Уважаемый Алексей!
По первому вопросу: вынужден Вас разочаровать - никто не оценивает частоту ААД при/после лечения ИППП: ее оценка проводится после курсов различных антибиотиков. Согласно недавнему доступно написанному обзору
Lembcke B, Kist M, Lentze MJ, Bruns J, Gesche M, Herrmann M, Gyr N. Links
Antibiotic-associated diarrhea: incidence, risk factors of antibiotics and patients, pathophysiology and differential diagnosis--an interdisciplinary approach to a common problem.
Schweiz Rundsch Med Prax. 2003 Apr 16;92(16):751-9. Review
ее частота колеблется от 5% до 39% и удельныЙ вес в ней Clostridium difficile-АД (КДАД) как 10-50%. Наиболее часто ААД возникает если:
антибиотик назначается длительно (более 3-7 дней);
плохо всасывается в ЖКТ;
подвергается экскреции с желчью;
имеет антианаэробное действие.
Увеличение риска развития при приеме отд. АБ:
цефоперазон (цефтриаксон) 40%
Амоксиклав 10-30%
Макролиды 14%
Ампициллин 5-25%
Тетрациклин 10-25%
клиндамицин 27%
фторхинолоны 17%
Среди факторов риска пациентов:
возраст младше 6 лет, старше 65 лет
патология ЖКТ
2 и более сопутствующих заболевания
Тоже самое в др. обзорах (в оригинале)
Bergogne-Berezin E.
Treatment and prevention of antibiotic associated diarrhea.
Int J Antimicrob Agents. 2000 Dec;16(4):521-6. Review.
...Antibiotic associated diarrhea (AAD) is a common complication of antibiotic therapy, occurring in approximately 5 to 25% of patients receiving antibiotics. The incidence of AAD varies with the class of antibiotic used and with risk factors in patients treated: AAD has been observed in a wide variety of patient populations including orthopedic, obstetric/gynecologic, intensive-care-unit patients and even ambulatory patients...
...The incidence of AAD varies between antibiotic classes and, within a given class, significant differences in the impact of a specific molecule on the occurrence of AAD have been underlined. Nearly all antibiotics (except for vancomycin and aminoglycosides) can be responsible for AAD, particularly if the anaerobic intestinal flora form part of their antibacterial spectrum and provided that antibiotic concentrations are high enough in the intestinal lumen to inhibit the anaerobes. The predominant antibiotics that have been reported to produce the highest incidence of AAD are the aminopenicillins (ampicillin/amoxicillin), combination of amoxicillin and clavulanic acid, cephalosporins and clindamycin.
Mylonakis E, Ryan ET, Calderwood SB.
Clostridium difficile--Associated diarrhea: A review.
Arch Intern Med. 2001 Feb 26;161(4):525-33
...Clostridium difficile is the cause of approximately 25% of all cases of antibiotic-associated diarrhea...
...Most cases of C difficile–associated disease occur in hospitals or long-term care facilities (rate of 25-60 per 100 000 occupied bed-days), causing more than 300 000 cases per year in the United States alone. The incidence of this infection in the outpatient setting (7.7 cases per 100 000 person-years; approximately 20 000 cases per year in the United States) is lower, but not negligible. Overall, the risk for development of C difficile–associated diarrhea (CDAD) within 6 weeks of a course of antibiotics in the outpatient setting is low (6.7 cases per 100 000 exposures)...
...Among hospitalized individuals, the risk for CDAD after clindamycin therapy has been estimated to range from 1 in 10 to 1 in 10 000...
... the antibiotics most frequently associated with infection in addition to clindamycin have been ampicillin, amoxicillin, and the cephalosporins...
Неплохие стат. данные приведены в в проспективн. исследовании из Швеции:
Wistrom J, Norrby SR, Myhre EB, Eriksson S, Granstrom G, Lagergren L, Englund G, Nord CE, Svenungsson B.
Frequency of antibiotic-associated diarrhoea in 2462 antibiotic-treated hospitalized patients: a prospective study.
J Antimicrob Chemother. 2001 Jan;47(1):43-50.
The frequency of antibiotic-associated diarrhoea (AAD) and Clostridium difficile-associated diarrhoea (CdAD) was prospectively determined in a population of 2462 patients recruited from five Swedish hospitals, including divisions for infectious diseases, orthopaedics, surgery, geriatrics, nephrology and internal medicine. AAD developed in 4.9% of the treated patients...
...and was highest in the nephrology and geriatric units (6.7 and 7.1%, respectively).
Of the 540 subjects with concomitant illness, 6.3% developed AAD. Patients suffering from two or more of these illnesses had a significantly increased risk of AAD (risk ratio 3.01; CI 1.55–5.86; P = 0.001) compared with patients with at most one concomitant disease. No such differences where found among patients with diabetes, chronic renal disease or malignancy only.
A significant increase in risk for AAD was observed for patients treated with antibiotics for >3 days (risk ratio 2.28; CI 1.23–4.21; P = 0.009) (Table IV). No significant differences were found among groups of patients treated for >3 days:
Duration(days) - Number treated - Number (%) with AAD:
less 3 - 422- 10 (2.4)
4–7 - 286 - 15 (5.2)
8–10 - 269 -12 (4.5)
10–21 - 932 - 46 (4.9)
Among groups of patients treated with only one antibiotic, the highest frequencies of AAD (6.7%) were found in patients treated with broad-spectrum penicillins (ampicillin derivatives, pivmecillinam and piperacillin alone or in combination with tazobactam) and those treated with cephalosporins (6.1%). None of those treated only with quinolones or co-trimoxazole developed AAD.
The frequencies of AAD and total illness were also analysed in groups of patients treated with more than one antibiotic either concomitantly or sequentially. The highest frequency of AAD (11%) was observed among those treated with clindamycin in combination with other antibiotics. Among 220 patients treated with metronidazole and 40 treated with glycopeptides in combination with other antibiotics, 7.7 and 5.0%, respectively, developed AAD.
Only one of 80 patients treated solely with cefuroxime experienced symptoms of AAD. When cefuroxime was given in combination with other antibiotics, 4.9% of the patients developed AAD compared with 7.5% for those who received cefotaxime in combinations and 11.4% for patients in whom ceftazidime was the cephalosporin in combinations. The frequency of AAD varied substantially among groups of patients treated with an oral cephalosporin in combination with other antibiotics. The highest frequency of AAD (28.6%, CI 15.9–48.7%) was found in patients treated with cefpodoxime proxetil, as compared with 1.6% in patients given loracarbef.
Tetracycline only: 1 (2.0%); Tetracycline + other: 3 (1.8%).
Думаю, инфо для размышления пока хватит, по-моему выбирая антибиотик для лечения ИППП, уже можно предположить вероятный индивидуальный риск ААД.