How to handle when children have diarrhea due to taking antibiotics

The article was professionally consulted by Assoc. Prof. TS.BS Huynh Thoai Loan - Head of Pediatrics - Neonatology Department, Vinmec Central Park International General Hospital. This is one of the leading experts in Pediatrics - Neonatology in Ho Chi Minh City with nearly 30 years of experience in examining and treating pediatric endocrinology, pediatric kidney and other pediatric - neonatal problems

Antibiotics are drugs commonly used to treat bacterial infections. However, the use of antibiotics can cause unwanted side effects. One of the most common side effects of antibiotics is diarrhea (accounting for 20% of all antibiotic use cases). Here are the causes and treatment of children who are taking antibiotics to have a bowel movement.

On average, 1 out of every 5 children using antibiotics has diarrhea (20% rate). Diarrhea is quite common in children under 2 years of age and can occur when a child takes any type of antibiotic. However, for most children, antibiotic-associated diarrhea is mild and does not cause serious sequelae if treated promptly.
Regarding the cause of children taking antibiotics, they usually have a bowel movement, usually, in the intestinal tract, there are always bacterial strains including both beneficial bacteria and harmful bacteria. The beneficial bacteria, if developed strongly and fully, will ensure the function of digestion, absorption of nutrients, elimination of toxic substances and inhibiting the growth of pathogenic bacteria in the intestinal tract.
Antibiotics are substances that have the ability to inhibit the growth or kill bacteria. When using one or more powerful antibiotics that are effective against many types of bacteria in high doses and for a long time, some strains of beneficial bacteria are also destroyed. Meanwhile, harmful bacteria are less affected because many of them are resistant to strong antibiotics. As a result, the balance between the two groups of beneficial bacteria and harmful bacteria is disrupted. Harmful bacteria that grow rapidly in the digestive tract secrete toxins that damage the intestinal mucosa, trigger inflammatory processes, edema, bleeding in the intestinal lumen and cause antibiotic-associated diarrhea syndrome. In particular, in young children, the digestive system is not yet mature, so it is easy to have diarrhea as a side effect of antibiotics.

Most cases of antibiotic-associated diarrhea are mild and go away on their own once antibiotics are stopped. However, there are some cases with severe manifestations, causing edematous inflammatory lesions in the colon (pseudomembranous colitis).

There are many strains of bacteria that can cause antibiotic-associated diarrhea, but the anaerobic bacterium Clostridium difficile is the main culprit in most cases of severe pseudomembranous colitis. This condition is common in patients in the ICU, where there are many strains of antibiotic-resistant bacteria and high doses of antibiotics are used for long periods of time.
Antibiotics that can cause simple diarrhea or pseudomembranous colitis are: clindamycin, erythromycin, ampicillin, amoxicillin, penicillin, cephalosporins (cefuroxime, cefixime, cefpodoxime), quinolones (ciprofloxacin, levofloxacin), and tetracycline (doxycycline, minocycline),... Patients may have diarrhea despite taking antibiotics orally or by injection.

After using antibiotics for about 2-9 days, children have symptoms of abdominal bloating, abdominal pain, mild abdominal distension; Children with abdominal pain, diarrhea many times a day, can be up to 15-20 times / day; Liquid stools with mucus or green, yellow, lumpy stools, foamy stools, raw, non-rotten stools, mixed with undigested food, sometimes with blood and mucus; Children have to push every time they have a bowel movement; The child's anal area may be red due to the acidic nature of the stool; When harmful bacteria proliferate too quickly, it can cause symptoms of colitis or pseudomembranous colitis such as: High fever, nausea and vomiting, abdominal cramps, diarrhea, and loose stools. blood.

