Gastrointestinal and Prophylaxis

Question 1

H. pylori

Answer 1

PPI: Lanasoprazole 30 mg BID, Omeprazole 20mg BID, Pantoprazole 40mg BID, Rabeprazole 20mg BID Esomeprazole 20mg BID

Amoxicillin 1000mg BID AND Clarithromycin 500mg BID AND PPI x 7d (can replace Amox with metronidazole 500mg BID)

Question 2

C difficile

Answer 2

Mild - Mod (WBC15, SCr >1.5 x baseline): Vancomycin 125mg QID x 10-14d, 40mg/kg/d TID-QID max2g/d

Question 3

Traveller’s diarrhea prevention (in patients with risk of complications)

Answer 3

Bismuth subsalicylate (Pepto) - 2tabs QID or 30mL QID with meals in evening

OR Ofloxacin 300mg OD
OR Ciprofloxacin 500mg OD

Question 4

Traveller’s diarrhea

Answer 4

Oral rehydration
mild-mod (3BM/d or blood or fever) :
Ofloxacin 400mg x 1 OR 300 mg BID x 3d
OR Ciprofloxacin 750 mg x 1 OR 500mg BID x 1-3d

Question 5

Prevention of infective endocarditis

Answer 5

Amoxacillin 2g, 50mg/kg

Reasons: Prosthetic material, previous BE, unrepaired cyanotic congenital HD

Procedures: dental, respiratory, infected skin, cystoscopy with known enterococcal UTI

Question 6

Malaria Prophylaxis

Answer 6

Atovaquone-proguanil 250mg/100mg OD (malarone 1 tab): start 1 d before travel until 1 week after travel with meals for chloroquine and mefloquine resistant areas (Cambodia, Myanmar, Thailand, Vietnam)

Chloroquine 500mg (300mg base) weekly: start 1-2 weeks before until 4 weeks after travel for chloroquine sensitive areas (Central America, Mexico, Argentina, Paraguay, N Africa, Societ Union, China, Middle East, Caribbean)

Doxycycline 100 mg OD: start 1 day before travel until 4 weeks after travel for all areas

Mefloquine 250mg base weekly: start 1-3 weeks before until 4 weeks after travel for chloroquine resistant areas (Sub-Sahara Africa, South America except Argentina and Paraguay, Oceania, Asia)

Primaquine 30 mg base (2 tabs) daily: start 1 d before to 3 d after travel second line forchloroquine resistant areas

Question 7

Intraabdominal infection

Answer 7

Community acquired mild/mod (diverticulitis, cholecystitis, appendicitis, etc): Cefazolin 2 g IV q8h + metronidazole 500mg PO/IV 2 12 h

Outpatient: SMX-TMP 1 DS tab PO + metro PO as above x 7d

Community acquired severe (perf to abscessed biliary tract, advanced age, immunocompromised): Cipro 750mg PO or 400mg IV q12h + metro as above

Healthcare associated, complicated or recurrent: Piptaz 3.375g IV q6h OR imipenem 500mg IV q6h

Add Vanco 15mg/kg if MRSA suspected or known hx