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Antibiotic-associated bloody diarrhea in infants: clinical, endoscopic, and histopathologic profiles
Maha Barakat1, Zeinab El-Kady, Mohamed Mostafa
1Department of Tropical Medicine and Gastroenterology, University Hospital, Assiut, Egypt. mahabarakat2001@yahoo.com
Insights
Antibiotic-associated bloody diarrhea (AABD) in infants is not rare and can present without fever. Stopping antibiotics often resolves AABD, especially when diagnostic tests are limited.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Clinical Pharmacology
Background:
- Antibiotic-associated diarrhea (AAD) is a common side effect of antimicrobial therapy.
- Antibiotic-associated bloody diarrhea (AABD) is a less understood variant, particularly in infants.
- Limited data exists on the clinical presentation and outcomes of AABD in very young children.
Purpose of the Study:
- To characterize the clinical, endoscopic, and histopathologic features of community-acquired AABD in infants.
- To provide insights into the diagnosis and management of AABD in this vulnerable population.
Main Methods:
- A prospective study involving 23 infants presenting with bloody diarrhea after antibiotic use.
- Clinical assessment, videosigmoidoscopy, and histopathologic examination of biopsies were performed.
- Infants received antibiotics for watery diarrhea, respiratory, or urinary tract infections.
Main Results:
- Bloody diarrhea resolved within 2–6 days of antibiotic discontinuation in most infants.
- Fever and leukocytosis were infrequent, present in only 34.8% of cases.
- Endoscopic findings included erythema and ulcers; pseudomembranes were seen in 5 infants (21.7%), and characteristic pseudomembranes histopathologically in only 3 (13%).
Conclusions:
- Community-acquired AABD in infants can be acute or chronic, often without fever or leukocytosis.
- Discontinuing antibiotics is a recommended management strategy when diagnostic facilities are limited.
- The characteristic pseudomembranes are infrequently observed, highlighting the need for clinical suspicion and judicious antibiotic use, especially for viral-origin watery diarrhea.
Objective:
Antibiotic-associated diarrhea constitutes 1 of the most frequent side effects of antimicrobial therapy with widely varying clinical presentations; however, little is known about its antibiotic-associated bloody diarrhea (AABD) form, particularly in very young children. The aim of this study was to describe the clinical, endoscopic, and histopathologic profiles of community-acquired AABD in infants.
Patients And Methods:
The study included 23 infants referred with bloody diarrhea that developed a few days after receiving antibiotics on an outpatient basis for watery diarrhea (18), respiratory tract infections (4), or urinary tract infection (1). Detailed clinical assessment, videosigmoidoscopy, and histopathologic examination of endoscopic biopsies were performed for all.
Results:
Clinically, on presentation, bloody diarrhea was acute in all except 1 patient with a prolonged course (for 25 days) and stopped in all 2 to 6 days after discontinuation of antibiotics. Fever and/or leukocytosis were present only in 8 (34.8%). Sigmoidoscopy revealed varying types of erythema (patchy, ring, diffuse) and ulcers (aphthoid, diffuse) in 18 and pseudomembranes in 5. Histopathologically, only 3 showed the characteristic mushroom-like pseudomembranes, whereas all of the other infants had nonspecific colitis.
Conclusions:
Community-acquired AABD is not uncommon in infants presenting with acute or chronic forms even without fever or leukocytosis. When suspected, discontinuation of antibiotics is a good policy if facilities for bacterial culture with cytotoxin assays are limited. The characteristic endoscopic or histopathologic pseudomembranes are encountered only in a small percentage (26%). Rational use of antibiotics should be adhered to particularly in cases of watery diarrhea that is mostly of viral origin.
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