (nutrition) of the intestine tissues is disturbed, which leads to an increased permeability of the intestinal barrier for toxins and pathogenic microbial flora.

Enzymes that produce intestinal microflora take part in the process of cleavage of bile acids. After the release into the gastrointestinal tract, the secondary bile acids are again absorbed, and their small amounts (5 - 15%) are released with the feces, participating in the formation and promotion of carts, impede their dehydration.

If bacteria in the intestines are excessively much, then bile acids begin to split prematurely, which leads to the occurrence of secretory diarrhea (diarrhea) and steatorea (allocating increased amount of fat).

All of the above factors form:

• antibiotic associated diarrhea - frequent complications In the treatment of antibacterial in adults. The frequency of occurrence of such a complication ranges from 5 to 25% in antibiotic persons;
• several less often is the development of colitis;
• rare, but a formidable disease, which develops after antibiotics - pseudommbranous colitis.

Fig. 4. In the photo, the normal intestinal wall (histological preparation).

Antibiotics that cause diarrhea

Penicillins

Penicillins of earlier generations (ampicillin, benzylpenicillin) more often affect the intestinal microflora. The use of modern penicillins does not lead to the development of clostrids - the main perpetrators of the pseudommbranous colitis.

Cephalosporins

Most cephalosporins contribute to the growth of enterobacteria and clostrid. Cefaclor and Cefradin do not affect intestinal biocenosis.

Erythromycin

M-cells epithelium fine intestine Motilin hormone is produced, which affects the intestinal motility, contributing to the promotion of food digestive tract. Erythromycin stimulates the production of Motilin, thereby speeding up the emptying of the stomach and intestines, which is manifested by diarrhea (diarrhea).

Clawulanic acid

Clawulanic acid, which is part of many antibiotics (amoxiclav, amoxicillin / clavulanate), also stimulates the intestinal motorcycle.

Tetracycline and neomycin adversely affect the intestinal epithelium, providing a direct toxic effect.

Fluoroquinolones

The antibiotics of this group suppress the growth of normal intestinal microflora, but do not contribute to the growth of clostrid.

Lincomycin

If the patient has a liquid chair 2 days in a row, two days later from the start of antibiotics and up to 2 months after the cessation of their reception - there is an antibiotic-associated diarrhea (ADA). Such a condition denotes that the patient occurred the pathological shifts of the composition of intestinal microflora (intestinal dysbiosis). Its frequency ranges from 5 to 25% among patients who were treated with antibiotics.

If the diarrhea proceeds with the symptoms of intoxication and high leukocytosis, then the reason should be considered a clostridium.

Fig. 5. The main mass of intestinal microflora is concentrated in the private intestinal zone.

In the risk group on the development of antibiotic-associated diarrhea are:

• children aged 2 months. up to 2 years old and adults older than 65 years,
• patients with diseases of the stomach and intestines,
• patients who were treated with antibiotics for more than 3 days,
• application in the treatment of a large number of antibiotics,
• sharp immunodeficiency.

The uncontrolled use of antibiotics contributes to the development of dysbacteriosis and increases the body allergization. On the risk of developing diarrhea after antibiotics, the method of introducing antibiotics and their dosage does not affect. Cases are described when diarrhea developed even after one-time reception.

Symptoms of antibiotic-associated diarrhea and colitis

The clinical picture of the dysbacteriosis after antibiotics has a wide range of manifestations - from minimal to life-degrading. In 70% of patients, the symptoms of the disease are manifested during the treatment period. In 30% of patients - after the end of treatment.

• Initially, a liquid chair (diarrhea) without any impurities. Often passes alone after 3 - 4 days. Sometimes the patient is bothering gravity abdominal pain. The overall condition of the patient is quite satisfactory. Endoscopic picture with AAD without pathology. When developing colitis, there is inflammation of the intestinal wall (swelling and hyperemia).
• With the negative development of the disease of the process of the process, such symptoms appear as fever, a chair is increased, the leukocyte levels increase in the blood, the leukocytes appear in feces, the pseudomambranous colitis is gradually developed, the cause of which are clostridia.

Asymptomatic flow of dysbacteriosis → Antibiotic-associated (diarrhea or diarrhea) → colitis → pseudommbranous colitis.

PseudoMembranous colitis is the extreme form of manifestation of clostrid infection.

Pseudommabranous colitis after antibiotics

Pseudommabranous colitis more often develops against antibiotic treatment, less often - after 7 - 10 days after their cancellation. It is based on the activation of pathogenic flora and primarily klostridium ( Clostridium Difficile.). There are cases of colitis development as a result of the reproduction of Staphilococci, Klebsiell, Salmonella and Mushrooms of the genus Candida. Among all pseudomambranous colitis, the colitis caused by the reception of antibiotics was from 60 to 85% in adults.

Clostridia produces toxins that lead to inflammation of the intestinal mucosa. Contacts between cells (enterocytes) are disturbed, which leads to an increase in the permeability of the intestinal wall, with the subsequent development of such symptoms as diarrhea, fever, convulsions. The inflammatory process is localized more often in the Tolstaya intestine, less often in the small intestine.

Fig. 6. In the photo, the classic "volcano" of the lesions with a pseudommbranous colitis (histological picture). The process of exudation went beyond the limits of the mucous meal, the process of formation of fibrous films begins. Symptoms of the disease in this period are rapidly growing.

Symptoms and symptoms of pseudommabranous colitis

The disease is characterized by a liquid meager watery chair with a frequency of 10 to 30 times a day, pain in the stomach and fever. Save diarrhea from 8 to 10 weeks. Stubborn diarrhea leads to loss of electrolytes and water. The volume of circulating blood decreases, blood pressure decreases. Developed sharp dehydration. Reducing the level of albumin in the blood leads to the development of peripheral edema.

Leukocytosis in the blood reaches 15 · 10 9 / l. In some cases, higher indicators are noted. Reducing the number of leukocytes is registered in patients who conducted chemotherapy for oncological diseases. The colon is damaged, expands (toxic expansion), its perforation occurs. When tying timely and adequate assistance, the disease often ends with the death of the patient.

Endoscopic picture

In diarrhea caused by antibiotics, endoscopy does not reveal any changes. When developing colitis, catarrhal inflammation appears at first. Next, against the background of hyperemia and edema of the intestine, erosion appear.

With endoscopy with a pseudommbranous colitis on the intestinal mucosa, fibrinous films (pseudomombra) are noted, which are formed on the necrosis areas of the mucous membrane. Fibrinous films have a pale yellowish color, often a ribbon form. Their size ranges from 0.5 to 2 cm in diameter. There is no intestinal epithelium. With the development of the disease, the bare sections and sections covered with films are expanding and occupied by a large area of \u200b\u200bthe intestine.

