PATHOGENESIS, ACTUAL ASPECTS OF PREVENTION AND TREATMENT OF THE ANTIBIOTIC-ASSOCIATED DIARRHOEA

Abstract

The article provides an overview of current Russian and foreign literature devoted to the problem of pathogenesis, and of the treatment and prevention of antibiotic-associated diarrhea. Antibiotic-associated diarrhea is one of the most relevant aspects of modern drug therapy in due to the frequent prescription of antibacterial agents. Antibiotic-associated diarrhea (according to WHO) is defined as the presence of three or more episodes of an unformed stool for two or more consecutive days that occurred during or after the end of antibiotic therapy. The risk of developing this disorder is highest when using aminopenicillins, as well as their combinations with clavulanic acid, cephalosporins, clindamycin. Despite the presence of a common etiologic factor — the intake of antibacterial agents, the immediate causes and mechanisms of antibiotic-associated diarrhea development in patients may be different. The article describes the main issues of the etiology and pathogenesis of this pathology, the risk factors for the development of antibiotic-associated diarrhea are named, that allows to predict this complication in certain categories of patients. Тhe virulence factors of Clostridium difficile, Klebsiella oxytoca, Candida spp. and the clinical manifestations associated with their effects are highlighted. The clinical variants of this disease are described: 1) pseudomembranous colitis; 2) segmental hemorrhagic colitis; 3) “mild illness”. Contemporary literature data on the possibilities of prevention, as well as effective methods of treatment of antibiotic-associated diarrhea, are presented. For the treatment and prevention of all clinical forms of antibiotic-associated diarrhea, most authors suggest the use of drugs that make up the deficiency of normal intestinal microbiota — probiotics and prebiotics. The problem of the benefits of adjuvant therapy with probiotics during the course of antibiotics for the prevention of antibiotic-associated diarrhea remains controversial, the effectiveness and safety of the use of various probiotic cultures for this purpose is being studied. The information presented in this review is intended to target physicians to the rational use of antibacterial agents, and to early diagnosis of their most frequent side effect, antibiotic-associated diarrhea.