GI Microbio and Antibiotics Flashcards
(32 cards)
H. pylori dx
- breath test
- stool antigen test
- endoscopy
- difficult to culture
- hard to test for resistance so must f/u to ensure eradication
H. pylori tx
- do not treat unless symptomatic
- aggressively tx any bleeding
- PPI
- 2+ abx
- bismuth
- compliance is an issue d/t complex regimen
preferred: quadruple therapy for up to 2 wk
- PPI
- bismuth
- tetracycline
- AND nitroimidazole
amoxicillin + clarithromycin or levofloxacin ± nitroimidazole also common
common causes of travel-related acute diarrhea
E. coli
campylobacter
giardia (parasite)
norovirus
chicken-related acute diarrhea
salmonella
shigella
campylobacter
beef-related acute diarrhea
EHEC
soft cheese-related acute diarrhea
listeria
lactose intolerance
seafood-related acute diarrhea
vibrio spp
hep A
reheated food and fried rice related acute diarrhea
bacillus
immunodeficiency related acute diarrhea
cryptosporidium
isopora belli
microsporidia
hospital acquired acute diarrhea most common cause
c diff
abx for acute diarrhea
usually not needed
moderate to severe
- quinolones (–floxacin)
- metronidazole
- need broad gram – coverage as most GI bugs are gram –
amoxicillin
ampicillin
broad gram + and some gram – coverage
outpatient, po
resistance common
NO:
- MRSA
- Pseudomonas
- anaerobes (lower GI infections e.g. diverticulitis, appendicitis, intraabdominal abcesses)
- atypicals
piperacillin/tazobactam
broad spectrum across GI
inpatient, iv only
YES:
- gram +
- gram –
- pseudomonas
- anaerobes (lower GI infections e.g. diverticulitis, appendicitis, intraabdominal abcesses)
NO:
- MRSA
- atypicals
commonly combined with vancomycin for empiric broad spectrum inpatient tx
metronidazole
broad spectrum
po and iv
YES:
- anaerobes (lower GI infections e.g. diverticulitis, appendicitis, intraabdominal abcesses)
- C diff
- parasites
NO:
- aerobic gram + or gram –
- MRSA
- pseudomonas
oral vancomycin
broad spectrum
when po only for GI infections
mainly C diff
iv vancomycin
gram + incl MRSA
for broadest spectrum empiric coverage commonly combined with pip/tazo
fluoroquinolones (–floxacin)
broad spectrum
po and iv
YES:
- gram –
- pseudomonas
- MOXI only: anaerobes
- some gram +
NO:
- MRSA
- total gram + coverage
importance of anaerobes in GI infections
the lower GI microbiota is largely made up of anaerobic or facultative anaerobic gram – bacteria
- enterobacterales
- klebsiella
- proteus
- E. coli
- bacteroides fragilis
- also some gram + anaerobes and enterococcus
when GI contents are released e.g.
- diverticulitis
- diverticular abscesses
- appendicitis
- other intraabdominal abcesses
systemic infection/sepsis by these anaerobes
good abx:
(IV, severe) *pip/tazo, carbapenems
(IV, moderate) ceftriaxone
(IV or PO, moderate) moxifloxacin, metronidazole
clindamycin
targets anaerobes but only above diaphragm
may be used for mouth, esophagus but not the rest of the GI tract
ceftriaxone
iv only
YES:
- gram +
- gram –
- anaerobes
NO:
- pseudomonas
- MRSA
- atypicals
fecal-oral hepatitises
A and E
blood/fluid hepatitises
B, C, and D
hepatitis w/ viral latency
B
chronic viral hepatitis
B (±D; not D alone)
C
in i.c., E
