Diarrhea and antibiotics
Those Painful Diabetic Nerves and Pesky Bugs
Sun/Jul/07 08:50 PM
Two common problems I face were addressed with some good studies in this past week's British Medical Journal (BMJ). The first involves the treatment of painful neuropathy caused by chronic (and often uncontrolled) diabetes. The longest nerves in the body are affected soonest so most patients complain of pain in the feet. The pain can be a severe burning and often does not respond to the usual over the counter pain relievers. Prevention with weight control and diet and later with tight glucose control is still the best way to deal with this problem but many of my patients still develop pain. Over the years my best treatment options have been topical (and occasionally oral) capsacin as well as low doses of tricyclic antidepressants or anticonvulsants. M. Wong, et al performed a systemic review of research documented in the literature. The results confirmed what clinicians have known: Capsacin works for many diabetics and when it doesn't use of tricyclic antidepressants and older anticovulsants worked quite well. In fact they outperformed the newer drugs with generally lower rates of withdrawl than some of the newer drugs. The good news is that many of the effective drugs are available as generics. If you have this problem please ask your doctor about capsacin and tricyclics before taking a sample of one of the newer heavily marketed drugs.
The second issue is diarrhea caused by antibiotics. Antibiotic use is widespread and the broad spectrum antibiotics kill gut bacteria along with the disease causing ones. This often results in diarrhea. In some cases a bacterium called Clostridium difficile may overgrow and it can produce a toxin that causes a severe diarrhea and colitis. These problems are especially worse in the geriatric patients who often overuse antibiotics anyway. For some time there has been evidence that the use of probiotics and even brewer's yeast could treat antibiotic induced diarrhea but that is like closing the barn door after the horse is out. M. Hikson et al did a quite nice double blind placebo controlled study looking at the use of probiotics to help PREVENT antibiotic associated diarrhea. Their results showed the they were able to prevent 1 case of diarrhea for every 5 persons treated with probiotics and more importantly for every 6 people treated they saw the prevention of 1 case of C. difficile colitis. Probiotics are inexpensive and readily available. They are well tolerated and this study confirms that early use of probiotics will prove helpful in preventing a common and potentially dangerous effect of antibiotic use.
The second issue is diarrhea caused by antibiotics. Antibiotic use is widespread and the broad spectrum antibiotics kill gut bacteria along with the disease causing ones. This often results in diarrhea. In some cases a bacterium called Clostridium difficile may overgrow and it can produce a toxin that causes a severe diarrhea and colitis. These problems are especially worse in the geriatric patients who often overuse antibiotics anyway. For some time there has been evidence that the use of probiotics and even brewer's yeast could treat antibiotic induced diarrhea but that is like closing the barn door after the horse is out. M. Hikson et al did a quite nice double blind placebo controlled study looking at the use of probiotics to help PREVENT antibiotic associated diarrhea. Their results showed the they were able to prevent 1 case of diarrhea for every 5 persons treated with probiotics and more importantly for every 6 people treated they saw the prevention of 1 case of C. difficile colitis. Probiotics are inexpensive and readily available. They are well tolerated and this study confirms that early use of probiotics will prove helpful in preventing a common and potentially dangerous effect of antibiotic use.
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