Fig. 7. In the photo pseudommbranous colitis. Fibrous films of yellowish color (pseudomberbran) are visible.

CT scan

For computer tomography The thickened wall of the thick bowel is revealed.

Complications

Infectious and toxic shock, perforation of the large intestine and peritonitis - formidable complications of pseudommbranous colitis in adults. In their development, ordinary therapy is powerless. Removal of the intestine is the only method of treatment.

The lightning form of the disease in half cases ends with a fatal outcome.

Diagnosis of the disease

Diagnosis of the disease is based on the determination of enterotoxins A and in clostridium diffusion.

The latex agglutination test is a qualitative method of diagnosing pseudommabranous colitis. It allows for one hour to identify the presence of enterotoxin and in the wheel masses. Its sensitivity and specificity are large and is more than 80%.

Fig. 8. In the photo, the view of the intestine with a pseudommabranous colitis. Psevomembranes are visible to the ribbon form, covering a large intestinal area (macro-treatment).

Treatment of pseudomembranous colitis

Preparations of choice in the treatment of pseudommabranous colitis in adults are antimicrobial preparations of Vancomycin and metronidazole.

conclusions

The intestinal dysbiosis is a background state that occurs over a variety of reasons. Almost every person is facing dysbacteriosis during life. In most cases, this state proceeds without visible symptoms and passes without a trace without treatment without disturbing general well-being. With a negative development of the situation, symptoms appear, the main of which are diarrhea (diarrhea). One of the reasons for the development of dysbacteriosis is the reception of antibiotics.

Antibiotics are appointed only by a doctor, it is he who will select the right one-time daily and term dose of the drug. Carefully read the instructions before taking a medicinal product.

How often did you take antibiotics without appointing a doctor? Whether the violation of the chair happened (diarrhea) after taking antibiotics?

Articles section "Dysbacteriosis"Most popular

• Unformed (liquid) chair three or more times for at least two days during the reception of antibiotics or within two months after it:
  • chair can be from 3-5 to 20-30 times a day in severe cases;
  • chair is usually watery, sometimes with blood and mucus;
  • in some patients, an alternation of a normal decorated chair with liquid, others, constant, which lasts up to several weeks or even months can be observed.
• Discomfort in the stomach.
• Stomach pain without clear localization (location).
• It is possible to increase body temperature to subfebrile numbers (37-37.5 ° C), with a long-term heavy course of the disease, the body temperature rises to 40 ° C.

Forms

Depending on the severity of the flow, several forms of the disease are distinguished.

• Easy shape. There are minor pains and discomfort in the stomach, the frequency of the chair does not exceed 3-5 times a day. Cancel antibacterial therapy (Applications antibacterial drugs), as a rule, leads to the disappearance of symptoms (multiple liquid stool). Clinical form called "mildillness" (moderate malaise).
• Medium-heavy shape. Chair is frequent, up to 10-15 times a day, with an admixture of mucus and blood, there is an increase in body temperature, abdominal pain, increasing during palpation (feeling). The abolition of antibiotics does not lead to the complete disappearance of symptoms. As a rule, with this form, segmental hemorrhagic colitis is developing (inflammation of the fat intestine mucosa in a separate section, accompanied by bleeding).
• Heavy shape. The patient's condition is very heavy, the body temperature rises to 39 ° C. More, the frequency of the chair reaches 20-30 times a day, complications are often developing (for example, perforation (tearing) of the intestine, dehydration (dehydration), etc.). Manifests itself a pseudommabranous colitis (acute inflammatory bowel disease caused by microorganism ClostridiumDifficile.).
• Fulminant shape (lightning room). For this form, a very rapid progression of the symptoms of the disease is characterized: a sharp increase in body temperature to 40 ° C, very sharp and severe abdominal pains (painting " acute belly"), A frequent liquid chair is rapidly replaced by constipation and intestinal obstruction (violation of the movement of food and cartoons by intestines). This form of the disease is often developing in weakened patients, which, for example, receive treatment malignant tumors (Cancer uncontrolled by the organism of the growth of cells and tissues leading to violation of organ functions).

The reasons

• Antibiotic therapy (use of antibacterial drugs). Most often, antibiotic associated diarrhea is developing after receiving:
  • penicillins (a group of antibiotics produced (produced) fungi genus Penicillium; the world's first antibacterial drugs);
  • cephalosporins class antibiotics (bactericidal (killing bacteria) antibiotics wide spectrum actions, including against microbes resistant to penicillins) - often the second-third generation;
  • macrolids - Effective Natural Antibacterial Prepares last generation (Diarrhea is relatively rare) and some others.

The probability of developing antibiotic-associated diarrhea increases:

• with simultaneous reception of several antibacterial drugs;
• when using chemotherapy, antineoplastic preparations (for the treatment of tumors), immunosuppressive therapy (overwhelming activities and activity of the immune system);
• when taking drugs of gold, non-steroidal anti-inflammatory agents (non-phonal anti-inflammatory drugs);
• when taking anti-diagram preparations (for treatment);
• when taking neuroleptics (psychotropic drugs - for the treatment of mental disorders).

In addition, it is of great importance to the presence of concomitant diseases, their severity, the general condition of the patient. For example, the risk of developing severe antibiotic-associated diarrhea increases:

• in chronic bowel diseases (for example, chronic colitis (intestinal inflammation));
• with malignant (oncological) intestinal tumors;
• when;
• after operations on the abdominal organs;
• after taking cytostatics (drugs that stop cell division);
• with long-term location in the hospital (with the attachment of concomitant diseases);
• after frequent diagnostic manipulations on the intestines (for example, colonoscopy and reorganosososcopy - diagnostic procedures, during which the doctor examines and evaluates the state of the inner surface of the colon using a special optical tool (endoscope)).

