Current approaches to the prevention and treatment of antibiotic-associated diarrhea
https://doi.org/10.66825/2949-4664-apps-3-4-67-76
Abstract
This literature review presents the latest data on methods for prevention and treatment of antibiotic-associated diarrhea caused by Clostridioides difficile. The effectiveness of etiotropic therapies and probiotics, as well as biological and immunotherapeutic approaches, is shown. The potential of fecal microbiota transplantation as a modern treatment strategy is also discussed. Special attention is given to the dietary management of antibiotic-associated diarrhea. Additionally, various surgical options are outlined for cases where conservative methods prove ineffective.
About the Author
S. G. Gorbunov
Russian Medical Academy of Postgraduate Education;
Research Clinical Institute of Childhood
Russian Federation
Competing Interests:
Russian Federation
Sergey G. Gorbunov, Dr. Sci. (Med.), Prof., Head of the Department of Children’s Infectious Diseases, Principal Researcher
Scopus Author ID: 57193925691;
Competing Interests:
The author declares no conflict of interest.
References
1. Livzan M. A., Fedorin M. M. Antibiotic-associated diarrhea in the practice of a clinician: approaches to prevention and therapy. RMZ. Medical review. 2022;6(5):259–265. (In Russ.). doi: 10.32364/2587-6821-2022-6-5-259-265.
2. Osipenko M. F., Bikbulatova E. A., Kholin S. I. Prevention and treatment of antibiotic-associated diarrhea: the place of probiotics. Medical advice. 2017;3(11):104–106. (In Russ.). doi: 10.21518/2079-701X-2017-104-106.
3. Sun X., Savidge T., Feng H. The enterotoxicity of Clostridium difficile toxins. Toxins (Basel). 2010;2(7):1848–1880. doi: 10.3390/toxins2071848.
4. Czepiel J., Drozdz M., Pituch H. et al. Clostridium difficile infection: review. Eur. J. Clin. Microbiol. Infect. Dis. 2019;38:1211–1221. doi: 10.1007/s10096-019-03539-6.
5. Shulpekova Yu. O. Antibiotic-associated diarrhea. Russian Medical Journal. 2007;15(6):1–6. (In Russ.).
6. Sekacheva M. I. Antibiotic-associated diarrhea. Consilium Medicum. Gastroenterology. 2007;2:39–42. (In Russ.).
7. Dmitrieva N. V., Petukhova I. N. Postoperative infectious complications: A practical guide. Moscow: Practical Medicine. 2013. 422 p. (In Russ.).
8. Fletcher J. R., Pike C. M., Parsons R. J., Rivera A. J., Foley M. H., McLaren M. R., Montgomery S. A., Theriot C. M. Clostridioides difficile exploits toxin-mediated inflammation to alter the host nutritional landscape and exclude completitors from the gut microbiota. Nature Communications. 2021;12(1):462. doi: 10.1038/s41467-020-20746-4.
9. Pilat T. L., Khanferyan R. A. Specialized dietary products as factors for increasing the effectiveness of pharmacotherapy of gastrointestinal diseases. Therapy. 2020;6:212–218. (In Russ.). doi: 10.18565/therapy.2020.6.212-218.
10. Ivashkin V. T., Yuschuk N. D., Maev I. V. et al. Recommendations of the Russian Gastroenterological Association for the diagnosis and treatment of Clostridium difficile associated disease. Russian Journal of Gastroenterology, Hepatology and Coloproctology. 2016;26(5):56–65. (In Russ.).
11. Kelly C. R., Fischer M., Allegretti J. R., LaPlante K., Stewart D. B., Limketkai B. N., Stollman N. H. ACG clinical guidelines: prevention, diagnosis, and treatment of Clostridioides difficile infections. Am. J. Gastroenterology. 2021;116:1124–1147. doi: 10.14309/ajg.0000000000001278.
12. Piliev D. V., Achkasov S. I., Korneva T. K., Sushkov O. I. Antibiotic-associated diarrhea: the current state of the problem. Russian Journal of Gastroenterology, Hepatology and Coloproctology. 2014;5:54–62. (In Russ.).
