Can Strep Throat or Antibiotics for Strep Cause Diarrhea?

Can Strep Throat Cause Diarrhea?

Strep throat, which is caused by group A streptococcus bacteria, is a common illness that causes a sore, scratchy throat. While strep throat itself doesn't directly cause diarrhea, the antibiotics used to treat strep throat can sometimes lead to diarrhea as a side effect.

Let's take a closer look at the connection between strep throat, antibiotics, and diarrhea.

What Is Strep Throat?

Strep throat is an infection in the throat and tonsils caused by Streptococcus pyogenes bacteria, also known as group A streptococcus. It is a contagious illness that spreads through respiratory droplets when someone with strep throat coughs or sneezes.

Common symptoms of strep throat include:

• Sore, scratchy throat
• Pain when swallowing
• Fever
• Headache
• Body aches
• Red and swollen tonsils sometimes with white patches or streaks of pus
• Tiny red spots on the roof of the mouth

Strep throat can occur at any age but is most common in school-aged children between 5-15 years old. It is diagnosed through a rapid strep test or throat culture from a swab of the throat.

How Is Strep Throat Treated?

Strep throat is treated with antibiotics, most commonly penicillin or amoxicillin. These antibiotics work by stopping the growth and spread of the streptococcus bacteria that cause the illness.

It's important to take all doses of the prescribed antibiotic as directed, even if you start feeling better sooner. Not finishing the full course of medication can lead to a recurrent infection.

Can the Antibiotics for Strep Cause Diarrhea?

Antibiotics, including those used to treat strep throat, can sometimes cause diarrhea as a side effect. Here's why:

• Antibiotics kill off good bacteria in the gut along with the bad bacteria they are targeting. This can allow "bad" bacteria like Clostridioides difficile to overgrow, causing diarrhea.
• Alterations in the gut microbiome from antibiotics can affect digestion and absorption of nutrients from food.
• Antibiotics may stimulate intestinal secretion and motility, speeding up the passage of stool.

While antibiotic-associated diarrhea can occur with penicillin or amoxicillin, it appears to be more frequent with broader spectrum antibiotics like azithromycin and cephalosporins.

Who Is at Risk for Antibiotic Diarrhea?

Anyone taking antibiotics can develop diarrhea, but certain individuals may be at increased risk:

• Older adults
• People taking proton pump inhibitors like omeprazole
• Those with compromised immune systems
• People who have been hospitalized
• Those who have taken antibiotics recently or frequently

Talk to your doctor if you are at high risk for antibiotic diarrhea.

How Long After Taking Antibiotics Does Diarrhea Start?

Diarrhea may come on at any point during or after a course of antibiotics, but it most often begins about a week after starting antibiotic treatment. Mild cases may resolve within a few days of finishing the antibiotics. More severe cases can last for several weeks or longer.

How to Treat Antibiotic Diarrhea

Mild antibiotic diarrhea often improves on its own once the antibiotics are finished. Things you can do at home to manage symptoms include:

• Drink plenty of water and clear fluids to prevent dehydration
• Eat bland, easy to digest foods like bananas, rice, applesauce, and toast
• Avoid dairy, greasy, or sugary foods which can make diarrhea worse
• Ask your doctor about taking an over-the-counter anti-diarrheal medication
• Take a probiotic supplement to help restore good bacteria to the gut

See your doctor if you have severe diarrhea with signs of dehydration like dizziness, dark urine, or inability to keep down fluids. You may need IV fluid replacement or additional medications to control the diarrhea.

Can Probiotics Help Prevent Antibiotic Diarrhea?

Probiotics are live microorganisms that provide health benefits when consumed. Common probiotic strains come from the Lactobacillus and Bifidobacterium groups of bacteria.

Studies show that taking probiotic supplements during and after a course of antibiotics may help reduce the risk of developing antibiotic-associated diarrhea. Possible mechanisms include:

• Restoring a healthy balance of gut bacteria
• Boosting the immune system
• Improving digestion and gut barrier function

Ask your doctor for probiotic recommendations. The best studied strains for preventing antibiotic diarrhea are Lactobacillus rhamnosus GG and Saccharomyces boulardii.

When to See a Doctor for Antibiotic Diarrhea

Contact your doctor if you experience any of the following while taking antibiotics or within a few weeks after finishing:

• Watery diarrhea 4 or more times per day
• Bloody or mucoid stool
• Severe cramping or abdominal pain
• Dehydration symptoms like dark urine, dizziness, or weakness
• Inability to keep down any fluids
• Fever over 101F (38C)
• Diarrhea persisting more than 2-3 days after antibiotics are done

Rarely, antibiotic use can cause a serious condition called pseudomembranous colitis caused by the bacteria Clostridioides difficile. Seek immediate medical attention if you have severe diarrhea, abdominal pain, fever, or blood or pus in the stool after taking antibiotics.

Can You Take Antidiarrheal Medication with Antibiotics?

Check with your doctor before taking any over-the-counter antidiarrheal agents like loperamide (Imodium), bismuth subsalicylate (Pepto-Bismol), or diphenoxylate with atropine (Lomotil) alongside antibiotics. There are some concerns they may slow the removal of bacteria and prolong infection.

However, your doctor may recommend short-term use of these medications if you have severe diarrhea that is affecting your everyday activities and hydration status.

The Bottom Line

Antibiotics used to treat strep throat infections can sometimes cause diarrhea due to their effects on the gut microbiome. Probiotics may help reduce the risk. Mild cases can often be managed at home with hydration, diet changes, and over-the-counter remedies. See a doctor if you have severe, persistent diarrhea or concerning symptoms after taking antibiotics for strep throat.

Speak with your healthcare provider if you develop significant diarrhea while on or after a course of antibiotics. They can provide guidance on managing symptoms and ensure there are no complications.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.