Дисбактериоз

[FRSM]

Antibiotic-associated colitis, also called antibiotic-associated enterocolitis, can occur following antibiotic treatment. The bacteria Clostridia difficile are normally found in the intestines of 5% of healthy adults, but people can also pick up the bacteria while they are in a hospital or nursing home. In a healthy person, harmless resident intestinal bacteria compete with each other for food and places to "sit" along the inner intestinal wall. When antibiotics are given, most of the resident bacteria are killed. With fewer bacteria to compete with, the normally harmless Clostridia difficile grow rapidly and produce toxins. These toxins damage the inner wall of the intestines and cause inflammation and diarrhea.

Although all antibiotics can cause this disease, it is most commonly caused by clindamycin (Cleocin), ampicillin (Omnipen), amoxicillin (Amoxil, Augmentin, or Wymox), and any in the cephalosporin class (such as cefazolin or cephalexin). Symptoms of the condition can occur during antibiotic treatment or within four weeks after the treatment has stopped.

In approximately half of cases of antibiotic-associated colitis, the condition progresses to a more severe form of colitis called pseudomembranous enterocolitis in which pseudomembranes are excreted in the stools. Pseudomembranes are membrane-like collections of white blood cells, mucus, and the protein that causes blood to clot (fibrin) that are released by the damaged intestinal wall.

[FRSM]

"...В программу Конгресса вошло несколько специальных заседаний и отдельных докладов по вопросам применения пробиотиков..."


- Probiotic therapy results in bacterial overgrowth syndrome have been inconclusive and not generally recommended for general clinic use.
Bures J, Cyrany J, Kohoutova D, et al. Small intestinal bacterial overgrowth syndrome. World J Gastroenterol. Jun 28 2010;16(24):2978-90. 27.Quigley EM, Quera R. Small intestinal bacterial overgrowth: roles of antibiotics, prebiotics, and probiotics. Gastroenterology. Feb 2006;130(2 Suppl 1)


Treatment in bacterial overgrowth syndrome (BOS) should include correction of primary underlying disease if any, including antibiotic therapy and nutritional support. The primary approach should be the treatment of any disease or anatomic defect that potentiated bacterial overgrowth. Many of the clinical conditions associated with bacterial overgrowth syndrome are not readily reversible, and management is based on antibiotic therapy aimed at rebalancing enteric flora. Careful consideration must be taken to prevent total eradication of protective microorganisms. The goal should be directed at reducing symptoms. Initial antibiotic therapy is usually empiric and should be broad and cover both aerobic and anaerobic microorganisms. Community resistance patterns should also be considered.

Tetracycline was the mainstay of therapy, but its use as single agent has fallen out of favor in adult patients given community increases in bacterial resistance.

Bacterial sensitivities from duodenal intubations with nonidiopathic bacterial overgrowth syndrome support the use of amoxicillin-clavulanate. Amoxicillin-clavulanate appears to be 75% effective in patients with diabetes.

Studies show that rifaximin eradicates bowel overgrowth syndrome in as many as 80% of patients.[18, 19] Higher doses (1200 or 1600 mg/d) are more effective then standard doses (600 or 800 mg/d).[20] Long-term favorable clinical results have been achieved with rifaximin in patients with irritable bowel and BOS.[21]

Clindamycin and metronidazole are useful in elderly patients with idiopathic bacterial overgrowth syndrome.

As outlined below, gentamicin, but not metronidazole, significantly improves intractable diarrhea in children younger than 1 year.[22]

Cholestyramine reduces diarrhea in infants and neonates with intractable diarrhea.[23] Infants with 10-25 days of severe persistent diarrhea for which a cause could not be found despite an extensive infectious and immunologic workup were treated with cholestyramine and gentamicin or metronidazole. Cholestyramine and gentamicin significantly reduced stool weight within 4-5 days of therapy but had mild detrimental effects on fat and nitrogen absorption.

Ciprofloxacin and metronidazole result in normalization of hydrogen breath tests in most patients with Crohn disease.[24]

Norfloxacin, cephalexin, trimethoprim-sulfamethoxazole, and levofloxacin have been recommended for the treatment of bacterial overgrowth syndrome.[4, 25]

The exact length of therapy is not clearly defined; length of therapy should be tailored to symptom improvement. A single 7-10 day course of antibiotic may improve symptoms in 46-90% of patients with bacterial overgrowth syndrome.[26] . Recurrence following therapy is not uncommon and is more likely in elder patients, especially those with history of appendectomy and chronic proton pump inhibitor use. Patients with recurrent symptoms may need repeated (eg, the first 5-10 d of every month) or continuous use of cyclical antibiotic therapy.[4]

Probiotic therapy results in bacterial overgrowth syndrome have been inconclusive and not generally recommended for general clinic use.[2, 27]

Therapeutic use of prokinetics in bacterial overgrowth syndrome due to motility disorders have been tried in many studies. Metoclopramide, cisapride, domperidone, erythromycin, tegaserod, and octreotide have been used; however, data suggest long-term effectiveness is limited.[25]

Nutritional support with dietary modifications such as lactose-free diet, vitamin replacement, and correction of deficiencies in nutrients like calcium and magnesium should be an important part of bacterial overgrowth syndrome treatment, if applicable.

Certain potential underlying abnormalities are amenable to treatment, as follows:
•
Infectious diarrhea

•
Malnutrition

•
Malabsorption

•
Hypothyroidism

•
Inflammatory bowel disease

•
Immunodeficiency


The following potential underlying diseases are not amenable to treatment, but prevention of their progression may be therapeutic:
•
Diabetic autonomic neuropathy

•
Scleroderma

•
Pseudoobstruction

•
Amyloidosis

•
Achlorhydria

•
Vagotomy

[Annabella]

В России склоняются к тому, что нужны (за исключением про-западнически настроенных специалистов).

Далеко пойдете, перспективная девушка. Сейчас такие в России, к сожалению, в цене. Тех, кто думает, учится, и читает, уже давно или "поносом смыло" - это цитата из Гиляровского, или они работают в единичных местах, где все же разум немножко побеждает.

[STc]

Исследование электрической активности желудка и кишечника - это заурядный Ph-монитор?
Наши с Вами понятия о заурядности расходятся. Или Вы не поняти сути исследования.

Прошу прощения, поленился сходить по ссылке - увидел гастроскан и сделал неверный вывод.
Однако ценность этого исследования, в отличие от суточной Ph-метрии, в статьях на сайте исток-системы изрядно преувеличена.

Далеко пойдете, перспективная девушка. Сейчас такие в России, к сожалению, в цене. Тех, кто думает, учится, и читает, уже давно или "поносом смыло" - это цитата из Гиляровского, или они работают в единичных местах, где все же разум немножко побеждает.

Мне почему-то кажется, что коллега вполне способна к продуктивному диалогу, надеюсь, разум и здесь победит.

[STc]

Лимфотропные и прочая.

Лимфотропные коллеги - воображение рисует что-то страшное