13. Zar F. A., Bakkanagari S. R., Moorthi K. M.L.S.T., Davis M. B. A сomparison of vancomycin and metronidazole for the treatment of Clostridium difficile associated diarrhea, stratified by disease severity. Clin. Infect. Dis. 2007;45:302–307. doi: 10.1086/519265.
14. Pikunov D.Yu., Rybakov E. G., Golovenko O. V. Pseudomembranous colitis. Coloproctology. 2010; 2(32): 55–60. (In Russ)
15. Ng Q. X., Loke W., Foo N. X., Mo Y., Yeo W.-S., Yu Sen Soh A. A systematic review of the use of rifaximin for Clostridium difficile infections. Anaerobe. 2019;55:35– 39. doi: 10.1016/j.anaerobe.2018.10.011.
16. Louie T. J., Miller M. A., Mullane K. M., Weiss K., Lentnek A., Golan Y., Gorbach S., Sears P., Shue Y.-K. Fidaxomicin versus vancomycin for Clostridium difficile infection. N. Engl. J. Med. 2011;364:422–431. doi: 10.1056/NEJMoa0910812.
17. Cornely O. A., Crook D. W., Esposito R., Poirier A., Somero M. S., Weiss K., Sears P., Gorbach S. Fidaxomicin versus vancomycin for infection with Clostridium difficile in Europe, Canada, and the USA: a double-blind, non-inferiority, randomised controlled trial. Lancet Infect. Dis. 2012;12:281–289. doi: 10.1016/S1473-3099(11)70374-7.
18. Cornely O. A., Miller M. A., Louie T. J., Crook D. W., Gorbach S. L. Treatment of first recurrence of Clostridium difficile infection: fidaxomicin versus vancomycin. Clin. Infect. Dis. 2012;55: S154-S161. doi: 10.1093/cid/cis462.
19. Cornely O. A., Nathwani D., Ivanescu C., Odufowora-Sita O., Retsa P., Odeyemi I. A.O. Clinical efficacy of fidaxomicin compared with vancomycin and metronidazole in Clostridium difficile infections: a meta-analysis and indirect treatment comparison. J. Antimicrob. Chemother. 2014;69:2892e900. doi: 10.1093/jac/dku261.
20. McDonald L. C., Gerding D. N., Johnson S., Bakken J. S., Carroll K. C., Coffin S. E., Dubberke E. R., Garey K. W., Gould C. V., Kelly C., Loo V., Shaklee Sammons J., Sandora T. J., Wilcox M. H. Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin. Infect. Dis. 2018;66: e1-e48. doi: 10.1093/cid/cix1085.
21. Duda A. K., Okruzhnov N. V. Antibiotic-associated diarrhea and pseudomembranous colitis: diagnosis and rational therapy. Family medicine. 2012;5:116–122. (In Russ.).
22. Osadchuk M. A., Svistunov A. A. Antibiotic-associated diarrhea in clinical practice. Issues of modern pediatrics. 2014;13(1):102–108. (In Russ.).
23. Khavkin A. I. Antibiotic-associated diarrhea: possibilities of using probiotics. A difficult patient. 2018;16(1–2):48–52. (In Russ.).
24. Wilcox M. H., Gerding D. N., Poxton I. R., Kelly C., Nathan R., Birch T., Cornely O. A., Rahav G., Bouza E., Lee C., Jankin G., Jensen W., Kim Y.-S., Yoshida J., Gabryelski L., Pedley A., Eves K., Tipping R., Guris D., Kartsonis N., Dorr M.-B. Bezlotoxumab for prevention of recurrent Clostridium difficile infection. N. Engl. J. Med. 2017;376:305–317. doi: 10.1056/NEJMoa1602615.
25. Mulligan M. E., Miller S. D., McFarland L. V., Fung H. C., Kwok R. Y. Elevated levels of serum immunoglobulins in asymptomatic carriers of Clostridium difficile. Clin. Infect. Dis. 1993;16:239–244. doi: 10.1093/clinids/16.supplement_4.s239.
