Antibiotic-Associated Diarrhea

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KEY POINTS

• Antibiotic-associated diarrhea is a side effect of taking antibiotic medicine. Symptoms usually start between 4 and 9 days after you start to take the medicine.
• For mild symptoms, your provider may have you stop taking the medicine that caused this problem or start taking a different medicine. For more severe symptoms, you may need to be treated with an antibiotic that treats C. diff.
• If your healthcare provider prescribes a new antibiotic, take all of the medicine as prescribed.

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What is antibiotic-associated diarrhea?

Antibiotic-associated diarrhea is a side effect of taking antibiotic medicine. Symptoms usually start between 4 and 9 days after you start to take the medicine. Most often the loose bowel movements are mild and go away when you stop taking the antibiotic. Sometimes the diarrhea can be very severe.

What is the cause?

Your intestines contain many types of bacteria. Some bacteria are “good,” helping to break down food, but some are “bad” and could be harmful. Your “good” bacteria usually keep the “bad” bacteria under control. This can change if you are sick, taking certain medicines, or even from stress.

Antibiotics can upset the natural balance of “good” and “bad” bacteria in your intestines. Different antibiotics treat different kinds of “bad” bacteria, but they also kill some of the “good” bacteria. When an antibiotic kills one type of bacteria, you can have too much of other types of bacteria in your intestines, which can cause diarrhea.

Bacteria called Clostridium difficile (or C. diff) are a common cause of severe antibiotic-associated diarrhea and infection. You are more likely to get this infection after a stay in a hospital or nursing facility.

What are the symptoms?

The main symptom of mild diarrhea is loose, unformed bowel movements or more bowel movements than normal.

Symptoms of C. diff infection are more severe and may include:

• Watery diarrhea, which may be bloody
• Fever
• Loss of appetite
• Nausea
• Belly pain

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. If your symptoms are mild, you may not need any lab tests. If you have more severe symptoms, tests may include:

• Test of a sample of your bowel movements
• Blood tests

How is it treated?

For mild symptoms caused by an antibiotic you have been taking for another infection, your provider may have you stop taking the medicine that caused this problem or start taking a different medicine. For more severe symptoms, you may need to be treated with an antibiotic that treats C. diff.

Drink enough liquids to keep your urine light yellow in color.

If you have severe diarrhea, your body can lose too much fluid and you can get dehydrated. Dehydration can be very dangerous, especially for children and older adults. You may also be losing minerals that your body needs to keep working normally. Your healthcare provider may recommend an oral rehydration solution (ORS), which is a drink that replaces liquids and minerals. You can buy an ORS at drug and grocery stores. Follow package directions for mixing powders or taking frozen products. Drink small amounts over several hours if you have vomiting along with diarrhea.

If you don’t have an ORS, you can drink clear broth or water mixed with fruit juice. These are easy for your body to absorb. Avoid concentrated fruit juices, dark sodas, milk, and milk products. They are not as easily absorbed and usually have too much sugar.

How can I take care of myself?

Follow the full course of treatment prescribed by your healthcare provider. If your healthcare provider prescribes a new antibiotic, take all of the medicine as prescribed.

In addition:

• Rest your belly, but make sure that you keep getting fluids. Clear liquids include water, weak tea, fruit juice mixed half and half with water, Jell-O, or clear soft drinks without caffeine (like lemon-lime soda). Stir soda until the bubbles are gone.
• Avoid liquids that are acidic, like orange juice, or caffeinated, like coffee. If you have diarrhea, don’t drink milk.
• You may eat soft, plain foods. Good choices are soda crackers, toast, plain noodles, or rice, cooked cereal, applesauce, and bananas. Eat small amounts slowly and avoid foods that are hard to digest or may irritate your stomach, such as foods with acid (like tomatoes or oranges), spicy or fatty food, meats, and raw vegetables. You may be able to go back to your normal diet in a few days.
• Rest as much as possible. Sit or lie down with your head propped up.
• Don’t take aspirin, ibuprofen, or other nonsteroidal anti-inflammatory drugs (NSAIDS) without checking first with your healthcare provider. NSAIDs, such as ibuprofen, naproxen, and aspirin, may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, you should not take this medicine for more than 10 days.

Ask your provider:

• How and when you will get your test results
• How long it will take to recover
• If there are activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

How can I help prevent antibiotic-associated diarrhea?

• Take antibiotics only when your healthcare provider prescribes them. Take antibiotics exactly as they are prescribed. Unless you are instructed otherwise by your provider, don’t increase the dosage and don’t change the time between your doses. Also don’t stop the antibiotic just because you feel better. You may not yet have killed all of the bacteria causing your infection.
• If you need to take antibiotics:
  • Tell your healthcare provider if you have had problems with diarrhea while taking antibiotics in the past. Your provider may prescribe an antibiotic that is less likely to cause diarrhea.
  • Ask your healthcare provider if you should take nonprescription probiotics. Probiotics help improve the balance of bacteria in your intestines. They are available in pills and liquids and added to some foods, such as yogurt.