DIARRHOEA, ANTIBIOTIC-ASSOCIATED

DESCRIPTION

Diarrhoea caused by altered bowel flora due to antibiotic exposure. Severe

cases present with pseudomembranous colitis. Toxins produced by

Clostridium difficile can be demonstrated on stool samples.

GENERAL MEASURES

The most important aspect of management is discontinuing antibiotics.

Rehydration may be necessary. This should be done with oral rehydration

solution (ORS) unless the patient is vomiting or profoundly dehydrated.

Surgery for bowel perforation.

MEDICINE TREATMENT

Loperamide is contraindicated as it may result in toxic megacolon.

If diarrhoea does not settle on antibiotic withdrawal or if pseudomembranous

colitis is present:

• Vancomycin, oral, 125 mg 6 hourly.

OR

• Metronidazole, oral, 800 mg 8 hourly for 10 days.

Reference and further reading

Standard Treatment Guidelines and Essential Medicines List for South Africa 2012 Edition