In the case of mild diarrhea, symptoms usually resolve on their own within a few days to 2 weeks after stopping antibiotics. However, if diarrhea lasts for a long time, it can cause many serious consequences for patients such as: Absorption and metabolism disorders, dehydration, electrolyte disturbances, rapid weight loss and possibly malnutrition. nursing. Some cases of severe diarrhea cause ulcers, intestinal perforation.
In addition, prolonged diarrhea can also cause toxic megacolon with enlarged colon accompanied by inflammation, stagnation of toxins in the colon, absorption through the intestinal wall into the blood, causing systemic toxicity , fever, abdominal pain, perforated colon,...

In case of mild diarrhea, the symptoms will disappear within a few days to 2 weeks after finishing the antibiotic regimen; In severe cases of diarrhea, the antibiotic associated with diarrhea should be stopped immediately. Combination of rehydration, electrolytes, acid-base balance. Oresol solution or hydrite tablets should be used to rehydrate the child. Parents should note that the rehydration solution should be mixed according to the instructions for use, once mixed with 1 pack or 1 tablet with the guided amount of cooked water, do not split the package or tablet. The rehydration solution that has been prepared should be discarded if left for more than 24 hours. Rehydration should be maintained until the child has a thick stool and less than 3 times a day. In addition, perform stool cultures, blood cultures to identify pathogenic bacteria strains. In case of pseudomembranous colitis, the antibiotic of choice is metronidazole or vancomycin; In case of severe dysbacteriosis or the antibiotic cannot be stopped, additional treatment with probiotics containing prebiotics and probiotics is required to rebalance the intestinal bacteria strains as prescribed by the doctor. In case of combined with microbiological products but not effective, it is necessary to consult a doctor to replace with another antibiotic; Do not use digestive enzymes for antibiotic-associated diarrhea; Change your diet to relieve symptoms of diarrhea: Eat several small meals throughout the day (smaller portions are easier to digest), eat soft, easily digestible foods (yogurt, potatoes, rice and bananas), avoid eating a lot of fiber and strong fermenting substances, make sure to provide enough nutrition for the child, provide enough water, avoid carbonated drinks, citrus juices and coca,... as they can make symptoms worse than.

Strictly follow the treatment regimen of the doctor, do not arbitrarily buy antibiotics for home treatment for the baby; Take your antibiotics exactly as prescribed, do not increase your dose, do not include a missed dose, or take it for longer than your doctor prescribed; Do not arbitrarily use anti-diarrheal drugs because these drugs can interfere with the body's ability to detoxify, causing many unpredictable complications; After the child recovers from the illness, avoid using the antibiotic that has caused diarrhea before. In the following treatment, the doctor should be informed of the antibiotic causing diarrhea so that he can replace other drugs when prescribing; Give your baby enough water, don't drink carbonated drinks, avoid eating legumes because these foods can cause gas in the intestines, limit spicy foods, breastfeed or drink milk as usual to avoid undernutrition; Treatment of diaper rash: In case a child has a diaper rash around the anus or diaper area due to diarrhea, parents should gently clean this area with clean water, dry it and then apply a layer of vaseline, zinc cream such as Penaten. , Zincofax or other diaper rash creams; When the antibiotic course is over, the child may use more probiotics containing beneficial bacteria to rebalance the intestinal bacteria strains as prescribed by the doctor.

In case the child has very severe, repeated and continuous diarrhea, severe abdominal pain, bloody stools, high fever, weakness, does not want to drink water, cannot drink water or cannot breastfeed, has signs dehydration such as little urine, fatigue, dry mouth, sunken eyes, ... need to take the child to the hospital immediately. At the hospital, doctors will examine and diagnose the child's diarrhea in order to have appropriate and effective treatment. If diarrhea is severe, the doctor may change the antibiotic you are taking and give fluids as needed.

To prevent children from having diarrhea due to taking antibiotics, parents should pay attention to the nutrition that improves the child's resistance. At the same time, add supporting foods containing lysine, essential micro-minerals and vitamins such as zinc, chromium, selenium, B vitamins,... snacks and less digestive problems.
Parents can learn more:
Why do you need to supplement Lysine for your baby?
The role of zinc - Guidelines for reasonable zinc supplementation
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