GI systems Flashcards
when would you treat campylobacter enteritis
Frequently self-limiting; treat if immunocompromised or if severe infection.
treatment of campylobacter enteritis
Clarithromycin (or azithromycin or erythromycin)
Alternative, ciprofloxacin
But be aware that strains with decreased sensitivity to ciprofloxacin isolated frequently!!!
oral 1st line for suspected or confirmed uncomplicated acute diverticulitis IF systemically unwell etc.
co amoxiclav
alt: cefalexin + metro, trimethoprim + metro, or cipflox + metro
what do do about pt which acute diverticulitis who can’t take oral treatment
refer to hospital
what is given for suspected or confirmed complicated acute diverticulitis (IV)
co amox, or
cefuroxime + metro, or
amox + gent + metro
alt: cipro + metro
Salmonella (non-typhoid)
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).
What is given for treatment? 2 options
ciproflox or cefotaxime
Shigellosis - abx are not indicated for mild cases. If they are indicated, what do you give
Antibacterial not indicated for mild cases.
Ciprofloxacin or azithromycin
Alternatives if micro-organism sensitive, amoxicillin or trimethoprim
what is typically given for typhoid fever
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
advice about typhoid fever from foreign countries
Infections from Middle-East, South Asia, and South-East Asia may be multiple-antibacterial-resistant and sensitivity should be tested.
how does CDI occur
normal gut microbiota are suppressed, allowing levels of toxin producing strains of C. difficile to flourish
toxin damages the lining of the colon and causes diarrhoea
5 complications of CDI
pseudomembranous colitis, toxic megacolon, colonic perforation, sepsis, and death.
which abx are freq associated with CDI
Clindamycin, cephalosporins (especially third and fourth generation), fluoroquinolones, and broad-spectrum penicillins
CDI infection risk increases with…
onger duration of antibacterial treatment, concurrent use of multiple antibacterials, or multiple antibacterial courses
other risk factors for CDI, not abx related
current use of acid suppressing drugs (such as proton pump inhibitors), age over 65 years, prolonged hospitalisation, underlying comorbidity, exposure to other people with the infection, and previous history of C. difficile infection(s).
when to refer pt with CDI
severely unwell, or their signs or symptoms worsen rapidly or significantly at any time.
Clinical judgement should be used to determine if antibacterial treatment is ineffective . This is not usually possible until day 7 because…
(CDI)
diarrhoea may take 1–2 weeks to resolve
CDI 1st episode of mild, moderate or severe CDI infection
1st and 2nd line + doses and duration
ORAL
1st: vancomycin 125mg QDS 10 days
2nd: fidoxamicin 200mg BD 10 days
further episode of CDI - 1st line if infection within 12 weeks of symptom resolution (aka relapse)
fidoxamicin 200mg BD 10 days
further episode of CDI - oral 1st line if recurrence aka infection >12 weeks after symptom resolution
vancomycin or fidoxamicin
what is given for biliary tract infection - 3 options
Ciprofloxacin or gentamicin or a cephalosporin
peritonitis infection
what to give
cephalosporin + metronidazole OR
gentamicin + metronidazole OR
gentamicin + clindamycin OR
piperacillin with tazobactam