Diagnostics

• Analysis of complaints and anamnesis of the disease: when (as long ago) appeared, how many times a day, what medications did the patient accepted and with what result, it was specified, whether antibacterial therapy was carried out over the past two months, which drugs.
• Anamnesis analysis of life: specifies any chronic diseases, especially the gastrointestinal tract (for example,), whether antibiotic therapy ever was ever been carried out and with what consequences.
• Inspection: The doctor draws attention to the possible presence of signs of dehydration (the general weakness of the patient, dry diryabe leather, dry tongue and so on), palprates (feeling) The abdomen area (pain is increased), listens to the peristaltics (wave-like reducing the intestinal walls, promoting the food lump). With a fulminant (lightning) disease, the patient's condition is very heavy, a picture of the "acute abdomen" is observed:
  • severe abdominal pains;
  • decrease in blood pressure;
  • a sharp increase in body temperature, pulse and breathing frequency.
• Laboratory examination methods.
  • General blood test: allows you to detect signs of inflammation in the body (increase in leukocyte levels (white blood cells), raising the level of ESP (the rate of sedimentation of erythrocytes (red blood cells), a non-specific sign of inflammation)).
  • General urine analysis: allows you to reveal elevated level Protein, leukocytes, red blood cells.
  • Biochemical blood test: an increase in acuteness proteins (blood proteins, which are produced in the liver in response to development inflammatory process In the body), hypoalbum (the content of albumin (the main blood protein) in the blood below 35 grams / liter).
  • Cala analysis: detected increased content leukocytes (only single cells can be detected), which indicates the presence of inflammation in the body.
  • Bacteriological method of diagnostics - sowing feces on special nutrient media for the purpose of cultivation of culture (colonies) of microorganisms contained in it (for example, bacterium ClostridiumDifficile.), and determining their sensitivity to antibiotics. Also, within the framework of this method, a study of cytopathic (toxic (poisonous) for cells) of the effect in the culture of microorganisms is carried out: the isolated microbes in different amounts are planted in the colony of living cells, this allows you to reveal the minimal concentration of toxin (poisoning substance produced by microorganisms).
  • Polymerase chain reaction (PCR diagnostic method) - a high-precision diagnostic method, which allows to detect DNA (deoxyribonucleic acid - a structure that provides storage, transmission from generation to generation and implementation of the genetic program of a living organism) of the disease pathogen in the sample under study and work with a large variety of microorganisms, which fails for one or another reasons to propagate in the laboratory conditions.
  • Envunimal analysis (ELISA) - a complex technique that allows you to identify specific toxins ClostridiumDifficile. A and B (subspecies of poisoning substances produced by a microbe).
• Instrumental research methods.
  • Endoscopic methods (inspection of the inner surface of the colon with the help of a special optical tool - endoscope) study of the intestine:
    • colonoscopy - inspection with a long flexible endoscope,
    • rectorOnoscopy - inspection using a rectoscope - a rigid metal tube, which is introduced into the rectum and allows you to estimate the state of the mucous for 25-30 cm from the anal hole.
• Intestinal biopsy (taking a small piece of tissue of the body under study with a special long needle for further study by its microscope).
• Computed tomography (CT) with contrasting - the kind of X-ray examination with the introduction into the body of contrast (special substance visible on x-ray), allowing you to get a layer-by-layer image of organs on the computer. The pictures are found: sealing the walls of the colon, the symptom of the "Accordion" (various accumulation of contrast in the intestinal lumen and on the damaged intestinal mucosa), the symptom of the "target" - a decrease in the accumulation (absorption of contrast by cells) of the injected contrast.
• Consultation.

Treatment of antibiotic-associated diarrhea

• Canceling antibiotics.
• Dietary table number 4 by Pevznera. Use of products that contribute to a decrease: rice, bananas, baked potatoes, toasts, kissels. Exception from diet oily, fried, acute and dairy food. Food is frequent, small portions.
• A sufficient use of fluid, as dehydration often occurs due to persistent diarrhea.
• When identifying a certain causative agent (for example, Klostridia - bacteria ClostridiumDifficile.) Specific (directed against a specific microorganism) therapy with anticoleosdial means is carried out.
• Disinfecting therapy (elimination of the actions of toxins - poisoning substances allocated by microorganisms).
• Elimination of dehydration (dehydration treatment):
  • oral (through the mouth) of salt solutions,
  • intravenous administration of saline solutions.
• Restoration of the normal intestinal microflora - the reception of probiotics (preparations containing microorganisms characteristic of the normal microflora of the human intestine: certain types of lactobacilli, bifidobacteria, enterococci, as well as therapeutic yeast - sugaromycete). Applies only after all of the above methods.
• Surgical treatment: with severe and fulminant (lightning room) the course of the disease, it is necessary to remove the affected part of the intestine.

Complications and consequences

• Dehydration of the body, infringement of metabolism.
• Reduced arterial pressure.
• Toxic megaColon (expansion of a large intestine, a loss of contractile ability, which leads to a long delay in the carts in the intestine and causes intoxication (organism poisoning)).
• Superinfection (re-development infectious diseaseif initially it was not properly cured)
• Reducing the quality of life of the patient.

Prevention diarrhea antibiotic-associated

• Rational application Antibiotics - strictly by appointment of a doctor.

Yu.O. Shulpekova
MMA named I.M. Sechenov

Modern medicine is unthinkable without the use of various antibacterial agents. However, to the appointment of antibiotics, it is necessary to approach thoughtlessly, remembering the possibility of the development of numerous adverse ReactionsOne of which is antibiotic-associated diarrhea.

Already the 50s of the twentieth century, with the beginning of the widespread use of antibiotics, the causal relationship between the use of antibacterial agents and the development of diarrhea was established. And today the intestinal defeat is considered as one of the most frequent unwanted effects Antibiotic therapy, which most often develops in weakened patients.

The concept of antibiotic-associated diarrhea includes cases of the appearance of a liquid chair in the period after the start of antibacterial therapy and up to a 4-week period after the abolition of the antibiotic (in cases where other causes of its development are excluded). In foreign literature, the terms "Nosocomial colitis", "Antibiotic-associated colitis" are also used as synonyms.

• 10-25% - when appointing amoxicillin / clavulanate;
• 15-20% - when appointing Cephixim;
• 5-10% - when appointing ampicillin or clindamycin;
• 2-5% - when prescribing cephalosporins (except for zefisim) or macrolides (erythromycin, clarithromycin), tetracycline;
• 1-2% - when appointing fluoroquinolones;
• less than 1% - when the trinometh - sulfamethoxazole is prescribed.

The causes of antibiotic-associated diarrhea in developed countries are leading penicillin derivatives and cephalosporins, which is due to their widespread use. The diarrhea more often occurs during the oral destination of antibiotics, but its development is possible in parenteral and even transvaginal use.

Pathogenesis

Antibacterial drugs are able to suppress the growth of not only pathogenic microorganisms, but also the symbiotic microflora inhabiting the gastrointestinal tract.

The symbolic microflora, inhabiting the clearance of the gastrointestinal tract, produces substances with antibacterial activity (in particular, bacteriocinates and short-chain fatty acids are dairy, acetic, oil), which prevent the introduction of pathogenic microorganisms and redundant growth, the development of a conditioned pathogenic flora. The most pronounced antagonistic properties have bifidobacteria and lactobacilli, enterococci, intestinal wand. With violation of the natural intestinal protection, conditions arise for the reproduction of the conditionally pathogenic flora.

Speaking about antibiotic-associated diarrhea, from a practical point of view, it is important to distinguish between its idiopathic option and diarrhea due to the clostridium difficile microorganism.

