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PR3124 > Infectious Diarrhea > Flashcards

Infectious Diarrhea Flashcards

1
Q

Definition of acute infectious diarrhea

A

Acute : less than 14 days
Infectious : more than 1 pathogens
Diarrhea : >=3 loose stools or more frequent than normal

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2
Q

When to do diagnostic tests for diarrhea

A
  1. Bloody stools
  2. Persisting fever
  3. Immunosuppressed
  4. Severe illness
  5. Non-responsive to treatment
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3
Q

Vaccinations available for infectious diarrhea

A
  1. Cholera and typhoid (for those travelling to endemic areas)
  2. Rotavirus (for infants 6months-5 years)
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4
Q

Indications for antibiotics in infectious diarrhea

A
  1. Severe illness (fever w bloody stools, mucoid stools & severe abdominal cramps/distension)
  2. Sepsis
  3. Immunocompromised
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5
Q

Empiric treatment for infectious diarrhea

A
  1. IV Ceftriaxone 2g q24h
  2. PO Ciprofloxacin 500mg BD
    duration 3-5 days
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6
Q

Clostridioides difficile description

A
  1. Gram +ve
  2. Spore forming
  3. Anaerobic bacilli
  4. Toxin A & B

aka Clostridium difficile

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7
Q

C. diff risk factors (healthcare)

A
  1. Hospitalisation
  2. Duration of hospitalisation
  3. Residence of long term care facilities or nursing homes
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8
Q

C. diff risk factors (pharmacotherapy)

A
  1. Systemic use of antibiotics
  2. Use of high risk antibiotics
    - clindamycin
    - fluoroquinolones
    - 2nd gen and above cephalosporins
  3. Use of gastric acid suppression (PPI)
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9
Q

C. diff risk factors (patient)

A
  1. Several or severe comorbidities
  2. Immunocompromised
  3. History of CDI
  4. > 65y/o
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10
Q

Is C. diff treated empirically?

A

No unless

  1. Delay in diagnostic >48h
  2. Fulminant CDI (toxic megacolon, ileus & hypotension)
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11
Q

C. diff diagnosis

A
  1. Clinical suspicion
    - unexplained new and onset diarrhea
    - radiologic evidence of toxic megacolon or ileus
  2. Confirmatory test or findings
    - toxin A & B
    - glutamate dehydrogenase enzyme
    - C.diff PCR
    - histopathological findings of pseudomembranous colitis
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12
Q

Initial treatment for CDI (non-severe)

A

1st line :

  • PO Vancomycin 125mg QDS
  • PO Fidaxomicin 200mg BD

Alternative if failed above :
- PO Metronidazole 400mg TDS

duration 10 days. 14 days if symptoms still present

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13
Q

Non-severe CDI definition

A
  1. WBC < 15x10^9/L
    AND
  2. SCr < 133umol/L
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14
Q

Initial treatment for CDI (severe)

A
  1. PO Vancomyin 125mg QDS
  2. PO Fidaxomicin 200mg BD

duration 10 days. 14 days if symptoms still present

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15
Q

Severe CDI definition

A
  1. WBC >= 15x10^9/L
  2. SCr >= 133umol/L

any one

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16
Q

Initial treatment for CDI (fulminant)

A 
IV Metronidazole 500mg q8h
\+ 
PO Vancomycin 500mg QDS
\+-
PR Vancomycin 500mg QDS

duration 10 days. 14 days if symptoms still present

17
Q

Fulminant CDI definition

A
  1. Toxic megacolon
  2. Ileus
  3. Hypotension

any one

18
Q

First recurrence of CDI treatment

aka 2nd episode

A

If use metronidazole in 1st episode :

  1. PO Vancomycin 125mg QDS x 10 days
  2. PO Fidaxomicin 200mg BD x 10 days

If use 1st life in 1st episode :

  1. PO Fidaxomicin 200mg BD x 10 days
  2. PO Vancomyin taper
19
Q

Second recurrence and above of CDI

aka 3rd episodes and above

A
  1. PO Fidaxomicin 200mg BD x 10 days
  2. PO Vancomycin taper
  3. PO Vancomycin 125mg QDS x 10 days followed by PO Rifaximin 300mg TDS x 20 days
  4. Fecal microbiota transplant
20
Q

How is PO Vancomycin compounded?

A

From IV Vancomycin solutions

21
Q

Why is metronidazole not used again after it is used once?

A

To prevent cumulative and potentially irreversible neurotoxicity

22
Q

Benefits of Fidaxomicin

A
  • lower MIC than for metronidazole and vancomyin
  • post antibiotic effect 5.5h-12.5h
  • less effect on normal gut flora (narrow spectrum)
23
Q

Limitation of Fidaxomicin

A

Very expensive, hence limit use for severe and/or recurrent cases non-responsive to maximal treatment

24
Q

Expected clinical improvement in _______

A

5-7 days

PR3124 (6 decks)

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