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Is it safe to Metronidazole for diarrhea caused by Augmentin usage?

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Posted on Thu, 24 Sep 2015
Question: Can metronidazole worsen diarrhea caused by Augmentin?
Diarrhea started 15 days ago on day 5 (of 7) of an Augmentin treatment, improved after probiotics, then turned watery again. I've been prescribed metronidazole (I’m on day 3), debridat, smecta and probiotics but there is no improvement. Tests for salmonella, shigella, clostridium diff. came negative, but doctors think the bacteria may not be detectible. White blood cells (in stool) are 3+ and red blood cells are 0. I have been eating only recommended food for 5 days. I'm afraid taking an antibiotic for diarrhea caused by another antibiotic is actually making it worse.XXXX
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Answered by Dr. Klerida Shehu (14 hours later)
Brief Answer:
Following advice...

Detailed Answer:
Hi and thank you for asking.


I read carefully all your concerns and I understood your query.

You are reporting to have diarrhea after antibiotic (augmentin) use and improved after probiotics. After that you have used metronidazole and your symptoms come again.

Regarding all your situation I can say as follows:
1. Diarrhea that you are experiencing recently may be related with:
- Metronidazole side effect (diarrhea is a common side effect)
- candida infection after antibiotic use (augmentin plus metronidazole)
- disbacteriosis (antibiotics damage bacterial flora of the bowel)

So to my opinion you should do fecal exam for candida infection to rule out fungal overgrowth infection. Otherwise, discuss with your doctor to start anti fungal treatment.
2. You are reporting that your diarrhea has started after antibiotic treatment and it's very rare to happen a bacterial infection during this time. Since your tests for shigella, salmonella, and C. difficile are negative, it means that you have excluded the major causes of bacterial diarrhea.

This is why i strongly suspect for candida infection, that may be worsen during metronidazole use. At this situation I would suggest stopping metronidazole use.

For the moment continue using :
- probiotics, smecta and debridat
- plenty of water
- take rest

Wish you all the best!
Dr. Klerida
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Klerida Shehu (17 hours later)
Dear Dr. Klerida Shehu,

Thank you for your answer.
One correction: diarrhea reoccurred the next day after I stopped taking probiotics. The doctor prescribed metronidazole right away, before the test results came out and instructed me to continue even after the tests came out negative because now she says she is not sure a bacterial infection is detectable after taking metronidazole...
An update: today stool has final improved, it is not watery any more and pretty close to normal.
My question now is: does this mean that indeed I had an infection and I should continue taking metronidazole another 2 days as recommended?

Thank you
doctor
Answered by Dr. Klerida Shehu (24 hours later)
Brief Answer:
Please follow

Detailed Answer:
Hi and thank you for following up.

Thank you for clarifing your medical history.

Since your symptoms are improved than you should take metronidazole for another two days.
Otherwise I suggest to do Fecal exam for candida overgrowth. It is a common side effect of antibiotics.
Continue taking probiotics and plenty of water.

wishing you all the best.
Dr.Klerida
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Klerida Shehu

Gastroenterologist

Practicing since :2006

Answered : 2266 Questions

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Is it safe to Metronidazole for diarrhea caused by Augmentin usage?

Brief Answer: Following advice... Detailed Answer: Hi and thank you for asking. I read carefully all your concerns and I understood your query. You are reporting to have diarrhea after antibiotic (augmentin) use and improved after probiotics. After that you have used metronidazole and your symptoms come again. Regarding all your situation I can say as follows: 1. Diarrhea that you are experiencing recently may be related with: - Metronidazole side effect (diarrhea is a common side effect) - candida infection after antibiotic use (augmentin plus metronidazole) - disbacteriosis (antibiotics damage bacterial flora of the bowel) So to my opinion you should do fecal exam for candida infection to rule out fungal overgrowth infection. Otherwise, discuss with your doctor to start anti fungal treatment. 2. You are reporting that your diarrhea has started after antibiotic treatment and it's very rare to happen a bacterial infection during this time. Since your tests for shigella, salmonella, and C. difficile are negative, it means that you have excluded the major causes of bacterial diarrhea. This is why i strongly suspect for candida infection, that may be worsen during metronidazole use. At this situation I would suggest stopping metronidazole use. For the moment continue using : - probiotics, smecta and debridat - plenty of water - take rest Wish you all the best! Dr. Klerida