Idiopathic antibiotic-associated diarrhea. The pathogenetic mechanisms for the development of idiopathic antibiotic-associated diarrhea remain not well-studied. It is assumed that various factors take part in its development.

When appropriate antibiotics containing clavulanic acid, diarrhea may develop due to stimulation of intestinal motor activity (that is, in such cases, diarrhea is characteristic of hyperkinetic).

When the cefopezone is prescribed and the development of the diarrhea, the character of hyperosmolar, due to the incomplete absorption of these antibiotics from the intestinal lumen.

Nevertheless, the most likely universal pathogenetic mechanism for the development of idiopathic antibiotic-associated diarrhea seems to be a negative impact of antibacterial agents on the microflora, inhabiting the clearance of the gastrointestinal tract. The interior of the intestinal microflora is accompanied by a chain of pathogenetic events leading to a violation of the intestinal function. The name "idiopathic" emphasizes that in this case, in most cases, it is not possible to identify a particular pathogen that causes the development of diarrhea. As possible etiological factors, Clostridium Perfrigens, Salmonella genus bacteria, which can be allocated in 2-3% of cases, staphylococcus, protea, enterococcus, as well as yeast fungi are considered. However, the pathogenic role of fungi in antibiotic-associated diarrhea remains the subject of discussion.

Another important consequence of the composition of the composition of the intestinal microflora is the change in the enterogeptic circulation of bile acids. Normally primary (conjugated) bile acids come into the lumen of the small intestine, where they are exposed to excessive deconjugation under the action of altered microflora. The increased amount of deconjugated bile acids enters the lumen of the colon and stimulates the secretion of chlorides and water (a secretory diarrhea develops).

Clinical picture

The risk of developing idiopathic antibiotic-associated diarrhea depends on the dose of the drug used. Symptomatics does not have specific features. As a rule, it is noted by a pronounced climb of the stool.

The disease, as a rule, proceeds without increasing the body temperature and leukocytosis in the blood and is not accompanied by the appearance of pathological impurities in feces (blood and leukocytes). With an endoscopic study, inflammatory changes in the gum mucosa are not detected. As a rule, idiopathic antibiotic-associated diarrhea does not lead to the development of complications.

Treatment

The main principle of treatment of idiopathic antibiotic-associated diarrhea is the abolition of an antibiotic drug or a decrease in its dose (if necessary to continue treatment). If necessary, anti-diarceders are prescribed (Loperamide, diosctitis, aluminum-containing antacids), as well as means for correction of dehydration.

It is advisable to prescribe probiotics preparations that contribute to the restoration of normal intestinal microflora (see below).

Diarrhea due to microorganism Clostridium difficile

The allocation of this form of antibiotic-associated diarrhea is substantiated by its special clinical value.

The most severe acute intestinal inflammatory disease caused by clostridium difficile microorganism and, as a rule, associated with the use of antibiotics, is called "pseudommbranous colitis". The cause of the development of pseudommabranous colitis is almost 100% of cases is the Clostridium Difficile infection.

Clostridium Difficile is a bond-anaerobic gram-positive spore-forming bacterium, which has natural resistance to most antibiotics. Clostridium Difficile is capable for a long time persist in the environment. His disputes are resistant to thermal processing. This microorganism was first described in 1935 by American microbiologists Hall and O'Tool in the study of the intestinal microflora of newborns and was not originally considered as a pathogenic microorganism. The species name "difficile" ("difficult") emphasizes the difficulties of the allocation of this microorganism by the culture method.

In 1977, Larson et al. It was isolated from the feces of patients with a severe form of antibiotic-associated diarrhea - a pseudommbranous colitis - toxin with a cytopathic effect in tissue culture. A slightly later installed a causative agent that produces this toxin: they were closeridium difficile.

The frequency of asymptomatic carriage of Clostridium difficile in newborns is 50%, among the adult population - 3-15%, while its population in the normal intestinal microflora of a healthy adult does not exceed 0.01-0.001%. It increases significantly (up to 15-40%) when taking antibiotics, oppressing the growth of intestinal flora strains, which normally suppress the vital activity of Clostridium Difficile (primarily clindamycin, ampicillin, cephalosporins).

Clostridium difficile in the lumen of the intestine produces 4 toxin. Invasia microorganism into the intestinal mucous membrane is not observed.

Enterotoxins A and B play a major role in the development of changes from the intestine. Toxin and has a concentrated and pro-inflammatory effect; It is capable of activating cells - participants in inflammation, cause the release of inflammation mediators and substances P, the degranulation of fat cells, stimulate chemotaxis polymorphous leukocytes. Toxin in manifests the properties of cytotoxin and has a damaging effect on colocuts and mesenchymal cells. This is accompanied by a actin disaggregation and violation of intercellular contacts.

The pro-inflammatory and disaggrating effect of toxins A and B leads to a significant increase in the permeability of the intestinal mucosa.

Interestingly, the severity of the flow of infection is not directly related to the toxicity of various strains of the causative agent. C. difficile media can detect a significant content of toxins in feces without clinical symptoms. Some antibiotics, especially lincomycin, clindamycin, ampicillin, in asymptomatic carriers C. difficile stimulate the products of toxins A and B without an increase in the overall population of microorganism.

For the development of diarrhea caused by C. difficile infection, it is necessary to have so-called predisposing, or trigger, factors. Such a factor in the overwhelming majority of cases is antibiotics (primarily Lincomicin and clindamycin). The role of antibiotics in the diarrhea pathogenesis is reduced to suppressing the normal intestinal microflora, in particular a sharp decrease in the number of non-operational clostridium, and the creation of conditions for the reproduction of the conditionally pathogenic microorganism Clostridium difficile. It was reported that even a single reception of an antibiotic can serve as an impetus for the development of this disease.

However, diarrhea caused by C. difficile infection can also develop in the absence of antibiotic therapy, under other conditions under which there is a violation of the normal microbial intestinal biocenosis:

• in old age;
• under Uremia;
• with congenital and acquired immunodeficiency (including on the background of hematological diseases, applications citostatic drugs and immunosuppressants);
• with intestinal obstruction;
• against the background of chronic inflammatory diseases of the intestine (nonspecific ulcerative colitis and crown disease);
• on the background of ischemic colitis;
• on the background of heart failure, with violations of the intestinal blood supply (including under shock conditions);
• against the background of staphylococcal infection.

Especially the threat of the development of pseudomambranous colitis after operations on the abdominal organs. It has been reported on the development of pseudommabranous colitis on the background active application laxatives.

The location of the predisposing factors in the pathogenesis of infection C. difficile, apparently, can be defined as follows: "The impact of predisposing factors → The oppression of normal microflora → The growth of the population S. difficile → Products of toxins A and B → Damage to the mucous membrane of the colon."

