GI

Question 1

if C. difficile testing is positive on stool culture, what severity assessment should be undertaken?

Answer 1

1+ marker = severe C. diff

• temperature >38.5
• ileus, colonic dilataiton >6cm on AXR/CT, toxic megacolon or pseudomembranous colitis
• WCC >15x10^9L
• serum creatine >1.5 x baseline

Question 2

if C. difficile testing is positive on culture but patient doesn’t have any markers of severity, what is the initial treatment?
(this is not a recurrence)

Answer 2

metronidazole 400mg TDS PO
for 10 days
if no oral route:
metronidazole 500mg TDS IV
for 10 days

Question 3

if C. difficile testing is positive on culture and patient has gone through 5 days of treatment with metronidazole but hasn’t had any improvement/has got worse what should the treatment be?

Answer 3

switch treatment to:
vancomycin 125mg PO (or with NG tube) QDS
for 10 days

Question 4

if C. difficile testing is positive on culture and patient has 1+ markers of severity, what is the initial treatment?

Answer 4

vancomycin 125 QDS
for 10 days
if no oral route:
give via NG tube
\+/- metronidazole IV

Question 5

what is the antibiotic treatment for acute gastroenteritis?

Answer 5

no antibiotic treatment unless patient systemically unwell or post antibiotic

Question 6

what is the antibiotic treatment for diverticulitis?

Answer 6

uncomplicated acute diverticulitis may not need treatment
if antibiotics indicate:
metronidazole 500mg TDS
PLUS
co-trimoxazole 960mg BD for 5 days

Question 7

what is the initial antibiotic treatment for peritonitis/biliary tract/intra-abdominal infections?

Answer 7

IV amoxicillin + metronidazole + gentamicin
7-10 days
penicillin allergic:
IV vencomycin + metronidazole+ gentamicin
7-10 days

Question 8

what is the step down antibiotic treatment for peritonitis/biliary tract/intra-abdominal infections?

Answer 8

PO co-trimoxazole + metronidazole