AAD or Antibiotics-associated diarrhoea is for real: Know all about this double-edged sword

Antibiotic-associated diarrhoea, also called antibiotic-induced diarrhoea is a fairly common phenomenon in adults. Research has estimated that between 5 to 25 percent of adults may experience diarrhoea while they are on an antibiotics course. Also known as ‘AAD’, antibiotic-associated diarrhoea can vary depending upon the specific type of antibiotic in question, the very health of the host and lastly, exposure to pathogens.

Usually, antibiotic-associated diarrhoea is mild but, in some cases, where it is more serious, AAD might require medical treatment or switching off antibiotic medication altogether. In rare cases, however, the symptoms of diarrhoea may not appear until days or even weeks after one has finished taking the entire antibiotic course.

While an antibiotic is supposed to help treat a condition, they can also eliminate so many of the gut’s good and harmless bacteria that the “bad” or hostile ones tend to multiply.

What are the symptoms of Antibiotic-associated diarrhoea?

A prominent symptom observed among many patients is loose, watery stools three or more times a day while they are on medication, while others also experience symptoms like:

Crampy abdominal pain
Abdominal tenderness
Mild fever
Nausea

When asked about its severity, Dr. Ahmad Wazir Aiman, General Practitioner, Department of Paediatrics, Sabah Women and Children’s Hospital said, “AAD in its most severe form, can result in a condition known as pseudomembranous colitis. This condition would usually be present with bloatedness, abdominal pain, increase in flatulence, vomiting as well as altered bowel habit. Clostridium difficile produces toxins that stimulate inflammation of the bowel lining.”

What antibiotics are most likely to cause AAD?

Nearly all antibiotics can cause antibiotic-associated diarrhoea, but a few tops the charts:

Cephalosporins, such as cefdinir and cefpodoxime
Penicillins, such as amoxicillin and ampicillin
Clindamycin, amoxicillin-clavulanate

One of the most common types of bacteria is the Clostridium difficile (C. difficile) –strong enough to cause you abdominal pain, cramps, diarrhoea, or/and mild fever. Patients with high-volume diarrhoea can also develop dehydration.

In simpler words, C. difficile is a toxin-producing bacterium that can cause loose stools, loss of appetiIn simpler words, C. difficile is a toxin-producing bacterium that can cause loose stools, loss of appetite, and an increase in bowel movements. and an increase in bowel movements.

Why do antibiotics cause diarrhoea?

The basic job of an antibiotic is to work on reducing or killing the growth of certain bacteria that are making a person ill, but the same antibiotics are also responsible for killing the good and helpful bacteria in a patient’s intestinal system. This can sometimes lead to disruption of the delicate balance in a patient’s intestines, allowing bad intestinal bacteria to flourish in an unrestricted manner. When antibiotics result in a Clostridium difficile (C. diff) infection– the bacteria can overgrow inside the bowel, producing irritating chemicals that damage the bowel wall and thus, in turn trigger bowel inflammation, called colitis. This means that a patient’s C. difficile is a toxin-producing bacterium that can cause loose stools, loss of appetite, and an increase in bowel movements. colon can become engorged and, in some cases, even ruptured.

When should you see a doctor?

One must see a doctor if antibiotics develop any of the following symptoms:

More than five loose stools or episodes of diarrhoea per day
High-volume, watery diarrhoea
High fever
Extreme abdominal pain
Blood or pus in stool
Vomiting

What are the complications of Antibiotic-associated diarrhoea?

While withdrawal of the inciting agent that caused AAD in the first place can be helpful, sometimes the condition becomes more severe and thus has complications. These include toxic megacolon (occurs when swelling and inflammation spread into the deeper layers of your colon resulting in the colon to stop working), perforation, and even, shock. Distension of the bowel may lead to it being ruptured, which is the most feared complication of all as death is highly likely.

How to get rid of AAD?

Dr. Ahmad further added, “The first step is to always stop the insulting antibiotics immediately. Relief may not be swift but further damages are hindered this way. The next step one can consider is to repopulate the gut with good bacteria. Use of probiotics can be considered.”

Probiotics are live bacteria (read: good) or/and yeasts that naturally live in your body. Oftentimes, patients are advised to turn to probiotics–found in foods such as Greek yoghurt, in a hope to retain the healthy bacteria in their digestive tract. While it is not fool-proof on whether the over-the-counter probiotics can help lessen the symptoms of antibiotic-associated diarrhoea immediately, if taken consistently, they can build a healthy gut over a period of time.

In fact, probiotics come in different varieties–Saccharomyces boulardii-based and Lactobacillus rhamnosus-based are known to be the most studied types of bacteria.

Probiotics can be consumed in the form of capsules, tablets, powders and even liquid. Saccharomyces boulardii is a non-pathogenic probiotic yeast which helps in restoring gut health and ones’ gastrointestinal tract. One such effective medical treatment using probiotics is the use of Normagut capsule–a doctor-endorsed medicine which helps in removing Clostridium difficile (C. diff) which further aids in the establishment and maintenance of a well-functioning intestinal/gut-flora and the treatment and prevention of traveller’s and antibiotic-associated diarrhoea. However, since Mega Probio contains yeast, it can also be given alongside other antibiotics as it can’t be killed by the antibiotics unlike many other bacterial probiotics. For dose recommendation, consulting a doctor is highly advisable.

Dr. Ahmad Wazir Aiman, also added that, “Antibiotics in children are meticulously calculated according to their body weight. This is important because the concentration for effective effect without risking toxicity, is different according to the body weight and size of the child.”

What foods to eat and avoid in Antibiotic-associated diarrhoea?

Drink more water and liquids like oral rehydration fluids to replace lost fluids.
Say no to spicy or oily foods that can aggravate diarrhoea.
Avoid milk products and foods that contain wheat flour.
Switch to a low-fibre diet and avoid fruits, corn and bran. One may even consult and integrate the FODMAP diet for a few days.
Avoid alcohol and caffeinated drinks and beverages.

How to care for a person suffering from AAD?

Ensure that caregivers wash their hands frequently and use an alcohol-based hand sanitiser.
Share with a doctor your history of antibiotic-associated diarrhoea. If you’ve had it before, your chance of antibiotics causing a similar reaction in the future increases.
Use a detergent or a chlorine bleach to wash clothing that has been soiled with loose stool.
Wipe contaminated bathroom surfaces with a chlorine-based household cleaner twice a day or more, as needed.

How can one prevent Antibiotics-associated diarrhoea?

Apart from observing how one’s body reacts to medication, there is one definitive preventative measure that a person can take to prevent AAD-taking antibiotics only when necessary, that too, upon your doctor’s prescription.

On being asked about the importance of taking antibiotics only when they are needed, both, in a child and adult, Dr Ahmad said, “Taking antibiotics when it is not indicated puts the person at risk of side-effects such as AAD. It is also worth noting that certain antibiotics require a healthy kidney as they can be elevated in the blood and lead to toxicity if they’re unable to be broken down effectively. Last but not the least, giving antibiotics when it is not needed and the course isn’t complete, will lead to antibiotic-resistance.”

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