Infectious Diarrhea Flashcards
Diarrhea is defined as an alternation in normal bowel movement, increase in water content, frequency of stools and volume, generally with ____ bowel movements / 24hrs
3
Infectious diarrhea is diarrhea + >1 of the following: _______, _______, ___________, ___________, fecal urgency, tenesmus
N/V, fever, abdominal cramps, blood in stool
The 4 different classifications of diarrhea?
1
2
3
4
1 Acute (1-2 days, may persist up to 14 days)
2 Persistant (14-29 days)
3 Chronic (may last at least 30 days, symptoms less severe or intermittent)
4 Traveler’s diarrhea
Signs of dehydration in adults include:
1
2
3
1 less urination
2 darker urine
3 dry skin
fatigue, dizziness, lighteheaded, confusion
Signs of dehydration in children include:
1
2
3
1 dry mouth
2 no tears when crying
3 no wet diaper in >3 hr
sunken eye cheeks, soft spot in skull, high fever, irritability
C. difficile typically presents without this feature:
Bloody stool
Fever may or may not
N/V may or may not
Abdominal pain present
Fecal WBC present
Fecal lactoferrin present (means inflammation present)
Risk factors for infectious diarrhea:
1
2
3
1 Extremes of age
2 Travel
3 Daycare
Consumption of unsafe food, medications (PPI), recent exposure to abx (past 3 months), immunocompromised etc
Non-bloody diarrhea
Neonates - often caused by ______
Travelers - often caused by ______
Bloody diarrhea
Travelers - often caused by ______, shigella, salmonella, campylobacter
Rotavirus
ETEC
Invasive STEC
Three antibiotics that increase ones C.Diff infections risk
1
2
3
1 Clindamycin
2 FQ
3 Cephalosporins
Risk factors for C.Diff ?
1
2
3
> 65
immunocompromised
Abx exposure
chemo, PPI, hospitalization duration
Non drug measures:
Mild diarrhea: use _______
Mod-Severe diarrhea: consider ____
ORS
IV hydration
True or false: Do not use alcohol based disinfectants since C.diff spores are not killed
True, frequent hand washing to prevent transmission and outbreaks
True or false: Travellers diarrhea does not need fecal sample in order to begin treatment
True
For treatment of infectious diarrhea, the following are your options:
Adults: _____ or _____
Children ____ or ______
Adults: FQ or macrolide
Children: tmp-smx or macrolide (azithromycin)
True or false: antibiotics are not recommended for preventing C.diff
True
C.Diff management first involves the following:
1
2
3
1 discontinue other abx if possible
2 discontinue anti-diarrheals
3 discontinue PPI if not indicated (may help reduce recurrence, unlikely to impact acute treatment)
Mild non severe C.Diff is defined as:
_________ AND ________
WBC <15,000 AND SCr <1.5 times baseline (<133)
Severe C.Diff is defined as:
_______ OR ________
WBC > 15,000 OR SCr >1.5 times baseline (>133)
Fulminant C.Diff is defined as:
ileum, megacolon, ________ or ______
hypotension or shock
What is the preferred treatment for initial C.Diff episode and NON SEVERE
1
2
3
- Fidaxomicin 200 mg po bid x 10 days
- vancomycin 125 mg po qid x 10 days (DOC PREGNANCY)
- Metronidazole 500 mg po tid x 10 days
What is the preferred treatment for initial C.Diff episode and SEVERE
1
2
- Vanco
- Fidaxomicin
What is the preferred treatment for initial C.Diff episode and FULMINANT
1
1 Vanco 125-500 mg po/ng QID + metro IV q8h
For the treatment of C.Diff, FIRST RECURRENCE, the following can be used
1
2
3
1 Vanco (if metro wasn’t used for first episode)
2 Pulse taper vanco
3 Fidaxo
For the treatment of C.Diff, SECOND OR MORE RECURRENCE, the following can be used
1
2
3
4
1 Pulse tapered vanco
2 Vanco then rifaximin
3 Fidaxo
4 Fecal microbiota transplant
