• Herbal Formula Science
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• v.22 no.2
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• pp.121-131
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• 2014

Objectives : The purpose of this study is to report a therapeutic effects of a Korean herbal prescription for antibiotics-associated diarrhea. Methods : Modified Hyangsayukgunja-tang was prescribed once or twice a day to a antibiotics-associated diarrhea patient. To observe the therapeutic effects, the frequency of defecation was counted and Bristol Stool Form Index was used. Laboratory tests were conducted periodically. Results : The frequency of defecation was decreased from 9 times a day to once a day. According to Bristol Stool Form Index, stool form was improved from Type 7 to Type 5. The level of red blood cell, hemoglobin and albumin increased slightly from the day of admission to discharge. Conclusions : Hyangsayukgunja-tang can be a choosable treatment option for a serious antibiotics-associated diarrhea.

• Journal of Physiology & Pathology in Korean Medicine
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• v.29 no.6
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• pp.517-522
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• 2015

The objective of this study is to report the clinical application of Korean and Western medicine on chronic diarrhea and Clostridium difficile associated diarrhea. Clostridium difficile associated diarrhea is usually triggered by using antibiotics. This patient also took some antibiotics and she started to suffer diarrhea diagnosed as chronic and Clostridium difficile associated diarrhea. She had suffered from diarrhea over 10 times per day. We checked changes of numbers, total volume of defecations and stool form. We treated the patient with acupuncture, moxibustion, herbal medicine and metronidazole. After treatment, diarrhea was stopped and the patient defecated normal form stool. According to this study, acupuncture, moxibustion, herbal medicine and metronidazole was effective for 1 case of stroke patient with chronic and Clostridium difficile associated diarrhea.

• Korean Journal of Clinical Pharmacy
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• v.20 no.1
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• pp.78-84
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• 2010

Background: Clostridium difficile is the primary reason of the nosocomial diarrhea. The antimicrobial therapy plays a central role in the pathogenesis of Clostridium difficile associated diarrhea (CDAD). Although nearly all classes of antimicrobial agents have been associated with CDAD, clindamycin and the third-generation cephalosporins have traditionally been considered to the greatest risk factor. Recent studies have also implicated fluoroquinolones as high-risk agents due to increasing use of the agents. This study was to determine the incidence and the risk factors of CDAD related to the administered antibiotics and to assess the therapeutic regimen of metronidazole or vancomycin based on the C. difficile toxin assay Methods: A retrospective study was performed in patients with Clostridium difficile toxin assay at I Hospital (Incheon, South Korea) during the period from January 2007 through December 2007. Administrative, laboratory, and pharmacy data were collected from Electronic Medical Databases. Results: The analysis included 129 reported C.difficile toxin assay results, with 42 positive cases and 87 negative cases. Significant antibiotic risk factors for CDAD included the use of the fourth-generation cephalosporinse (OR=5.97, 95% CI 1.37-25.98, P=0.017). Administration of metronidazole was protective against CDAD (OR=0.30, 95% CI 0.12-0.74, P=0.009). Prolonged antimicrobial therapy has been associated with an increased risk of CDAD. The third-generation cephalosporins (OR=3.81, 95% CI 1.08-13.41, P=0.037) and aminoglycoside (OR=5.50, 95% CI 1.43-21.10, P=0.013) demonstrated greater risk for CDAD over 15 days than 8days or less days of treatment duration. Conclusions: The fourth and third generation cephalosporin, aminglycoside were the significant risk factors compared with other antibiotics, whereas metronidazole appears to be protective. The longer duration of antiobiotic use increased CDAD.

