Antibiotic-Associated Diarrhoea: Pharmacotherapeutic and Preventive Aspects in Children

Objective: Putting in perspectives the important information in the literature on therapeutics and prevention of antibiotic-associated diarrhoea (AAD) in children. Resource and Design: Systematic review of literature. Salient Features: Most important first-aid measure in AAD is withdrawal of the offending antibiotic. Supportive measures to maintain fluid and electrolyte balance and nutrition too are important. As a therapeutic measure (as and when warranted), metronidazole (preferably oral) should be considered the preferred drug. Ornidazole or nitazoxanide may be given as an alternative to metronidazole. In cases not responding to first-line drug, vancomycin is recommended as such or in combination with the first-line drug. Good food and water hygiene, meticulous hand-washing and proper environmental cleaning is helpful. Incorporation of probiotics may have both a preventive and therapeutic role. Future Perspective: A vaccine against C. difficile, already developed, needs further evaluation. Conclusion: Judicious use of antibiotics is the most important preventive measure in AAD. Treatment modalities include withdrawal of the offending agent and administration of metronidazole, ornidazole or nitazoxanide. In case of poor response, vancomycin yields gratifying response. At times, rifampicin or Cholestyramine may be combined with vancomycin. In an occasional case still showing poor response, a pharmacological option is to use fidaxomicin (a very expensive agent) which is very effective against the usual etiologic agent, Cl. difficile.