Antibiotic-associated bloody diarrhea in infants: clinical, endoscopic, and histopathologic profiles.
OBJECTIVE
Antibiotic-associated diarrhea constitutes 1 of the most frequent side effects of antimicrobial therapy with widely varying clinical presentations; however, little is known about its antibiotic-associated bloody diarrhea (AABD) form, particularly in very young children. The aim of this study was to describe the clinical, endoscopic, and histopathologic profiles of community-acquired AABD in infants.


METHODS
The study included 23 infants referred with bloody diarrhea that developed a few days after receiving antibiotics on an outpatient basis for watery diarrhea (18), respiratory tract infections (4), or urinary tract infection (1). Detailed clinical assessment, videosigmoidoscopy, and histopathologic examination of endoscopic biopsies were performed for all.


RESULTS
Clinically, on presentation, bloody diarrhea was acute in all except 1 patient with a prolonged course (for 25 days) and stopped in all 2 to 6 days after discontinuation of antibiotics. Fever and/or leukocytosis were present only in 8 (34.8%). Sigmoidoscopy revealed varying types of erythema (patchy, ring, diffuse) and ulcers (aphthoid, diffuse) in 18 and pseudomembranes in 5. Histopathologically, only 3 showed the characteristic mushroom-like pseudomembranes, whereas all of the other infants had nonspecific colitis.


CONCLUSIONS
Community-acquired AABD is not uncommon in infants presenting with acute or chronic forms even without fever or leukocytosis. When suspected, discontinuation of antibiotics is a good policy if facilities for bacterial culture with cytotoxin assays are limited. The characteristic endoscopic or histopathologic pseudomembranes are encountered only in a small percentage (26%). Rational use of antibiotics should be adhered to particularly in cases of watery diarrhea that is mostly of viral origin.
Barakat
Maha
M
Department of Tropical Medicine and Gastroenterology, University Hospital, Assiut, Egypt. mahabarakat2001@yahoo.com
El-Kady
Zeinab
Z
Mostafa
Mohamed
M
Ibrahim
Naglaa
N
Ghazaly
Hamdy
H
D000617:Aminoglycosides / Q000009:adverse effects; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D001706:Biopsy; D002511:Cephalosporins / Q000009:adverse effects; D003113:Colonoscopy; D003968:Diarrhea, Infantile / Q000139:chemically induced* / Q000473:pathology*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000473:pathology*; D006801:Humans; D007223:Infant; D008297:Male; D010406:Penicillins / Q000009:adverse effects; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000009:adverse effects
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D010406:Penicillins; D015662:Trimethoprim, Sulfamethoxazole Drug Combination