• The Journal of Korean Medicine
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• v.22 no.3
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• pp.179-188
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• 2001

Diarrhea is the frequent passage of loose, watery stool (frequency: ${\geq}4/day$, weight: ${\geq}250g/day$) Most antibiotics can cause inflammatory change of the colon or Pseudomembranous colitis (PMC). Typical presentations of PMC are watery diarrhea, abdominal pain, fever, leukocytosis ($12,000~20,000/\textrm{mm}^3$), hypoalbuminemia, hypovolemia and recent or concurrent use of antibiotics. Diagnostic methods of PMC are stool assay, sigmoid scopy, abdominal CT, abdominal US, etc. The age-related susceptibility noted with PMC is impressive but unexplained. Two stroke patients had diarrhea, abdominal pain, fever hypoalbuminemia and a history of recent or concurrent use of antibiotics. By use of Shirhyung- Tang, we could improve clinical symptoms (diarrhea, abdominal pain, fever hypoalbuminemia, etc.) and so report clinical course of two stroke patients with antibiotics-associated PMC.

• Journal of Sasang Constitutional Medicine
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• v.32 no.1
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• pp.50-57
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• 2020

Objectives Allergic reaction to antibiotics is associated with increased use. And rate of Irritable Bowel Syndrome(IBS) is on the increase associated with stress, depression, anxiety, or previous intestinal problem. This case study reports significant improvement of patients with diarrhea accompanied by IBS who had suffered from allergic reaction to antibiotics after treatment with Sasang constitutional medicine. Methods This patient was diagnosed as Taeeumin type. Sasang constitutional medicine was taken by the patient, almost three times per day during treatment periods. We measured the degree of the main symptoms such as diarrhea, abdominal discomfort, insomnia, itching etc, using Visual Analogue Scale(VAS). Results The symptoms of diarrhea, abdominal discomfort, and insomnia were improved. VAS score was decreased from 4~5 to 0~1 for about two weeks. Conclusions This case shows that Sasang constitutional medicine treatment can contribute to improve main symptoms accompanied by IBS.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.21 no.2
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• pp.141-146
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• 2018

Nowadays, Klebsiella oxytoca is described as a causative organism for antibiotic-associated hemorrhagic colitis (AAHC). Here we report two cases of pediatric AAHC, from which K. oxytoca was cultured after starting amoxicillin-clavulanate or amoxicillin treatment. The patients developed severe abdominal pain and a large amount of bloody diarrhea. K. oxytoca was obtained in intestinal fluid culture of a boy through the colonoscopy. On the other hand, colonic tissue culture and intestinal fluid culture were negative of the other patient. K. oxytoca was detected in stool culture when he was admitted. These cases showed characteristic endoscopic findings of segmental hemorrhagic colitis, and both boys recovered spontaneously within 2-3 days after they stopped taking the antibiotics. Therefore, in children who develop relatively large amount of bloody diarrhea after antibiotic treatment, we should consider AAHC caused by K. oxytoca.

• The Journal of Internal Korean Medicine
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• v.38 no.2
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• pp.172-179
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• 2017

Objectives: The aim of this clinical study is to describe the case of a patient with antibiotic-associated diarrhea, which was improved by treatment with herbal medicine. Methods: The antibiotic-associated diarrhea improved following treatment with Boikyangwi-tang and Opae-san for two months. During this period, western medicine, including antibiotics, was also administered. To evaluate the effect of the treatment, the Bristol Stool Form Scale was used. Results: During the treatment, the Bristol Stool Form Scale changed from type 7 to type 5. Conclusion: The results suggest that traditional Korean medicine may be an effective treatment for antibiotic-associated diarrhea.

• Korean Journal of Clinical Pharmacy
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• v.27 no.2
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• pp.77-82
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• 2017

