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Causes
By Mayo Clinic staffAntibiotic-associated diarrhea occurs when antibacterial medications (antibiotics) upset the balance of good and bad bacteria in your gastrointestinal tract.
The antibiotics most likely to cause diarrhea
Nearly all antibiotics can cause antibiotic-associated diarrhea, colitis or pseudomembranous colitis. The antibiotics most commonly linked to antibiotic-associated diarrhea include:
- Cephalosporins, such as cefixime (Suprax) and cefpodoxime (Vantin)
- Clindamycin (Cleocin)
- Erythromycin (Erythrocin, E.E.S., others)
- Penicillins, such as amoxicillin (Larotid, Moxatag, others) and ampicillin
- Quinolones, such as ciprofloxacin (Cipro) and levofloxacin (Levaquin)
- Tetracyclines, such as doxycycline (Vibramycin, Periostat, others) and minocycline (Minocin, Solodyn, others)
How antibiotics cause diarrhea
Your digestive tract is a complex ecosystem that's home to millions of microorganisms (intestinal flora), including hundreds of species of bacteria. Many of these bacteria are beneficial, performing essential functions. But some of the bacteria that normally inhabit your intestinal tract are potentially dangerous. The bad bacteria are usually kept in check by beneficial bacteria unless the delicate balance between the two is disturbed by illness, medications or other factors.
Antibiotics can be especially disruptive to intestinal flora because they destroy beneficial bacteria along with harmful ones. Without enough "good" microorganisms, "bad" bacteria that are resistant to the antibiotic you received grow out of control, producing toxins that can damage the bowel wall and trigger inflammation.
Clostridium difficile causes most serious antibiotic-associated diarrhea
The bacterium responsible for almost all cases of pseudomembranous colitis and many instances of severe antibiotic-associated diarrhea is C. difficile. Most people acquire a C. difficile infection during a stay in a hospital or nursing home after they've received antibiotics.
- Kelly CP, et al. Antibiotic-associated diarrhea, pseudomembranous enterocolitis and Clostridium difficile-associated diarrhea and colitis. In: Feldman M, et al. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2006. http://www.mdconsult.com/das/book/body/189880460-5/0/1389/0.html. Accessed March 19, 2010.
- Ferri FF. Pseudomembranous colitis. In: Ferri FF. Ferri's Clinical Advisor 2010. Philadelphia, Pa.: Mosby; 2010. http://www.mdconsult.com/das/book/body/189880460-5/0/2088/0.html. Accessed March 19, 2010.
- Thielman NM, et al. Antibiotic-associated colitis. In: Mandell GL, et al. Mandell, Douglas and Bennett's Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa.: Churchill Livingstone; 2009. http://www.mdconsult.com/book/player/book.do?method=display&type=aboutPage&decorator=header&eid=4-u1.0-B978-0-443-06839-3..X0001-X--TOP&isbn=978-0-443-06839-3&uniq=190074036#lpState=open&lpTab=contentsTab&content=4-u1.0-B978-0-443-06839-3..X0001-X--TOP%3Bfrom%3Dcontent%3Bisbn%3D978-0-443-06839-3%3Btype%3DbookHome. Accessed March 19, 2010.
- O'Mahony S, et al. Enteric bacterial flora and bacterial overgrowth. In: Feldman M, et al. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2006. http://www.mdconsult.com/das/book/body/189880460-5/0/1389/0.html. Accessed March 26, 2010.
- Diarrhea. National Institute for Diabetes and Digestive and Kidney Diseases. http://digestive.niddk.nih.gov/ddiseases/pubs/diarrhea/index.htm. Accessed March 25, 2010.
- Peterson MA. Disorders of the large intestine. In: Marx JA, et al. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa.: Mosby; 2009. http://www.mdconsult.com/book/player/book.do?method=display&type=aboutPage&decorator=header&eid=4-u1.0-B978-0-323-05472-0..X0001-1--TOP&isbn=978-0-323-05472-0&uniq=191219029#lpState=open&lpTab=contentsTab&content=4-u1.0-B978-0-323-05472-0..X0001-1--TOP%3Bfrom%3Dcontent%3Bisbn%3D978-0-323-05472-0%3Btype%3DbookHome. Accessed March 25, 2010.
- Diarrhea. ADA Nutrition Care Manual. http://nutritioncaremanual.org/topic.cfm?ncm_heading=Nutrition%20Care&ncm_toc_id=19099. Accessed March 26, 2010.
- Parkes GC, et al. The mechanisms and efficacy of probiotics in the prevention of Clostridium difficile-associated diarrhoea. Lancet Infectious Diseases. 2009;9:237.
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