The bulk of diarrhea cases caused by C. difficile is cases of nosocomial diarrhea. Additional factors of the non-hospital distribution of infection C. difficile are infected with fecal-oral (transfer of medical personnel or with contact between patients). It is also possible in case of endoscopic examination.

The manifestations of C. difficile infection varies from asymptomatic carriage to severe enterocolitis forms that are denoted by the term "pseudomambranous colitis". The prevalence of C. difficile infection, according to various authors, is among the hospital patients from 2.7 to 10% (depending on the nature of the background diseases).

In 35% of patients with pseudommabranous colitis, the localization of inflammatory changes is limited to the colon, in other cases the pathological process is involved in the pathological process. The predominant defeat of the colon, apparently, can be explained by the fact that this is a predominant habitat of anaerobic clostrid.

Clinical manifestations can develop both against the background of the antibiotic taking (more often from the 4th to the 9th day, the minimum period - a few hours later) and after a significant time (up to 6-10 weeks) after the cessation of its reception. In contrast to the idiopathic antibiotic-associated diarrhea, the risk of the development of pseudommabranous colitis does not depend on the dose of the antibiotic.

The beginning of the pseudo-membrane colitis is characterized by the development of abundant water diarrhea (with a stool frequency up to 15-30 times a day), often with blood admixture, mucus, pus. As a rule, fever is observed (reaching up to 38.5-40 ° C), moderate or intense pain in the abdominal abdominal or permanent character. Neutrophilic leukocytosis is observed in the blood (10-20 x 10 9 / l), in some cases a leukemoid reaction is observed. With pronounced exudation and significant loss of protein with feces, hypoalbuminemia and swelling are developing.

Cases of the development of reactive polyarthritis with the involvement of large joints are described.

Complications of pseudommbranous colitis include: dehydration and electrolyte violations, the development of hypovolemic shock, toxic megolone, hypoalbuminemia and swelling up to Anasarki. To rare complications include colon perforation, intestinal bleeding, the development of peritonitis, sepsis. To diagnose sepsis, a prerequisite is to identify sustainable bacteremia in the presence of clinical signs System inflammatory reaction: body temperature above 38 ° C or below 36 ° C; Frequency of heart rate Over 90 UD. per minute; frequency respiratory movements Over 20 per minute or Paco 2 less than 32 mm Hg; The number of leukocytes in the blood is over 12x10 9 / l or less than 4x10 9 / l or the number of immature forms exceeds 10%. It is extremely rarely a lightning course of pseudo-membrane colitis, resembling cholera, in these cases for several hours is developing sharp dehydration.

In the absence of treatment, mortality in pseudommabranous colitis reaches 15-30%.

In patients who need to continue antibacterial therapy, in 5-50% of cases, diarrhea recurrences are observed, and when the "guilty" antibiotic is reused, the frequency of repeated attacks increases to 80%.

Diagnosis of pseudommbranous colitis Based on 4 main signs:

• the emergence of diarrhea after taking antibiotics;
• identification of characteristic macroscopic changes in the colon;
• peculiar microscopic pattern;
• proof of the etiological role of C. difficile.

Among the visualization methods, colonoscopy and computed tomography are used. Colonoscopy allows you to identify sufficiently specific macroscopic changes in the colon (first of all the straight and sigmoid): the presence of pseudommable, consisting of a necrotized epithelium impregnated with fibrin. Pseudommabra on the mucous membrane of the intestine is found in the medium-and-heavy and heavy forms of pseudo-membrane colitis and have the form of yellowish-greenish plaques, soft, but densitated with the subjectable tissues, with a diameter of several mm to several cm, on a slightly raised base. In the place of the tight membranes can be detected ulcers. The mucous membrane between membranes looks not modified. The formation of such pseudommabran serves as a fairly specific feature of the pseudommabranous colitis and can serve as a differential-diagnostic difference from non-specific ulcerative colitis, Crohn's disease, ischemic colitis.

In a microscopic examination, it is determined that the pseudomber contains necrotic epithelium, abundant cell infiltrate and mucus. In the membrane there are reproduction of microorganisms. Full-blood vessels are visible in the subject to intact mucous membrane and the submucosity.

With lighter forms of the disease, the mucosa can be limited only by the development of catarrhal changes in the form of full-blood and edema of the mucous membrane, its grain.

In computed tomography, you can reveal the thickening of the colon wall and the presence of inflammatory traffic in the abdominal cavity.

The use of methods that make it possible to prove the etiological role of C. difficile, it seems the most stringent and accurate approach in the diagnosis of antibiotic-associated diarrhea caused by this microorganism.

Bacteriological study of the anaerobic portion of the microorganisms of feces is not allowed, expensive and does not meet clinical requests, because takes a few days. In addition, the specificity of the culture method is low due to the widespread prevalence of asymptomatic carriage of this microorganism among hospital patients and patients taking antibiotics.

Therefore, the identification of the toxins produced by C. difficile is recognized by the method of choice, in feces of patients. A highly sensitive and specific method of detecting toxin in using tissue culture is proposed. In this case, it is possible to quantify the cytotoxic effect of the patient's feces filtrates on the tissue culture. However, the use of this method is economically unprofitable, it is used only in few laboratories.

The latex agglutination reaction to detect toxin and C. difficile allows less than 1 hour to establish the presence of toxin and in feces. The sensitivity of the method is about 80%, specificity - more than 86%.

Since the beginning of the 90s of the 20th century, in most laboratories, an immununimal analysis is used to detect toxin A or toxins A and B, which increases the informativeness of the diagnosis. The advantages of the method are simplicity and fast execution. Sensitivity is 63-89%, specificity - 95-100%.

Treatment of antibiotic-associated diarrhea due to infection Clostridium Difficile.

Since the antibiotic-associated diarrhea, due to microorganism C. difficile, can be qualified as an infectious diarrhea, when establishing this diagnosis, it is advisable to isolate the patient in order to prevent the infection of others.

Mandatory condition is the abolition of an antibacterial agent that caused the appearance of diarrhea. In many cases, this measure leads to the relief of the symptoms of the disease.

In the absence of effect and in the presence of severe clostridial colitis, an active treatment tactic is necessary.

Antibacterial drugs are prescribed (vancomycin or metronidazole), overwhelming C. difficile population growth.

Vancomycin is poorly absorbed from the intestinal lumen, and here its antibacterial action is carried out with maximum efficiency. The drug is prescribed at 0.125-0.5 g 4 times a day. Treatment continues for 7-14 days. The effectiveness of vancomycin is 95-100%: in most cases of infection C. difficile when prescribing vancomycin, fever disappears after 24-48 hours, the diarrhea is stopped by the end of the 4-5-day. With vancomycin inefficiencies, you should think about another possible reason Diarrhea, in particular, debut of nonspecific ulcerative colitis.