Background: Clostridium difficile associated diarrhea (CDAD) is a leading cause of hospital-associated gastrointestinal illness. Risk factors for CDAD include advanced age, long-term admission, antibiotics, proton-pump inhibitor or $H_2$ blocker use and immunosuppression. The practice guideline of American Journal of Gastroenterology (2013) suggests metronidazole for the first-line therapy of mild-moderate CDAD as well as vancomycin for severe CDAD. MICU inpatients receiving stress ulcer prophylaxis and antibiotics are susceptible to nosocomial CDAD. Therefore, this study aimed to evaluate occurrence and treatment of CDAD in MICU. Methods: Patients who were admitted to the MICU and had CDAD from August 2012 to August 2015 were analyzed retrospectively. Results: Of the 90 patients with CDAD, 20 patients (2.22%) had mild-moderate CDAD (16 received metronidazole and 4 received vancomycin therapy) and 70 patients (77.8%) had severe CDAD(54 received metronidazole and 16 received vancomycin therapy). Among the patients with mild- moderate CDAD, treatment with metronidazole or vancomycin resulted in same clinical cure in 50% of the patients (p=1.00). Among the patients with severe CDAD, treatment with metronidazole or vancomycin resulted in clinical cure in 40.7% and 50.0% of the patients, respectively (p=0.511). Clinical symptoms recurred in 7.4% of the severe CDAD patients treated with metronidazole and 6.3% of those treated with vancomycin(p=0.875). Conclusion: Our findings suggest that metronidazole and vancomycin are equally effective for the treatment of mild-moderate CDAD; however, vancomycin demonstrated higher clinical cure rate and lower recurrence rate for severe CDAD, although the difference was not statistically significant. For better clinical outcomes, appropriate medication use by disease severity is needed.

• Korean Journal of Veterinary Research
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• v.37 no.4
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• pp.773-777
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• 1997

A retrospective study of 132 cases of natural Escherichia coli infection in preweaning piglets with diarrhea submitted to the Department of Veterinary Pathology in Seoul National University from 1995 to 1996 was performed to determine the biochemical characteristics and antibiotics susceptibility. Most field isolates were lysine decarboxylase-positive (99.2%), phenylalanine decarboxylase-negative (100%), and fermented sorbitol (91.7%). Antibiotic susceptibilities will be determined by agar diffusion method. A large percentage of isolates were resistant to many antibiotics in common usage. Most isolates were susceptible to colistin (98.8%), gentamycin (64.3%), amikacin (100%), and ceftiour sodium (64.2%), whereas most isolates were notably resistant to ampicillin (86.9%), neomycin (66.7%), streptomycin (84.5%), tetracycline (98.8%), penicillin (98.8%), and amoxacillin (58.3%).

• Quality Improvement in Health Care
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• v.8 no.1
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• pp.10-21
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• 2001

Background : The Clostridium difficile is the most important identifiable cause of nosocomial infectious diarrhea and colitis, which lengthens hospital stay. Recently incidence of C. difficile has been increasing in an university hospital, and an intervention for prevention and control of C. difficile associated diarrhea (CDAD) was in prompt need. Methods : Subjects were the patients in the neurosurgical intensive care unit(NCU) where C. difficile was most frequently isolated. To increase participation of various departments, we used the CQI method, because management of CDAD requires a wholistic approach including control of antibiotics, barrier precaution and environmental cleaning and disinfection. Duration of the CQI activities was 9 months from April to December 1999. Results : The identified problems were misuse and overuse of antibiotics, lack of consciousness of medical personnels and the possibility of transmission from the contaminated environment and tube feeding. Education for proper use of antibiotics and management of C. difficile infection, use of precaution stickers, supplement of handwashing equipments, emphasis on environmental disinfection, and the change of the process of tube feeding were done. The CDAD rate in NCU was significantly decreased after the CQI program (8.6 case per 1,000 patient days from January to April 1999 vs 4.8 from May to December 1999). The distribution of neurosurgical wards including NCU among the total number of isolated C. difficile from the clinical specimens dropped from 49.4% in January to April to 33,7% in May to December. The average hospital stay of the neurosurgical department changed from 19.6 days to 15.2 days. Also, the effect of the CQI activities for C. difficile may have affected the incidence of vancomycin resistant enterococci (VRE). Duration and dosage of certain antibiotics used in the NS department were decreased. The distribution of neurosurgical department in the number of VRE isolated patients declined from 18.4% to 11.1%. Conclusion : Infection control of resistant organisms such as C. difficile is likely to be successful when management of environmental contamination an collaborative efforts of decreasing the patients' risk factors such as antibiotics management and decreasing the length of hospital stay come simultaneously. For this work, related departments need to actively participate in the entire process under a common target through discussions for identifying problems and bringing up solutions. In this respect, making use of a CQI team is an efficient method of infection control for gathering participation and cooperation of related departments.