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TREATMENT OF DYSBIOSIS DURING ANTIBIOTIC THERAPY FOR ACUTE
INTESTINAL INFECTIONS
Pulatov Muzaffar Ergashevich
Assistants of the Department of Infectious Diseases
Andighan State Medical Institute
Abstract:
Acute intestinal infections (AIIs) remain one of the most frequent causes of
morbidity across various age groups, particularly among children and immunocompromised
patients. Bacterial or mixed etiology infections often require antibiotic therapy, which can
significantly disrupt the gut microbiota. This dysbiosis may manifest clinically and lead to
prolonged gastrointestinal symptoms, malabsorption, and increased susceptibility to
secondary infections. This article reviews current knowledge regarding the pathophysiology
of dysbiosis induced by antibiotic treatment of AIIs and presents evidence-based strategies
for restoring a balanced gut microbiota. Key approaches include using probiotics, prebiotics,
and synbiotics, alongside antibiotic stewardship and careful monitoring of gastrointestinal
function.
Keywords
: acute intestinal infections, antibiotics, dysbiosis, probiotics, gut microbiota,
antibiotic stewardship
ЛЕЧЕНИЕ ДИСБАКТЕРИОЗА ВО ВРЕМЯ АНТИБИОТИКОТЕРАПИИ
ОСТРЫХ КИШЕЧНЫХ ИНФЕКЦИЙ
Аннотация:
Острые кишечные инфекции (ОКИ) остаются одной из наиболее частых
причин заболеваемости в различных возрастных группах, особенно среди детей и
пациентов с ослабленным иммунитетом. Бактериальные или смешанные инфекции
часто требуют антибактериальной терапии, которая может значительно нарушить
микробиоту кишечника. Этот дисбактериоз может проявляться клинически и
приводить к длительным желудочно-кишечным симптомам, мальабсорбции и
повышенной восприимчивости к вторичным инфекциям. В этой статье
рассматриваются современные знания о патофизиологии дисбактериоза, вызванного
антибиотикотерапией ОКИ, и представлены научно обоснованные стратегии
восстановления сбалансированной микробиоты кишечника. Ключевые подходы
включают использование пробиотиков, пребиотиков и синбиотиков, а также
рациональное использование антибиотиков и тщательный мониторинг функции
желудочно-кишечного тракта.
Ключевые слова:
острые кишечные инфекции, антибиотики, дисбактериоз,
пробиотики, микробиота кишечника, рациональное использование антибиотиков
INTRODUCTION
Acute intestinal infections (AIIs) are among the most common causes of acute
gastroenteritis worldwide, leading to significant morbidity and, in certain regions, elevated
mortality, especially in pediatric populations 111. Their etiological agents include bacteria
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(e.g.,
Salmonella spp.
,
Shigella spp.
, pathogenic
Escherichia coli
), viruses (rotavirus,
norovirus), and protozoa [1]. Depending on the severity and cause, bacterial AIIs frequently
necessitate antibiotic therapy. While antibiotics can be lifesaving, they often disrupt the gut
microbiome’s natural balance, resulting in dysbiosis and associated complications 222.
The present article provides an overview of how antibiotic therapy contributes to dysbiosis
during AIIs, the clinical implications of this dysbiosis, and current evidence-based
interventions that aim to restore a healthy gut microbiota [2].
Etiology and pathogenesis of aii-related dysbiosis
Mechanisms of Antibiotic-Induced Dysbiosis - Antibiotics work by targeting bacterial
pathogens, but they also non-selectively impact commensal flora in the gut. Key
mechanisms include: Reduced Microbial Diversity: Broad-spectrum antibiotics can eradicate
beneficial bacteria (e.g.,
Bifidobacterium
spp.,
Lactobacillus
spp.), diminishing overall
richness and diversity of the microbiome 333. Overgrowth of Resistant Strains: With
commensals depleted, antibiotic-resistant organisms (e.g.,
Clostridioides difficile
) can
proliferate, leading to secondary infections and inflammation. Metabolic Shifts: Loss of
beneficial bacteria impairs short-chain fatty acid (SCFA) production, influencing gut pH and
epithelial integrity [3].
Clinical Manifestations - Prolonged Diarrhea: Antibiotic-associated diarrhea can be
exacerbated in an environment of ongoing intestinal infection. Malabsorption: Dysbiosis
reduces the capacity of the gut to digest and absorb nutrients. Recurrence or Persistence of
Infection: An imbalanced microbiota may fail to outcompete remaining pathogens [4]. Risk
of Secondary Infections: The prevalence of opportunistic pathogens (e.g.,
C. difficile
)
increases under dysbiotic conditions.
DIAGNOSTIC CONSIDERATIONS
Microbiological Testing - Stool Culture: Useful for identifying primary pathogenic bacteria,
as well as any emerging resistant flora. Molecular Methods (PCR): Can detect low levels of
pathogenic bacteria or viruses, and sometimes quantify pathogenic or beneficial strains.
Microbiota Profiling - 16S rRNA Gene Sequencing: Provides insights into microbial
community composition. Although more common in research settings, next-generation
sequencing techniques are increasingly being used clinically to assess the extent of dysbiosis.
Metabolomic Analysis: Evaluates functional changes (e.g., SCFA production). Still largely
in the research phase but offers a deeper understanding of metabolic alterations [5].
Clinical markers - Inflammatory Markers: Elevated C-reactive protein (CRP) or fecal
calprotectin can indicate intestinal inflammation [6]. Symptom Assessment: Frequency of
diarrhea, abdominal pain, bloating, and presence of systemic symptoms help evaluate the
severity of dysbiosis.
TREATMENT STRATEGIES
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Rational Antibiotic Therapy - Narrow-Spectrum Agents: Whenever possible, select agents
that specifically target the identified pathogen. Reducing the use of broad-spectrum
antibiotics helps preserve beneficial gut flora. Antibiotic Stewardship: Includes de-escalating
therapy based on pathogen sensitivities, limiting treatment duration, and avoiding
inappropriate antibiotic use.
Probiotic Supplementation - Single-Strain Probiotics:
Lactobacillus rhamnosus GG
,
Saccharomyces boulardii
, and
Bifidobacterium
species are commonly used. Studies show
they can reduce the incidence and severity of antibiotic-associated diarrhea 444. Multi-Strain
Formulations: Combining different species may broaden the coverage and enhance
resilience against multiple pathogens [7]. Timing and Dosage: Probiotics are most effective
when initiated early in therapy and continued for at least 1–2 weeks post-antibiotic course.
Dosages typically range from 10^7 to 10^10 CFU/day, though optimal levels depend on
specific strains.
Prebiotics and Synbiotics - Prebiotics: Non-digestible food ingredients (e.g.,
fructooligosaccharides, inulin) that selectively feed beneficial gut bacteria. Synbiotics:
Formulations that combine probiotics and prebiotics, aiming to improve probiotic survival
and colonization [8]. Dietary Fiber: Encouraging whole-grain foods, fruits, and vegetables
can enhance gut flora recovery.
Adjunctive Therapies - Enterosorbents (e.g., activated charcoal, smectite) can help bind
bacterial toxins, though their role in dysbiosis remains under investigation. Zinc
Supplementation: Particularly beneficial in pediatric populations, as zinc supports epithelial
integrity and immune function. Rehydration Therapy: Oral rehydration solutions are key to
preventing dehydration in patients with ongoing diarrheal symptoms.
Prevention and Long-Term Management
Vaccination - Preventing primary infections (e.g., rotavirus vaccine, COVID-19 vaccine,
influenza vaccine) can reduce the need for antibiotics and, hence, lower the risk of dysbiosis.
Infection control - Hand Hygiene and Sanitation: Reduces the transmission of pathogenic
bacteria and viruses. Isolation Precautions: In hospital settings, adherence to infection
control protocols can prevent healthcare-associated infections that complicate the patient’s
gastrointestinal condition.
Ongoing Microbiome Monitoring - In cases of severe or recurrent dysbiosis, periodic stool
analyses or other emerging diagnostics may guide personalized interventions, including
targeted probiotic use or dietary modifications.
DISCUSSION
Antibiotic-induced dysbiosis can prolong or worsen the clinical course of acute intestinal
infections, resulting in additional morbidity and extended convalescence. The gut microbiota
plays a critical protective role, acting as a barrier to pathogen colonization and contributing
to immune function. When antibiotics are necessary for life-threatening infections, the
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judicious selection of agents and the concurrent or subsequent use of microbiome-supportive
measures can mitigate the negative impact on the gut ecosystem.
Challenges persist in identifying optimal probiotic strains, dosages, and durations for
different patient populations. Moreover, while current evidence supports the efficacy of
many commercially available products, further large-scale, randomized clinical trials are
needed to standardize best practices, especially in pediatric and immunocompromised
individuals.
CONCLUSION
The management of dysbiosis during antibiotic therapy for acute intestinal infections
necessitates a multifaceted approach. Central to this is the rational use of antibiotics guided
by precise microbiological diagnoses, combined with probiotic supplementation, prebiotics,
and synbiotics to help restore intestinal homeostasis. Emphasizing antibiotic stewardship,
promoting preventive measures (e.g., vaccination), and advancing diagnostic techniques will
contribute to improved patient outcomes and a reduced burden of antibiotic-associated
dysbiosis.
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World Health Organization. Diarrheal disease.
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