As an alternative to Vancomycin can perform a metronidazole, which has comparable with vancomycin efficiency. The advantages of metronidazole are significantly lower cost, the lack of risk of selection of vancomycinostable enterococci. Metronidazole is prescribed inside 0.25 g 4 times a day or 0.5 mg 2-3 times a day for 7-14 days.

Another antibiotic, effective in pseudomambranous colitis - bacitracycin, belonging to the class of polypeptide antibiotics. It is prescribed 25,000 meters inside 4 times a day. Bacitracine is practically not absorbed from the gastrointestinal tract, and in connection with which a high concentration of the drug is created in the colon. The high cost of this drug, the frequency of development of side effects limit its application.

If it is impossible to oral administration to these antibacterial agents (with an extremely serious condition of patient, dynamic intestinal obstruction), metronidazole is used intravenously 500 mg every 6 hours; Vancomycin is introduced to 2 g per day through a subtle cast or rectal probe.

If there are signs of dehydration, prescribe infusion therapy For the correction of the water and electrolyte balance.

In order to sorption and remove clostridial toxins and microbial bodies from the intestinal lumen, it is recommended that enterosorbents and drugs that reduce the adhesion of microorganisms on colocuts (diosctitis) are recommended.

The appointment of antidiare and antispasmodics is contraindicated due to the danger of developing a formidable complication - toxic megolon.

In 0.4% of patients with the most severe forms of pseudo-membrane colitis, despite the etiotropic and pathogenetic therapy, the state is progressively deteriorating and the need for a kolactomy occurs.

The treatment of relapses of the Clostridium DiffiLile infection is carried out according to the vancomycin scheme or PER OS metronidazole for 10-14 days, then the cholestiramine is 4 g 3 times a day in combination with lactobacterin 1 g 4 times a day for 3-4 weeks. and vancomycin at 125 mg every other day for 3 weeks.

For the prevention of relapses, the appointment of therapeutic yeast saccharomyces boulardii is 250 mg 2 times a day for 4 weeks.

Comparative characteristics clinical features idiopathic antibiotic-associated diarrhea and antibiotic-associated diarrhea caused by C. difficile infection, and treatment approaches are presented in Table 1.

Table 1.
Comparative characteristics of idiopathic antibiotic-associated diarrhea and diarrhea associated with infection C. Difficile

Characteristic	Diarrhea associated with C. Difficile infection	Epiopathic antibiotic-associated diarrhea
The most frequent "guilty" antibiotics	Clindamycin, Cephalosporins, Ampicillin	Amoxicillin / Clawulanate, Cephixim, Cefoperazazon
The likelihood of development depending on the dose of antibiotic	Weak	Strong
Cancellation of the drug	Diarrhea often persist	Usually leads to diarrhea resolution
Leukocytes in Calais	Detected in 50-80%	Do not detect
Colonoscopy	Signs of colitis in 50%	No pathology
CT scan	Signs of colitis in 50% of patients	No pathology
Complications	Toxic megaColon, hypoalbuminemia, dehydration	Rarely
Epidemiology	Non-community epidemic outbreaks, chronic carriage	Sporadic cases
Treatment	Vancomycin or metronidazole, healing yeast	Cancellation of the drug, anti-stage drugs, probiotics

The possibility of using probiotics in the prevention and treatment of antibiotic-associated diarrhea

Currently, much attention is paid to the study of the effectiveness of various types of probiotics, which includes representatives of the main intestinal microflora.

Therapeutic effect of probiotics is explained by the fact that the microorganisms included in their composition replace the functions of their own normal intestinal microflora in the intestine:

• create adverse drags for breeding and vital activity of pathogenic microorganisms due to the production of lactic acid, bacteriocinnes;
• participate in the synthesis of vitamins in 1, 2, 3, in 6, in 12, n (biotin), RR, folic chiotin, vitamins K and E, ascorbic cylinders;
• create favorable conditions for suction of iron, calcium, vitamin D (due to the production of lactic acid and reducing pH);
• lactobacillia and enterococcus in the small intestine carry out the enzymatic splitting of proteins, fats and compound carbohydrates (in the chision with lactase insufficiency);
• enzymes, facilitating the digestion of proteins in infants (phosphatein phosphatase bifidobacteria participates in the metabolism of casein of milk);
• bifidum-bacteria in the colon cleaved not attemptable components of food (carbohydrates and proteins);
• participate in the metabolism of bilirubin and bile kilot (sterkobiline, coprogen, deoxychole and lithochole kiclot formation; contribute to the reabsorption of biliary kilot).

The complexity of the organization of the evaluation of the effect and comparison of actions of various probiotics is that there are currently no pharmacokinetic models for studying in humans of complex biological substances consisting of components with different molecular weight and non-systemic blood flow.

Nevertheless, with respect to some therapeutic microorganisms, convincing data was obtained regarding the prevention and treatment of antibiotic-associated diarrhea.

1. Saccharomyces Boulardii in a dose of 1 g / day. prevents the development of antibiotic-associated diarrhea in patients on artificial nutrition through the catheter; They also prevent recurrences of Clostridium Difficile infection.
2. The purpose of Lactobacillus GG leads to a significant decrease in diarrhea severity.
3. Saccharomyces Boulardii Combined with Enterococcus Faecium or Enterococcus Faecium SF68 has shown themselves as effective agents in the prevention of antibiotic-associated diarrhea.
4. ENTEROCOCCUS FAECIUM (10 9 CFU / DAT.) Connects the frequency of the development of antibiotic-associated diarrhea from 27% to 9%.
5. Bifidobacterium Longum (10 9 CFU / day) prevents erythromycin-associated disorders of the gastrointestinal tract functions.
6. With a comparative estimate of the effectiveness of Lactobacillus GG, Saccharomyces Boulardii, Lactobacillus Acidophilus, Bifidobacterium Lactis: All probiotics turned out to be more efficient than placebo in the prevention of antibiotic-associated diarrhea.

As a probiotic for preventing the development of antibiotic-associated diarrhea and the restoration of the intestinal function after the abolition of the antibacterial agent, the drug Linex can be recommended. The preparation includes a combination of living lyophilized lactic acid bacteria - representatives of natural microflora from different departments of the intestine: Bifidobacterium infantis v. Liberorum, Lactobacillus Acidophilus, Enterococcus Faecium. To include, in the composition of the drug, strains are selected, characterized by stability to most antibiotics and chemotherapeutic agents and capable of further reproduction for several generations, even under antibacterial therapy. In special procedures, it was shown that the transfer of resistance from these microbes to other intestinal inhabitants does not occur. The composition of Linex can be described as "physiological", since the combination includes types of microbes related to the classes of the main inhabitants and playing the most important role in the products of short-chain fatty acids, ensuring the epithelium trophy, antagonism relative to the conditionally pathogenic and pathogenic microflora. Due to the inclusion in the Linexis Faecium (Enterococcus faecium), which has high enzymatic activity, the effect of the drug also applies to top departments intestines.

