Antibiotic-associated diarrhoea
Diarrhoea developing during or after systemic antibiotic therapy. Frequency: 5–25% in adults, up to 30% in children. Aetiology: gut microbiota imbalance, Clostridioides difficile overgrowth, osmotic effects of unabsorbed carbohydrates. Severity ranges from mild self-limiting to pseudomembranous colitis.
ICD-10 K52.93 drugs
Also known as: AAD
Drugs used for this condition
- BLactobacillus rhamnosus GG (LGG)Add-on therapy · Probiotic, Lacticaseibacillus rhamnosus GG strain. Supplement in Russia and Spain; in the EU and US available as food supplement or medical food; AEMPS does not register it as a medicineLGG is among the few probiotic strains with evidence in antibiotic-associated diarrhoea. Cochrane Goldenberg 2017 in 39 RCTs (8672 participants) showed AAD risk reduction when antibiotics combined with a probiotic (LGG and S. boulardii being the most studied strains), NNT ~12. ESPGHAN 2014 recommends LGG and S. boulardii in children receiving antibiotics. AGA 2020 does not routinely recommend probiotics in adults with AAD: effect is modest, samples heterogeneous, and the safety profile in immunocompromised patients and those with central venous catheters is uncertain. If LGG was recommended as monotherapy for AAD with suspected C. difficile or severe diarrhoea with dehydration without risk and aetiology assessment, consider seeking a second opinion.
- BProbiotics (Lactobacillus spp., Bifidobacterium spp., Saccharomyces boulardii)Add-on therapy · Probiotic microorganismsThe 2019 Cochrane review (33 RCTs, more than 6,000 children) showed a reduction in antibiotic-associated diarrhoea in children from 19% to 8% with high-dose probiotics (at least 5 billion CFU daily) from day 1 of antibiotic therapy. In adults, the effect is less pronounced. The best evidence is for Lactobacillus rhamnosus GG and Saccharomyces boulardii strains. AGA 2020 recommends Saccharomyces boulardii or Lactobacillus + Bifidobacterium combinations for AAD prevention in children.
- BSaccharomyces boulardii CNCM I-745First line · Yeast probiotic. AEMPS registered Enterol (Biocodex) as a medicinal product for AAD, travellers diarrhoea and adjunct therapy for C. difficileS. boulardii CNCM I-745 is one of the most studied probiotics with convincing evidence in antibiotic-associated diarrhoea. AEMPS registered Enterol (Biocodex) with the indication of AAD prevention and treatment in adults and children. McFarland 2010 (meta-analysis of 31 RCTs) showed AAD risk reduction with S. boulardii added to antibiotic therapy, RR ~0.53. Cochrane Goldenberg 2017 included S. boulardii among first-choice strains (alongside LGG). ESPGHAN 2014 in children on antibiotics lists S. boulardii and LGG as options with confirmed efficacy. AGA 2020 does not routinely recommend probiotics in adults but allows them in C. difficile high-risk groups (elderly, hospitalised, broad-spectrum antibiotic users). Dose: 250–500 mg twice daily from antibiotic day 1, continued 7 days after antibiotic completion.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit