Antibiotic-associated diarrhea in clinical practice: preventive and therapeutic approaches

Abstract

Antibiotic-associated diarrhea (AAD) is one of the most common adverse effects of antimicrobial therapy. This paper discusses AAD pathogenesis related to the direct effect of an antibiotic on the intestinal wall and modulation of gut microbiocenosis composition (including idiopathic and Clostridioides difficile-associated AAD). Searching the keywords "antibiotic-associated diarrhea", "microbiota", "intestinal motor activity", "prebiotics", "probiotics", "diarrheal syndrome" for publications indexed in the PubMed and Google Scholar databases was per- formed. Mechanisms of the effect of microbiota composition on intestinal motility and mechanisms of action of probiotics are systematized. Pathogenic mechanisms of AAD are heterogeneous, thereby requiring a differentiated approach to its prevention and management strategy. Among the etiological agents of AAD, Clostridioides difficile, a grampositive aerobic spore-forming bacillus that is resistant to most antibiotics, is of particular importance. To prevent idiopathic and Clostridioides difficile-associated AAD and recover healthy gut microflora, high-risk patients are recommended with probiotics. Among probiotics, Saccharomyces boulardii that is used as monotherapy or in combination therapy is one of the most effective ones. KEYWORDS: antibiotic-associated diarrhea, microbiota, probiotics, diarrheal syndrome, Saccharomyces. FOR CITATION: Livzan M.A., Fedorin M.M. Antibiotic-associated diarrhea in clinical practice: preventive and therapeutic approaches. Russian Medical Inquiry. 2022;6(5):259–265 (in Russ.). DOI: 10.32364/2587-6821-2022-6-5-259-265