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Diarrhea and antibiotics. Stop the antibiotic? Switch to another? Continue with the same?
The answer to this question is dependant on a number of variables including the age of the child, whether the diarrhea is a primary gastroenteritis or secondary to the antibiotic, the severity of the diarrhea, the type of antibiotic used, and the certainty of the diagnosis for which the antibiotic was initially prescribed. For a child with a confirmed diagnosis of acute otitis media, who develops mild diarrhea (less than three loose stools per day) after beginning amoxicillin, the recommendation would be to continue the antibiotic unless the diarrhea became significantly worse. For moderate diarrhea (three watery stools per day) a reduction of the dose by half would be in order in the first instance. For severe watery diarrhea the antibiotic should be stopped altogether and an alternative antibiotic should be used if the original condition being treated is still present upon re-examination of the child. If on re-examination of a child with otitis media, the condition has improved, the antibiotic may be discontinued. If the child has a primary gastroenteritis to begin with it would be preferable to avoid oral antibiotics altogether, or until the gastroenteritis resolves, since most antibiotics will likely aggravate the diarrhea. If an antibiotic must be used to treat a more serious bacterial infection such as pneumonia, then it might be preferable to administer the drug intravenously, particularly in young infants. Certain antibiotics such as Clavulin may produce wicked diarrhea in some children and should be discontinued immediately when this occurs. The occurrence of diarrhea with the new 7:1 formulation of amoxicillin: clavulanic acid is significantly less than in the older 4:1 formulation and is now the product of choice when prescribing Clavulin.
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