GI infections treatment summaries

Question 1

Gastro Enteritis

Answer 1

Frequently self-limiting and may not be bacterial.

Antibacterial not usually indicated.

Question 2

Campylobacter enteritis

Answer 2

Frequently self-limiting; treat if immunocompromised or if severe infection.

Clarithromycin (or azithromycin or erythromycin)
Alternative, ciprofloxacin
Strains with decreased sensitivity to ciprofloxacin isolated frequently

Question 3

Diverticulitis

Answer 3

Suspected or confirmed uncomplicated acute diverticulitis
Oral first line:
Co-amoxiclav.
Alternative in penicillin allergy or co-amoxiclav unsuitable: cefalexin (caution in penicillin allergy) with metronidazole, or trimethoprim with metronidazole, or ciprofloxacin (only if other antibacterials are inappropriate, and if switching from intravenous route under specialist advice) with metronidazole.
Suspected or confirmed complicated acute diverticulitis
Intravenous first line:
Co-amoxiclav, or cefuroxime with metronidazole, or amoxicillin with gentamicin and metronidazole.
Alternative only in penicillin and cephalosporins allergy: ciprofloxacin with metronidazole.
For alternative antibacterials consult local microbiologist.

Question 4

Salmonella

Answer 4

Treat invasive or severe infection. Do not treat less severe infection unless there is a risk of developing invasive infection (e.g. immunocompromised patients, those with haemoglobinopathy, or children under 6 months of age).

Ciprofloxacin or cefotaxime

Question 5

Shigellosis

Answer 5

Antibacterial not indicated for mild cases.

Ciprofloxacin or azithromycin
Alternatives if micro-organism sensitive, amoxicillin or trimethoprim

Question 6

Typhoid fever

Answer 6

Infections from Middle-East, South Asia, and South-East Asia may be multiple-antibacterial-resistant and sensitivity should be tested.

Cefotaxime (or ceftriaxone)
azithromycin may be an alternative in mild or moderate disease caused by multiple-antibacterial-resistant organisms.
Alternative if micro-organism sensitive, ciprofloxacin

Question 7

C.diff

Answer 7

First episode of mild, moderate, or severe C. difficile infection
Oral first line:
Vancomycin.
Oral second line:
Fidaxomicin.
If first and second line antibacterials are ineffective: seek specialist advice.
Further episode of C. difficile infection
Oral first line for infection within 12 weeks of symptom resolution (relapse):
Fidaxomicin.
Oral first line for infection more than 12 weeks after symptom resolution (recurrence):
Vancomycin or fidaxomicin.
Life-threatening C. difficile infection
Specialist may offer oral vancomycin with intravenous metronidazole.

Question 8

Biliary Tract infection

Answer 8

Ciprofloxacin or gentamicin or a cephalosporin

Question 9

Peritonitis

Answer 9

A cephalosporin + metronidazole or gentamicin + metronidazole or gentamicin + clindamycin or piperacillin with tazobactam alone

Question 10

Peritonitis: peritoneal dialysis-associated

Answer 10

Vancomycin (or teicoplanin) + ceftazidime added to dialysis fluid or vancomycin added to dialysis fluid + ciprofloxacin by mouth
Suggested duration of treatment 14 days or longer