Antibiotic-associated diarrhea. Practical issues of diagnosis and treatment in elderly and senile patients

Aim. To evaluate the effectiveness of the Bactimunal® metabiotic complex (active metabolites of Bacillus subtilis) in the treatment regimens of antibiotic-associated diarrhea (AAD) in elderly and senile patients.
Material and methods. The study involved 42 patients from a multidisciplinary hospital aged 65 to 90 years with a diagnosis of AAD. Patients in the main group (n=27) received the Bactimunal® metabiotic complex 1 capsule 2 times a day for 28 days in addition to standard AAD therapy; patients in the control group (n=15) did not receive metabiotic support during AAD therapy. In all patients of the main and control groups, the clinical condition, severity of gastrointestinal symptoms, stool frequency and consistency, laboratory test data were assessed at the beginning of the study and after 28 days. Colonoflor-16 method was used to assess the colon microbiocenosis.
Results. The clinical performance of AAD in elderly and senile patients was dominated by diarrheal syndrome with increased stool frequency up to 4-6 times a day without hematochezia. C. difficile toxins A and B were detected in 44,4% of patients. According to the Colonoflor-16 test, a decrease in the total bacterial count was revealed, mainly due to Bifidobacterium spp. (100%) and Lactobacillus spp. (77,7%). With Bactimunal® metabiotic complex therapy, the repeated study revealed a decrease in the number of bowel movements and a tendency to normalize stool consistency, an increase in Lactobacillus spp. (in 40%), a tendency to increase in Bifidobacterium spp. (50,2%), compared with the control group.
Conclusion. The administration of the Bactimunal® metabiotic complex 1 capsule 2 times a day for 28 days demonstrated an increase in obligate microbiota, a decrease in the number of bowel movements and a tendency to normalize stool consistency.

1. . Uspensky YuP, Fominykh YuA. Antibiotic-associated diarrhea — a new problem of civilization. The Russian Archives of Internal Medicine. 2012;2:46-53. (In Russ.)

2. Belousova EA. Antibiotic-associated diarrhea and antibiotic-associated colitis. Almanac of Clinical Medicine. 2014;33:39-46. (In Russ.)

3. Drapkina OM, Lazebnik LB, Bakulin IG, et al. Clostridioides difficile infection: diagnosis, treatment, and prevention Clinical guidelines of the Russian Scientific Medical Society of Internal Medicine, the Gastroenterological Scientific Society of Russia, and the North-West Society of Gastroenterologists and Hepatologists. Experimental and Clinical Gastroenterology. 2023;(2):4-32. (In Russ.)

4. Kelly CR, Fischer M, Allegretti JR, et al. ACG Clinical Guidelines: Prevention, Diagnosis, and Treatment of Clostridioides difficile Infections. Am J Gastroenterol. 2021;116(6):1124-47. doi:10.14309/ajg.0000000000001278. Erratum in: Am J Gastroenterol. 2022;117(2):358. doi:10.14309/ajg.0000000000001529.

5. Osadchuk MA, Svistunov AA. Antibiotic-associated diarrhea in clinical practice. Issues of modern pediatrics. 2014;13(1):102-8. (In Russ.)

6. Goodman C, Keating G, Georgousopoulou E, et al. Probiotics for the prevention of antibiotic-associated diarrhoea: a systematic review and meta-analysis. BMJ Open. 2021;11(8):e043054. doi:10.1136/bmjopen-2020-043054.

7. Franceschi C, Santoro A, Bonafè M, et al. Inflammaging. An evolutionary perspective on immunosenescence. Ann NY Acad Sci. 2000;908:244-54. doi:10.1111/j.1749-6632.2000.tb06651.x.

8. Potel G, Montassier E, Hardouin JB, et al. Human intestinal microbiota gene risk factors for antibiotic-associated diarrhea: perspectives for prevention. Risk factors for antibiotic-associated diarrhea. Microb Ecol. 2010;59(4):830-7. doi:10.1007/s00248-010-9637-2.

9. Monot M, Eckert C, Lemire A, et al. Clostridium difficile: New Insights into the Evolution of the Pathogenicity Locus. Sci Rep. 2015;5:15023. doi:10.1038/srep15023.

10. Bakulin IG, Zhuravleva MS, Eremina EYu, et al. Clostridial infection: clinical picture, diagnosis, treatment and prevention. Clinical guidelines for therapists and gastroenterologists. St.Petersburg. 2022. pp. 5-9. (In Russ.)

11. Nikolaeva IV, Khaliullina SV, Murtazina GKh, et al. Infection caused by Clostridioides (Clostridium) difficile. Review of current clinical guidelines. Practical Medicine. 2020;18(6):106-12. (In Russ.)

12. Skazyvaeva EV, Skalinskaya MI, Bakulin IG, et al. Updated clinical guidelines for Clostridium difficile infection of the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA): a brief review of the main provisions, critical comments, and possible prospects. Experimental and Clinical Gastroenterology. 2019;165(5):3-14. (In Russ.)

13. Patangia DV, Anthony Ryan C, Dempsey E, et al. Impact of antibiotics on the human microbiome and consequences for host health. MicrobiologyOpen. 2022;11(1):e1260. doi:10.1002/mbo3.1260.

14. Gerding DN, Johnson S, Rupnik M, et al. Clostridium difficile binary toxin CDT: Mechanism, epidemiology, and potential clinical importance. Gut Microbes. 2014;5:1-13. doi:10.4161/gmic.26854.

15. In general, elderly patients in medical practice: a guide for doctors. Frolova EV, Kuznetsova OYu, eds. Moscow: GEOTAR-Media, 2023. p. 480. (In Russ.)

16. Zhang L, Zeng X, Guo D, et al. Early use of probiotics might prevent antibioticassociated diarrhea in elderly (>65 years): a systematic review and meta-analysis. BMC Geriatr. 2022;22(1):562. doi:10.1186/s12877-022-03257-3.

17. Allen SJ, Wareham K, Wang D, et al. Lactobacilli and bifidobacteria in the prevention of antibiotic-associated diarrhea and Clostridium difficile diarrhea in elderly inpatient patients (PLACIDE): a randomized, double-blind, placebocontrolled, multicenter study. Lancet. 2013;382:1249-57. doi:10.1016/S0140-6736(13)61218-0.

18. Yelin I, Flett KB, Merakou C, et al. Genomic and epidemiological evidence of bacterial transmission from probiotic capsule to blood in ICU patients. Nat Med. 2019;25:1728-32. doi:10.1038/s41591-019-0626-9.

19. Ohishi A, Takahashi S, Ito Y, et al. Bifidobacterium septicemia associated with postoperative probiotic therapy in a neonate with omphalocele. J Pediatr. 2010;156(4):679-81. doi:10.1016/j.jpeds.2009.11.041.

20. Kunz AN, Fairchok MP, Noel JM. Lactobacillus Sepsis Associated with Probiotic Therapy. Pediatrics. 2005;116(2):517. doi:10.1542/peds.2004-2137