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Antibiotic associated colitis
1Department of Pediatrics, J.N. Medical College, Aligarh Muslim University.
Insights
Antibiotic-associated diarrhea (AAD) in children is often linked to Clostridioides difficile. Certain antibiotics like chloramphenicol, gentamicin, and penicillin are frequently implicated, highlighting the need for careful antibiotic selection in pediatric care.
Area of Science:
- Pediatrics
- Infectious Diseases
- Gastroenterology
Background:
- Antibiotic-associated diarrhea (AAD) is a common complication following antibiotic use in children.
- Clostridioides difficile (C. diff) is a significant pathogen implicated in AAD, particularly in healthcare settings.
Purpose of the Study:
- To investigate the incidence and clinical features of AAD in pediatric patients.
- To identify the specific antibiotics associated with AAD and the role of C. diff.
Main Methods:
- Prospective study of 100 pediatric patients with diarrhea post-antibiotic therapy.
- Stool analysis including microscopy, culture for pathogens (including C. diff), and C. diff cytotoxin assay.
- Endoscopic examination in selected C. diff positive cases.
Main Results:
- Clostridioides difficile was detected in 18% of cases, with 14% being cytotoxin-positive.
- Patients with C. diff showed significantly higher purge rates and presence of mucus/blood in stool.
- Antibiotics like chloramphenicol, gentamicin, and penicillin were strongly associated with AAD; ampicillin alone was not.
- Endoscopy revealed pseudomembranous colitis in 3 cases and non-specific colitis in 2 cases.
Conclusions:
- Clostridioides difficile is a key contributor to severe AAD in pediatric patients.
- Specific antibiotics are more frequently associated with AAD, necessitating cautious prescription.
- Early identification and management of C. diff are crucial for improving patient outcomes and reducing mortality.
Abstract:
It is a prospective study based on 100 consecutive cases of diarrhea following antibiotic therapy admitted to the pediatric services of J.N. Medical College, A.M.U., Aligarh between January to December 1987. They had C. penicillin (50), chloramphenicol (34), ampicillin (34), gentamicin (34), cephalosporin (4) and cotrimoxazole (4) for 3 days to 3 weeks prior to the onset of diarrhea. Apart from routine and special investigations, naked eye and microscopic examination of stool, its culture for pathogens including Cl. difficile were carried out in all cases. Presence of Cl. difficile cytotoxin was demonstrated by observing the cytopathic. Effect on veru cell culture, 18 grew Cl. difficile (14 cyto toxin positive). Frequency of fever, vomiting, abdominal distension, dehydration and duration of diarrhea was not different (p > 0.05) in the two groups. Purge rate and presence of mucus and blood in Cl. difficile positive patients was significantly higher (p < 0.05). Eight Cl. difficile positive (7 cytotoxin+ve) were subjected to endoscopy. Three of them showed P.M. colitis and 2 non specific colitis. Chloromycetin, gentamicin and penicillin were the main culprits responsible for AAC. None of the patients given ampicillin alone suffered from AAC. The mortality was 5%.