Linex is produced in the form of capsules containing at least 1.2x10 7 some live lyophilized bacteria. All three strains of Linex bacteria are resistant to exposure aggressive environment The stomach, which allows them to be easily achieving all departments of the intestine, without losing their biological activity. When applied in children early age The contents of the capsule can be divorced in a small amount of milk or other liquid.

Contraindication to the purpose of Linex is hypersensitivity to the components of the drug. There is no message about the overdose of lines. Side effects are not registered. The procedures performed showed the absence of the teratogenic effect of lyophilized bacteria. There are no messages about the side effects of using Linex during periods of pregnancy and lactation.

Unwanted medicinal interactions Linex is not marked. The drug can be used simultaneously with antibiotics and chemotherapeutic agents.

You can find a list of references on the website rmj.ru

Antibiotic-associated diarrhea is a common problem among the population. The essence of this pathological process is the appearance of a liquid chair for several days against the background of taking antibacterial drugs. Such a disorder can last up to four weeks even after have been canceled. Often, this disease has a slight course, and all clinical manifestations independently pass after the abolition of antibacterial therapy. However, sometimes this condition may entail the development of many serious complications not only by the gastrointestinal tract, but also the whole organism.

Antibiotic-associated diarrhea is also called nosocomial colitis. According to various data, the frequency of occurrence of this pathological process among people taking antibiotics is from five to thirty percent. It is worth noting that any dependence on age or floor is not traced. This suggests that even children can face with such a disease.

Antibacterial agents belonging to penicillin and tetracycline groups, as well as to cephalosporins, are most often played in the occurrence of this disease. An important point is that the method of administering antibiotics into the body is practically no meaning. However, it is impossible not to say that in the case of oral administration, the leading role in the pathogenesis is given precisely the damaging effect on the gastrointestinal mucous membrane and the oppression of the normal intestinal microflora.

The classification of antibiotic-associated diarrhea includes two main options: idiopathic and clostridium-associated. The essence of the idiopathic version lies in the fact that antibacterial drugs suppress the normal microflora of the gastrointestinal tract, due to which the active growth of the conditionally pathogenic and pathogenic flora is noted. In this case, staphylococci, streptococci, proteins, yeast-like fungi and so on may be as causative agents. The closeridium-associated version is represented by the same mechanism, however, the gastrointestinal tract is preferably settled with conventional pathogenic bacteria called Clostridium difficile. This option is usually accompanied by a heavier course and frequent occurrence of complications. Often with a long flow, it leads to the formation of the megacolon and the withdrawal of mucous membranes. In the hardest cases, it may even come to the fatal outcome.

There is a very large number of factors that increase the likelihood of such a disease. First of all, it is an overly long-term reception of antibacterial drugs, as well as the excess of the recommended dose. Reducing the level of immune protection, severe concomitant diseases, chronic inflammatory pathologies from the gastrointestinal tract transferred surgical interventions On the abdominal organs - all this increases the risk of this pathological process.

Separately, it is worth saying that the antibiotic associated diarrhea does not always have an infectious nature. In some cases, antibacterial drugs and their exchanges are direct impact on organs. digestive system, leading to the emergence of various functional disorders. In this case, hyperkinetic or hyperosmolar disorders may occur. Sometimes the intestinal mucosa is also damaged by penicillin and tetracycline metabolites, which leads to toxic disorders.

As for clostridium-associated, it is divided into four forms that have arisen on the basis of the severity of the disorders. The fulminant form is heavier, in which literally in a few hours develop a pronounced lesion of the gastrointestinal tract and septic disorders.

Digestion disorder is able to provoke not only infections or improper nutrition. In some people, the antibiotic associated diarrhea is often developing - intestinal indisposition arising against the background of antibacterial preparations. Treatment of such a disease depends on the type of diarrhea, the features of its flow and general status patient.

Causes of the antibiotic associated diarrhea

The main cause of the development of an antibiotic associated diarrhea (AAD) is the use of antibacterial drugs. The method of reception may not have much importance, intestinal indisposition develops during oral use of drugs and with invasive administration of medicines.

Gastroenterologists also distinguishes the following risk factors that increase the likelihood of disease development:

• Simultaneous use of several types of antibiotics at once.
• Harmful habits: smoking, adoption of antibacterial drugs simultaneously with alcohol.
• Chronic digestive organs: Crohn's disease, nonspecific ulcerative colitis.
• Long antibacterial therapy.
• Long violation exchange processescaused by hormonal failure, avitaminosis.

The factors listed above are already the cause of the intestinal microflora balance disorders. The likelihood of the occurrence of AAD with a combination of negative factors increases significantly.

Pathogenesis

When using the antibacterial agents of a wide spectrum in the intestine of a person, high-quality and quantitative composition of saprophistic flora varies significantly. This leads to a violation of the metabolism of the body, which, in turn, provokes the growth and dominance of pathogenic flora: Staphylococcus Aureus, Klebsiella Oxytoca, C. difficile, as well as suppressing normal intestinal microflora. Gradually, patients taking antibiotics develop dysbacteriosis.

The probability of developing diarrheal syndrome increases, if:

• Patient age is over 70 or less than 5 years.
• The patient has increased sensitivity to the components of the antibacterial drug.
• The patient takes an antacid agent for a long time.
• Human has such diseases: diabetes, cancer tumors, Chronic renal failure, inflammatory diseases of the intestinal shell.
• Patient conducted probe feeding, endoscopic studies.
• The patient for a long time is in stationary treatment.

The most negative impact on the cephalosporins, clindamycin, penicillins of a wide spectrum are most negative. Only 10% of patients complain about the occurrence of diarrheal syndrome when using ampicillin, 2-5% - in the treatment of tetracycline, macrolide, nitrofurantoin.

Classification

Depending on the nature of the arms of the gastroenterologists, the AAD is divided into the following types:

• Non-infectious. Such ailments in patients develop quite often. The cause of the food disorder becomes influenced by an antibiotic on the intestinal tract, toxic effect on the mucous membacity, a possible presence in the drug component with a relaxing effect.
• Infectious. It is characterized by a change in the composition of the endogenous Flora GTS. In this case, in 2-3 days after taking an antibiotic, the colonization of the intestinal mucosa is developing with clostridium difficili patogenic bacteria.