26. Kyne L., Warny M., Qamar A., Kelly C. P. Association between antibody response to toxin A and protection against recurrent Clostridium difficile diarrhoea. Lancet. 2001;357:189–193. doi: 10.1016/S0140-6736(00)03592-3.
27. Goldberg E. J., Bhalodia S., Jacob S., Patel H., Trinh K. V., Varghese B., Yang J., Young S. R., Raffa R. B. Clostridium difficile infection: а brief update on emerging therapies. Am. J. Health-Syst. Pharm. 2015;72:1007–1012. doi: 10.2146/ajhp140645.
28. Hogenauer C., Hammer H. F., Krejs G. J., Reisinger E. C. Mechanism and management of antibiotic-associated diarrhea. Clin. Infect. Dis. 1998;27:702–710. doi: 10.1086/514958.
29. Scherbakov P. L., Belova N. D., Generozov E. V., Zhgun E. S., Ivanova O. I., Il’ina E.N., Kalachnyuk T. N., Pavlenko A. V., Podgorskiy V. V., Manolov A. I., Matorin R. I., Olekhnovich E. I., Scherbakova M. Yu. The use of fecal transplantation in the treatment of diseases of the digestive tract (the first clinical experience). Doctor. ru. 2019;3(158):40–46. (In Russ.). doi: 10.31550/1727-2378-2019-158-3-40-46.
30. Golovenko A. O., Golovenko O. V., Khalif I. L. The experience of successful transplantation of fecal microbiota in recurrent Clostridium difficile infection. Experimental and clinical gastroenterology. 2016;136(12):115–120. (In Russ.).
31. Fischer M., Sipe B. W., Rogers N. A., Cook G. K., Robb B. W., Vuppalanchi R., Rex D. K. Faecal microbiota transplantation plus selected use of vancomycin for severe-complicated Clostridium difficile infection: Description of a protocol with high success rate. Aliment. Pharmacol. Ther. 2015;42:470–476. doi: 10.1111/apt.13290.
32. Ianiro G., Valerio L., Masucci L., Pecere S., Bibbo S., Quaranta G., Posteraro B., Curro D., Sanguinetti M., Gasbarrini A., Cammarota G. Predictors of failure after single faecal microbiota transplantation in patients with recurrent Clostridium difficile infection: Results from a 3 year cohort study: Authors’ reply. Clin. Microbiol. Infect. 2017;23:337e1–337.e3. doi: 10.1016/j.cmi.2016.12.025.
33. Abou Khalil M., Bhatnagar S. R., Feldman L., Longtin Y., Vasilevsky C.-A., Carignan A., Morin N., Boutros M. Development and validation of a clinical risk calculator for mortality after colectomy for fulminant Clostridium difficile colitis. J. Trauma Acute Care Surg. 2019;87(4):856–864. doi: 10.1097/TA.0000000000002412.
34. Lamontagne F., Labb A. C., Haeck O., Lesur O., Lalancette M., Patino C., Leblanc M., Laverdiere M., Pepin J. Impact of emergency colectomy on survival of patients with fulminant Clostridium difficile colitis during an epidemic caused by a hypervirulent strain. Ann. Surg. 2007;245:267–272. doi: 10.1097/01.sla.0000236628.79550.e5.
35. McDonald L. C., Gerding D. N., Johnson S., Bakken J. S., Carroll K. C., Coffin S. E., Dubberke E. R., Garey K. W., Gould C. V., Kelly C., Loo V., Shaklee Sammons J., Sandora T. J., Wilcox M. H. Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin. Infect. Dis. 2018;66(7): e1-e48. doi: 10.1093/cid/cix1085.
36. Keeney K. M., Yurist-Doutsch S., Arrieta M.-C., Finlay B. B. Effects of antibiotics on human microbiota and subsequent disease. Annu. Rev. Microbiol. 2014;68:217–235. doi: 10.1146/annurev-micro-091313-103456.
Review
For citations:
Gorbunov S.G. Current approaches to the prevention and treatment of antibiotic-associated diarrhea. Archives of Pediatrics and Pediatric Surgery. 2025;3(4):67-76. (In Russ.) https://doi.org/10.66825/2949-4664-apps-3-4-67-76
Views:
24
JATS XML
Email this article 