Gastro-intestinal system infections, antibacterial therapy Flashcards
Gastro-enteritis:
Q: Is antibacterial treatment usually indicated for gastro-enteritis?
A: Antibacterial treatment is not usually indicated for gastro-enteritis, as it’s frequently self-limiting and may not be bacterial.
Q: When should you consider treating Campylobacter enteritis with antibacterials?
A: Treat Campylobacter enteritis with antibacterials if the patient is immunocompromised or if there’s severe infection. Use Clarithromycin (or azithromycin or erythromycin) or alternatively, ciprofloxacin.
Diverticulitis, Acute:
Q: What is acute diverticulitis, and what strategy is recommended for treating it in patients who are systemically well?
A: Acute diverticulitis is inflammation of diverticula in the large intestine. In patients who are systemically well, consider a watchful waiting and a no antibacterial prescribing strategy.
Q: When should you offer antibacterial treatment for acute diverticulitis, and what are the first-line options for suspected or confirmed uncomplicated and complicated cases?
A: Offer antibacterial treatment to patients who are systemically unwell, immunosuppressed, or have significant comorbidities.
Uncomplicated: Co-amoxiclav or alternatives if applicable.
Complicated: Intravenous first-line options include co-amoxiclav, cefuroxime with metronidazole, or amoxicillin with gentamicin and metronidazole.
Salmonella (non-typhoid):
Q: When should you treat Salmonella infection, and what are the recommended antibacterials?
A: Treat Salmonella infection if it’s invasive or severe, and consider ciprofloxacin or cefotaxime.
Shigellosis:
Q: Is antibacterial treatment indicated for mild cases of shigellosis? If yes, what are the recommended antibacterials?
A: Antibacterial treatment is not indicated for mild cases. For more severe cases, consider ciprofloxacin or azithromycin, with alternatives like amoxicillin or trimethoprim if applicable.
Typhoid Fever:
Q: When should you treat typhoid fever, and what are the first-line and alternative options?
A: Treat typhoid fever, especially in cases from regions with multiple-antibacterial-resistant strains. Use Cefotaxime (or ceftriaxone) as the first line, and consider azithromycin for mild or moderate disease due to multiple-antibacterial-resistant organisms.
Clostridioides Difficile Infection:
Q: What are the risk factors for Clostridioides difficile (C. difficile) infection?
A: Risk factors include recent or concurrent use of certain antibacterials, proton pump inhibitors, age over 65, prolonged hospitalization, underlying comorbidity, exposure to infected individuals, and previous C. difficile infection(s).
Q: When should you offer antibacterial treatment for C. difficile infection, and what are the first-line options for mild, moderate, severe, or life-threatening cases?
A: Offer antibacterial treatment for C. difficile infection.
First episode: Vancomycin or fidaxomicin.
Further episodes (relapse or recurrence): Fidaxomicin or vancomycin.
Life-threatening infection: Consult a specialist for a tailored approach.
Biliary-tract Infection and Peritonitis:
Q: What are the first-line antibacterials for treating biliary-tract infection and peritonitis?
A: Ciprofloxacin, gentamicin, or a cephalosporin for biliary-tract infection. A cephalosporin + metronidazole, gentamicin + metronidazole, gentamicin + clindamycin, or piperacillin with tazobactam for peritonitis.
Q: What is the recommended antibacterial therapy for peritoneal dialysis-associated peritonitis?
A: Vancomycin (or teicoplanin) + ceftazidime in dialysis fluid, or vancomycin in dialysis fluid + ciprofloxacin by mouth. Suggested duration of treatment is 14 days or longer.
Gastro-enteritis:
Q: Is antibacterial treatment usually indicated for gastro-enteritis?
A: Antibacterial treatment is not usually indicated for gastro-enteritis, as it’s frequently self-limiting and may not be bacterial.
Q: When should you consider treating Campylobacter enteritis with antibacterials?
A: Treat Campylobacter enteritis with antibacterials if the patient is immunocompromised or if there’s severe infection. Use Clarithromycin (or azithromycin or erythromycin) or alternatively, ciprofloxacin.
Diverticulitis, Acute:
Q: What is acute diverticulitis, and what strategy is recommended for treating it in patients who are systemically well?
A: Acute diverticulitis is inflammation of diverticula in the large intestine. In patients who are systemically well, consider a watchful waiting and a no antibacterial prescribing strategy.
Q: When should you offer antibacterial treatment for acute diverticulitis, and what are the first-line options for suspected or confirmed uncomplicated and complicated cases?
A: Offer antibacterial treatment to patients who are systemically unwell, immunosuppressed, or have significant comorbidities.
Uncomplicated: Co-amoxiclav or alternatives if applicable.
Complicated: Intravenous first-line options include co-amoxiclav, cefuroxime with metronidazole, or amoxicillin with gentamicin and metronidazole.
Salmonella (non-typhoid):
Q: When should you treat Salmonella infection, and what are the recommended antibacterials?
A: Treat Salmonella infection if it’s invasive or severe, and consider ciprofloxacin or cefotaxime.
Shigellosis:
Q: Is antibacterial treatment indicated for mild cases of shigellosis? If yes, what are the recommended antibacterials?
A: Antibacterial treatment is not indicated for mild cases. For more severe cases, consider ciprofloxacin or azithromycin, with alternatives like amoxicillin or trimethoprim if applicable.
Typhoid Fever:
Q: When should you treat typhoid fever, and what are the first-line and alternative options?
A: Treat typhoid fever, especially in cases from regions with multiple-antibacterial-resistant strains. Use Cefotaxime (or ceftriaxone) as the first line, and consider azithromycin for mild or moderate disease due to multiple-antibacterial-resistant organisms.
Clostridioides Difficile Infection:
Q: What are the risk factors for Clostridioides difficile (C. difficile) infection?
A: Risk factors include recent or concurrent use of certain antibacterials, proton pump inhibitors, age over 65, prolonged hospitalization, underlying comorbidity, exposure to infected individuals, and previous C. difficile infection(s).
Q: When should you offer antibacterial treatment for C. difficile infection, and what are the first-line options for mild, moderate, severe, or life-threatening cases?
A: Offer antibacterial treatment for C. difficile infection.
First episode: Vancomycin or fidaxomicin.
Further episodes (relapse or recurrence): Fidaxomicin or vancomycin.
Life-threatening infection: Consult a specialist for a tailored approach.
Biliary-tract Infection and Peritonitis:
Q: What are the first-line antibacterials for treating biliary-tract infection and peritonitis?
A: Ciprofloxacin, gentamicin, or a cephalosporin for biliary-tract infection. A cephalosporin + metronidazole, gentamicin + metronidazole, gentamicin + clindamycin, or piperacillin with tazobactam for peritonitis.
Q: What is the recommended antibacterial therapy for peritoneal dialysis-associated peritonitis?
A: Vancomycin (or teicoplanin) + ceftazidime in dialysis fluid, or vancomycin in dialysis fluid + ciprofloxacin by mouth. Suggested duration of treatment is 14 days or longer.