Although infectious antibiotic-associated diarrhea occurs in just 20% of cases, this ailment is transferred to the patient much more difficult than the disease that has noncommunicable nature. Infection of pathogenic bacteria occurs in a hospital. The human organism microorganisms come from hand medical personnel, medical instruments, table surfaces, floor.

Bacterium Clostridium produces two toxins that provoke damage and inflammation of the intestinal mucosa, which further leads to severe digestive disorder.

Symptoms of the antibiotic associated diarrhea

According to the classification by gravity, antibiotic-associated diarrhea is divided into the following clinical forms:

• Easy. The liquid stool is observed 3-5 times a day. Cal watery, without blood impurities and mucus. With the abolition of the antibiotic, the patient's condition stabilizes.
• Medium-heavy. With this form of the disease, a patient may develop a segmental hemorrhagic colitis, which is manifested by an unformed chair. During the day the patient has up to 15 flakes. Blood appears in feces, mucus. A person can complain about weakness, fever, abdominal pain that are intensified during palpation. The abolition of the antibacterial agent partially helps to get rid of unpleasant symptoms, but not in all situations.
• Heavy. With this form of ailment of diarrhea, it takes from 20 to 30 times a day. In Kale, there is blood and mucus. Body temperature reaches 39ºC. There are obvious signs of intoxication: acute pain in the stomach, headache, dizziness, dry mouth. Since the toxins stimulate the selection of water into the intestinal lumen, dehydration is rapidly developing. When canceling an antibiotic, the patient's condition improves slightly.

Most often, the difficult course of the disease is observed in the infectious nature of the AAD. Also, gastroenterologists allocate the lightning form of the disease, which is characterized by progressed rapid growth of symptoms: a strong diarrhea, acute abdomen pain, a significant increase in body temperature. Such a form of an antibiotic associated diarrhea may develop in small children, weakened cancer patients, lying elderly patients.

Complications

In itself, the development of diarrheal syndrome leads to the emergence of complications in the form of dehydration. In the future, the patient suffers the cardiovascular system, brain. But the antibiotic-associated diarrhea is dangerous not only by disadvantage of fluid and salts in the tissues. Since the intestine is settled by the pathogenic flora, which is a toxin-producing anaerobic wand, extensive intoxication of the body is gradually developing.

In the future, patients with AAD arise the following complications:

• Heat hyperemia and ulceration of the gum mucosa.
• Acidosis.
• Development of intestinal obstruction due to colon atony.
• Peritonitis colon.
• Perforation of colon.
• Septic shock.

When forming a megacolon in a large intestine, pathogenic bacteria from the lumen of the gasts fall into the systemic blood flow. Patient feels strong painwhich blooms throughout the abdominal cavity. The symptoms of sepsis are growing: heat, confusion of consciousness, termination of urination, raising blood pressure.

Treatment of antibiotic associated diarrhea

Gastroenterologists always begin treatment of an antibiotic associated diarrhea from diagnostic measures and further replaced or completely cancel the antibacterial agent.

Diagnostics

Most often on the background of a bacterial infection, a patient develops a pseudomambranous colitis. To confirm the diagnosis, the patient is prescribed an ultrasound abdominal cavity or CT with a contrast, which allows you to see a pronounced thickening of the colon. Also perform radiographic research and colonoscopy. More informative with an antibiotic associated diarrhea is not rectosigmoidoscopy, but fibrocolonoscopy, which allows you to detect the pseudomber gauge on the intestine mucosa.

In addition to the study of the intestine, special analyzes are held:

• Calais analysis to determine the content of toxins.
• Linked immunosorbent assay.
• Bacterial sowing feces.
• Blood test (allows you to identify leukocytosis, an increase in creatinine).

Without CT, radiography or ultrasound analyzes are not informative. Be sure to check the diagnosis of an in-depth examination.

Medicia treatment

Having established that the cause of intestinal malaise is the reception of antibiotics, the gastroenterologist may pick up another antibacterial drug, more secure or completely cancel the use of drugs. In the future, antiodeary therapy is built at the reception of probiotics and disinfect drugs.

In diarrhea, the light and medium-wing form of the flow patients need to be taken:

• Rehydration drugs. Practiced as oral reception REGIDRONER, NORMOGRODER, and drip infusion of Ringer's solution, azesole, disol. To replenish the lack of nutrients, the patient also conduct drip infusion of glucose solution.
• Enterosorbents. Any intestinal disorder provokes intoxicating the body. But with an infectious antibiotic associated diarrhea, a huge amount of toxic substances comes into the blood of the patient. Therefore, without applying adsorbents it is not necessary. Usually in the conditions of the hospital, patients are recommended to receive activated coal. But it is quite successful with the removal of intoxication, other enterosorbents are coping with: Polysorb, Smekt, Enterosgel.
• Probiotics. The main emphasis in the ADA is made of any degree on probiotic therapy. Patients are assigned to taking lines, biform, bifidumbacterin. The volume of enterobiotic is calculated depending on the weight of the patient and the peculiarities of intestinal indisposition. Drink probiotics need for a long time, at least a month.

If the disorder of the digestion is of severe, additionally requires special preparations: metronidazole or vancomycin. Medicines are accepted 4 times a day, the methods of adult patient is prescribed in a one-time dose of 250 mg, vancomycin - 125 mg. With a disease of a light or medium-heavy form, it is necessary to give preference to metronidazole. Vancomycin is prescribed when developing severe ADA and in cases where the patient was detected allergic to metronidazole.

In situations where the abolition of antibiotic therapy is impossible, experts adhere to the principles of anti-diaper therapy, as close as possible to the one that is carried out with a heavy antibiotic associated diarrhea. It is also desirable to refuse to receive antacid drugs that can lead to a deterioration in the state of the patient.

Important! With the AEAD, any severity cannot be prescribed to patients, depressing peristaltics (Loperamide, Imodium). Their use can lead to the formation of megacolon, sepsis, toxic shock.

Prevention

The main role in the prevention of the antibiotic associated diarrhea is given to probiotics. Patients belonging to the risk group (children and people of old age), simultaneously with antibacterial drugs, it is necessary to take eubiotics. These medicinal products They contribute to the intestinal settlement with useful bacteria that prevent the reproduction of pathogenic microorganisms.

For the prevention of infectious ADA, disinfection measures should be observed. Medical workers and patients should regularly wash their hands with soap. In hospital wards, careful disinfection of all surfaces is required.

Patients must be followed by the rules for the reception of antibacterial drugs. In no case, without indications, it is impossible to independently begin treatment with antibiotics of any diseases. The use of antibacterial drugs is possible only under the control of the doctor.