GI infections: antibacterial therapy Flashcards
Would you routinely prescribe antibiotics in an immunocompetent patient with Campylobacter enteritis?
NO
- frequently self-limiting
Treat if immunocompromised or if severe infection
What is the first-line antibiotic for Campylobacter enteritis (if patient is immunocompromised or if severe infection)?
Clarithromycin
(or azithromycin or erythromycin)
Alternative: ciprofloxacin
What complications are associated with complicated acute diverticulitis? (6)
- Abscess
- Bowel perforation and peritonitis
- Fistula
- Intestinal obstruction
- Haemorrhage
- Sepsis
Which patients with acute diverticulitis should be offered oral antibacterials? (3)
- Systemically unwell
- Immunosuppressed
- Significant comorbidities
For patients with acute diverticulitis who are systemically well, consider a watchful waiting and no antibacterial prescribing strategy
How soon should patients with suspected complicated acute diverticulitis and uncontrolled abdominal pain be referred to the hospital for assessment?
Same-day
If patients are admitted to hospital with suspected or confirmed complicated acute diverticulitis, what is the route of administration for antibacterials?
IV
Should antibacterial prophylaxis be given to prevent recurrent acute diverticulitis?
NO
What is the route of administration of antibiotics in suspected or confirmed uncomplicated acute diverticulitis?
Oral
First line: co-amoxiclav
- 500/125 mg 3 times a day for 5 days then review
What is the first-line antibiotic in suspected or confirmed uncomplicated acute diverticulitis?
Co-amoxiclav (oral)
- 500/125 mg 3 times a day for 5 days then review
Alternative in penicillin allergy or co-amoxiclav unsuitable:
- cefalexin (caution in penicillin allergy) + metronidazole, OR
- Trimethoprim + metronidazole, OR
- Ciprofloxacin (only if switching from IV route with specialist advice) + metronidazole
What are the two options for antibiotic regimes in suspected or confirmed complicated acute diverticulitis?
- Co-amoxiclav, or cefuroxime, + metronidazole
OR
- Amoxicillin + gentamicin + metronidazole
Alternative in penicillin and cephalosporin allergy:
- ciprofloxacin + metronidazole
When do we treat salmonella (non-typhoid) with antibiotics? (2)
- Invasive or severe infection
- Risk of developing invasive infection (e.g. immunocompromised patients, those with haemoglobin, or children under 6 months of age)
Antibiotics: ciprofloxacin or cefotaxime
Which patients are at increased risk of an invasive salmonella (non-typhoid) infection and should be treated with antibiotics?
- Immunocompromised patients
- Patients with haemoglobinopathy
- Children under 6 months of age
Antibiotics: ciprofloxacin or cefotaxime
Which two antibiotics are used to treat invasive or severe salmonella (non-typhoid) infections?
Ciprofloxacin
OR
Cefotaxime
Name 6 antibiotic classes/drugs that have increased risk of the patient developing a C. difficile infection?
- Ampicillin
- Amoxicillin
- Co-amoxiclav
- 2nd and 3rd generation cephalosporins
- Clindamycin
- Quinolones
May be a side effect of all antibiotics
What are the three antibiotic drugs used in the treatment of C- difficile infection?
Metronidazole (oral)
- 400 mg every 8 hours for 10-14 days
Vancomycin (oral)
- 125 mg every 6 hours for 10-14 days
Fidaxomicin (oral)
- 200 mg every 12 hours for 10-14 days
What is the first-line treatment for the first episode of mild to moderate C. difficile infection?
Metronidazole (oral)
- 400 mg every 8 hours for 10-14 days
What is the first-line treatment for the second or subsequent episode of C. difficile infection?
Vancomycin (oral)
- 125 mg every 6 hours for 10-14 days
Alternative: fidaxomicin (oral)
- 200 mg every 12 hours for 10-14 days
What is the first-line treatment for a severe infection of C. difficile?
Vancomycin (oral)
- 125 mg every 6 hours for 10-14 days
Alternative: fidaxomicin (oral)
- 200 mg every 12 hours for 10-14 days
What antibiotic would you consider for a C. difficile infection that is not responding to metronidazole or if the patient is intolerant of metronidazole?
Vancomycin (oral)
- 125 mg every 6 hours for 10-14 days
What antibiotic would you consider for a C. difficile infection that is not responding to vancomycin (it is NOT a life-threatening infection and there is NO ileus)?
Fidaxomicin (oral)
- 200 mg every 12 hours for 10-14 days
What is the first-line treatment for life-threatening C. difficile infection?
Oral vancomycin + IV metronidazole
- 10-14 days
What is the first-line treatment for C. difficile in a patient with ileus?
Oral vancomycin + IV metronidazole
- 10-14 days
What antibiotic treatment would you consider for a C. difficile infection that is NOT responding to vancomycin or fidaxomicin?
Oral vancomycin + IV metronidazole
- 10-14 days
What are two antibacterial options for a severe C. difficile infection in patients with multiple co-morbidities who are receiving treatment with other antibacterials?
Fidaxomicin (oral)
- 200 mg every 12 hours for 10-14 days
OR
Vancomycin (oral)
- 125 mg every 6 hours for 10-14 days
Can fidaxomicin be used to treat systemic infections?
NO
It is poorly absorbed from the GI tract
Fidaxomicin is a macrocyclic antibacterial
What three antibiotics would you consider in the treatment of a biliary-tract infection?
Ciprofloxacin OR Gentamicin OR A cephalosporin
What are 4 options for antibiotic regimes for the treatment of peritonitis?
A cephalosporin + metronidazole OR Gentimacin + metronidazole OR Gentamicin + clindamycin OR Peperacillin with tazobactam alone
What are the two options for antibiotic regimes for peritonitis associated with peritoneal dialysis?
Vancomycin (or teicoplanin) + ceftazidime added to dialysis fluid
OR
Vancomycin added to dialysis fluid + ciprofloxacin by mouth
Duration of treatment 14 days or longer
What organisms are commonly involved in cholangitis in the UK?
Klebsiella spp. Escherichia coli Enterobacter spp. Enterococci Streptococci
https://patient.info/doctor/cholangitis
