GI Abx

Question 0

Esophagitis: HIV+ pts; HIV-pts

Answer 0

HIV(+) with CD4 < 100: Fluconazole (90% Candida)

HIV(-): endoscopy

Question 1

Acute pancreatitis with > 30% necrosis on CT scan?

Answer 1

Imipenem (lowers mortality) +

CT-guided biopsy to determine presence of infection

Question 2

Gastritis: Type 2 (non-erosive) Type B (H.Pylori)

Answer 2

(1) PPI + Clarithromycin + Amoxicillin
(2) If the above fails: NEW antibiotics; quadruple therapy - PPI + Metronidazole + Tetracycline + Bismuth
(3) If repeat treatment fails, evaluate for Zollinger-Ellison

Question 3

Inflammatory Bowel Disease:
(1) Initial TX (2) Acute Episode/recurrence when TX stopped (3)CD with fistula (4) CD with perianal involvement (5)curative in UC + CD with stricture/obstruction

Answer 3

(1) Mesalamine
(2) Budesonide; Azathioprine + 6MP to wean off
(3) Infliximab (4) Metronidazole + Ciprofloxacin (5)Surgery/Colectomy (recurs in CD)

Question 4

Diarrhea - Infectious (invasive pathogen)

• indicated by blood (can present with out blood)
• indicated by fecal leukocytes (best initial test)
• most accurate: stool culture

Answer 4

mild: hydration
severe: (blood, fever, abdominal pain, hypotension, tacky) - fluoroquinolones (ciprofloxacin)

Question 5

Nonbloody/noninvasive Diarrhea:

(1) Giardia (2)Staphylococcus aureus (3)Bacillus cereus
(4) Crytosporidiosis (5)Scombroid (6)Rota/norovirus

Answer 5

Giardia -Metronidazole or Tinidazole
S.aureus/B.cereus/viral: Resolve spontaneously
Crypto: HAART to raise CD4; Nitazoxanide or Paromycin
Scombroid: Diphenhydramine

Question 6

Antibiotic-associated diarrhea/Clostridium Difficile

• caused by
• treatment plan

Answer 6

caused by: clindamycin, fluoroquinolone (cipro)
TX if WBC < 15,000 & Cr 15,000 & Cr > baseline: Oral Vancomycin
No response to Metronidazole: Oral Vancomycin
Recurrence after cure with Metronidazole: Metronidazole

Question 7

Malabsorption
    Tropical Sprue (small bowel bx: microorganisms)
Whipple Disease (small bowel bx: PAS+ organisms)

Answer 7

Tropical Sprue: Tetracycline or TMP/SMX x 3-6 mos

Whipple Disease: Tetracycline or TMP/SMX x 12 mos

Question 8

Diverticulitis

Answer 8

• Ciprofloxacin + Metronodiazole
  Need to cover E.Coli + Anaerobes in bowel =
  Gram (-) bacilli: Quinolone or cephalosporin and
  Anaerobes: Metronidazole

Question 9

Diabetic Gastroparesis (longstanding DM)

Answer 9

Erythromycin or Metoclopramide

Question 10

Acute Pancreatitis + 103F

Acute Pancreatitis + 30% Necrosis

Answer 10

Imipenem (decreases mortality)

Question 11

Acute Hepatitis B

Chronic Hepatitis B

Answer 11

Acute: Supportive (resolves in 1-3 mos, 5% become chronic)
Chronic: Single agent (lamivudine, tenofovir, Entecavir, INF)

Question 12

Acute Hepatitis C

Chronic Hepatitis C

Answer 12

Acute: Ribavirin + Interferon
Chronic: Ribavirin + Interferon + Boceprevir

Question 13

Cirrhosis:

Ascites with SBP

Answer 13

Tx: Cefotaxime (IV)
Prophylaxis: Norfloxacin, TMP-SMX