Why does it develop after antibiotics?
The colon is home to hundreds of species of bacteria that compete with each other and inhibit the growth of potentially dangerous microbes. An antibiotic prescribed for an infection in another organ also affects the intestinal flora, sharply reducing its diversity. If there are C. difficile spores in the intestines that are resistant to most drugs, they will germinate and begin producing toxins. The risk is higher when using broad-spectrum antibiotics, with long courses and repeated prescriptions. Infection with spores is also possible in a hospital: they are stable in the external environment and are not destroyed by alcohol antiseptics.
- Suppression of normal microflora with antibiotics
- Germination of C. difficile spores
- Production of toxins that damage the mucous membrane
- Particular risk with broad-spectrum antibiotics
- Transmission of spores in hospital settings
- An additional factor is drugs that reduce acidity
Symptoms
The main symptom is profuse, watery stools, which can be repeated many times a day and sometimes have a characteristic unpleasant odor. Diarrhea appears while taking an antibiotic or for several weeks after it ends. Often accompanied by cramping pain in the lower abdomen, bloating, fever and weakness. In severe cases, dehydration develops, protein levels drop, edema appears, and white blood cells in the tests increase sharply. A dangerous complication is toxic expansion of the colon, in which diarrhea can suddenly stop and the condition worsen.
- Copious watery stools
- Cramping pain in the abdomen
- Bloating
- Temperature rise
- Weakness and dehydration
- Sudden cessation of bowel movements due to deterioration is an alarming sign
Diagnostics
The diagnosis is confirmed by testing stool for C. difficile toxins or its genetic material; it makes sense to do the analysis only in the presence of diarrhea, because carriage without symptoms does not require treatment. A general blood test shows an increase in leukocytes, biochemistry shows the level of protein, creatinine and electrolytes, which is important for assessing severity. Colonoscopy is not always performed: it clearly shows pseudomembranes, but in severe inflammation it is associated with risk. In case of severe pain and bloating, a plain X-ray or computed tomography scan of the abdomen is prescribed to rule out intestinal dilatation.
- Stool testing for C. difficile toxins
- General blood test
- Biochemical blood test and electrolytes
- Colonoscopy according to indications
- X-ray or computed tomography of the abdomen for complications
- Fecal calprotectin as a marker of inflammation
Treatment
The first step is to stop or replace the offending antibiotic, if possible. Then specific antibacterial therapy is prescribed, directed specifically against C. difficile; The doctor selects the medications and duration depending on the severity. Be sure to replenish the loss of fluid and electrolytes, in case of severe cases intravenously. Drugs that slow down peristalsis and stop diarrhea are contraindicated: they retain toxins in the intestine and increase the risk of complications. For repeated relapses, intestinal microbiota transplantation is used. In rare severe cases, surgery is required.
- Discontinuation or replacement of the causative antibiotic
- Specific therapy against C. difficile
- Replenish fluids and electrolytes
- Ban on drugs that stop diarrhea
- Intestinal microbiota transplantation for relapses
- Isolation and thorough hand washing with soap
- Surgical treatment for complications
Prevention and relapses
The main preventative measure is the reasonable prescription of antibiotics: only according to indications, in the required course and without self-extension. Alcohol hand sanitizers do not kill pathogen spores, so it is important to wash your hands with soap and water, especially in the hospital and when caring for the sick. Surfaces are treated with products containing chlorine. Relapses occur in a significant proportion of patients, usually in the first weeks after the end of treatment, and require a second visit to the doctor, rather than independently resuming previous medications. Probiotics are discussed with your doctor and do not replace primary treatment.
- Take antibiotics strictly as prescribed
- Do not renew or repeat courses on your own
- Wash your hands with soap and water, not just sanitizer
- Treating surfaces with chlorine-containing products
- If diarrhea returns, consult a doctor again
- Discuss the need for acid-reducing medications