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ABSTRACT
Antibiotic-associated diarrhea (AAD) is the most common cause of diarrhea in
hospitalized patients, representing an important source of morbidity, mortality, and
cost. Although no infectious agent is found in most cases of AAD, Clostridium difficile
is frequently identified in patients with signs and symptoms of colitis. All types of
antimicrobial agents have been implicated, leading to a wide range of clinical
manifestations, from asymptomatic carrier state to severe pseudomembranous colitis.
Most cases of AAD respond to supportive measures and withdrawal of antibiotics. In
patients with severe and persistent symptoms effective antibiotic therapy is available,
but relapses are common.
INTRODUCTION
Antibiotic-associated diarrhea (AAD) is defined as otherwise unexplained diarrhea
that occurs in association with the administration of antibiotics. AAD can occurs in
patients who are treated with ampicillin (5-10 %), amoxillin-clavulanate (10-25 %),
cefixime (15-20 %), cephalosporins, fluoroquinolones, azithromycin, chlarithromycin,
erythromycin, and tetracycline (2-5 %). The rates of AAD associated with parenterally
administered antibiotics are similar with orally administered agents. Infection with
Clostridium difficile accounts for only 10-20 percent of the cases of AAD but it accounts
for the majority of cases of colitis associated with antibiotic therapy
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BAGIAN-SMF PENYAKIT DALAM FK. UNAIR RSU Dr. SOETOMO SURABAYA
PATOPHYSIOLOGY
Anti bi oti cs ~ speci fi c bacteri a
W hen an anti bi oti c ki l l s one type of bacteri a (i ncl ude fecal anaerobes that are norm al l y present),
other bacteri a i n the gut are present i n greater num bers
Too m any harm ful bacteri a i n the i ntesti nes can cause di arrhea
(Havi ng too m any of the bacteri a cal l ed Cl ostri di um di ffi ci l e/
e/ other causes severe di arrhea /
pseudom em branous col i ti s)
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PENDIDIKAN KEDOKTERAN BERKELANJUTAN ILMU PENYAKIT DALAM XXII-2007
SYMPTOMS
Symptoms usually start between 4 and 9 days after you start to take the medicine.
The main symptoms are loose bowel movements or more bowel movements than
normal. Most often the loose bowel movements are mild and go away when stop
ta kin g the an ti bio tic . Som eti me s a ve ry se rio us ty pe of di arr hea c all ed
psudomembranous colitis happens. Symptoms of pseudomembranous colitis are
more severe and may include
DIAGNOSTIC TEST
Laboratory findings
Non specific
Leucocytosis
Hypoalbuminemia (reflecting a protein-losing enteropathy)
Fecal leucocytes
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BAGIAN-SMF PENYAKIT DALAM FK. UNAIR RSU Dr. SOETOMO SURABAYA
DIAGNOSIS
THERAPY
If
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PENDIDIKAN KEDOKTERAN BERKELANJUTAN ILMU PENYAKIT DALAM XXII-2007
PROGNOSIS
In Mild case : Diarrhea may last up to 14 days after stop taking the antibiotic
In more severe cases : The symptoms may not go away until several weeks after
we begin treatment, and the symptoms may return after treatment because some
antibiotics have an effect on bacteria for a long time
PREVENTION
REFERENCES
1.
2.
Greb C, Kalem T, Kalble T (2003). Antibiotic induced diarrhea and pseudomembranous colitis.
Urologe A; 42(1): 82-89.
3.
Guerrant RL, et al (2001). Practice guidelines for the management of infections diarrhea. Clin
Infect Dis; 32: 331-348
4.
Horne JS, Swanson LN (1996). Diarrhea. The Center for Disease Control (CDC); Available at
www.cdc.gov/mcidod/disease.htm
5.
Ticehurts JR, Aird DZ, Dam LM, et al (2006). Effective detection of toxigenic clostridium difficile
by algorithm including test for antigen and cytotoxin. J Clin Microbiol 2006; 44(3): 1145-1149.
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BAGIAN-SMF PENYAKIT DALAM FK. UNAIR RSU Dr. SOETOMO SURABAYA