Daptomycin-Associated Diarrhea: A Case Report and Review of the Literature.

Antibiotic-associated diarrhea (AAD) describes any unexplained diarrhea associated with the use of antibiotics. AAD develops through diverse mechanisms, ranging from pharmacologic effects on gut motility to disturbance of the function and carbohydrate metabolism of the indigenous intestinal flora and overgrowth by pathogenic micro-organisms. Clostridioides difficile-associated diarrhea (CDAD) is a subset of AAD; however, it accounts only for a small percentage of diarrhea caused by antibiotics. Diarrhea has been reported as a side effect of daptomycin use, nevertheless, it's thought to be mild and carries significantly less risk of diarrhea than other alternative treatments of S. aureus bacteremia, i.e., vancomycin or cefazolin. The authors present an interesting case of daptomycin-associated diarrhea presenting with a protracted and severe course. Patient symptoms didn't improve with empiric Clostridioides difficile therapy and CDAD testing was negative. Diarrhea promptly resolved after discontinuation of daptomycin. Furthermore, a thorough literature review was conducted and discussed in this article to raise awareness of this under-recognized complication. Clinicians should be mindful of daptomycin-associated diarrhea along with its presentation and treatment. Further studies are needed to identify the pathophysiology of daptomycin-associated diarrhea and other forms of AAD. Understanding their mechanism could help prevent, treat, and reduce the significant medical costs associated with antibiotic adverse events.

Knowledge, attitude, and practice of iodized salt use in Al-Riyadh and Al-Ozozab areas, Khartoum, Sudan.

Iodine deficiency and subsequent iodine deficiency disorders have been a longstanding problem in many areas of the world, including Sudan, and still remains as the leading cause of preventable brain damage. According to the Sudan Household Health Survey, in 2006, the consumption of iodized salt in Sudan was 11%, only to deteriorate later on in 2011 to 9.5%. This is a descriptive cross sectional study which assesses the knowledge, attitude, and practice regarding the use of iodized salt in two socioeconomically different residential areas, Al-Riyadh and Al-Ozozab, Khartoum city, Sudan. From total of 152 participants selected from Al-Riyadh and Al-Ozozab areas (50% from each), there were 87 (57 %) females. Participants from Al-Riyadh had a higher educational and income level than those from Al-Ozozab, and better knowledge regarding the importance of regular iodized salt consumption to treat iodine deficiency (61% and 54%, respectively). However, only 39% of the participants were actually buying iodized salt. There was a significant relationship between residency and buying of iodized salt among the participants from Al-Riyadh (49%) and Al-Ozozab (30%) areas (p-value = 0.02). There was also significant association between the educational level and buying iodized salt (p-value = 0.014), but not with the income (p-value = 0.23). The consumption of potential goitrogenic foods (pearl millet or peanut butter) was high among the participants (n = 142) from Al-Riyadh and Al-Ozozab, and constituted 76% and 83%, respectively. Compulsory national salt specification needs to be established in Sudan, together with monitoring the market availability of iodized salt.