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CDM 3 Exam 2 > Lecture 8 - GI Infections 2 > Flashcards

Lecture 8 - GI Infections 2 Flashcards

1
Q

Toxin A vs B

A

Toxin A = make sick
Toxin B = virulence

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2
Q

C.Diff Risk factors

A

Meds = Abx, acid suppressing, chemo
Advanced age
Hospialization
Severe illness = immunocompromised, stem cell transplant
Enteral feeding
Obesity
GI surgery

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3
Q

Risk factors for recurrent C.diff

A

Age > 75
> 10 unformed stools/24hrs
SCr > 1.2mg/dL

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4
Q

C.diff has resistance to…

A

Clindamycin and fluoroquinolone, cause increases virulence

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5
Q

C.diff clinical presentation

A

Asymptomatic -> full blown diarrhea
Typical onset w/I 2-3 days of colonization
Foul-smelling, greenish, watery stools
Ab discomfort, cramping
Fever (103/104)
Nausea, anorexia
Inc WBC, SCr, Lactate

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6
Q

C.diff complications

A

Dehydration, electrolyte disturbance
Post-infectious IBS
Fulminant colitis = bunch of issues
Death

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7
Q

What agents to avoid C.diff?

A

Antiperistaltic agents

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8
Q

C.diff diagnosis

A

> 3 unformed stools in < 24hrs or radiographic evidence

  • Liquid stool, positive test for toxigenic C.diff, imaging

Difference w/ community acquired = symptoms present n no prior inpatient stay 12weks before onset

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9
Q

C.diff diagnostic testing

A
  1. Clinical evidence of C.diff
  2. Send stool for GDH (antigen) and Toxin (A/B EIA)

Both positive = C.diff +
Both negative = C.diff -
If antigen + / toxin - then do NAAT PCR

if toxin positive = C.diff positive

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10
Q

C.diff prevention

A

surveillance/early detection
Hand hygiene contact precautions
environmental control

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11
Q

C.diff approach to therapy

A

D/c - acid suppression, constipation, diarrheal

Classify

Select txm

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12
Q

Non-severe C.diff

A

WBC < 15 and SCr < 1.5

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13
Q

Severe C.diff

A

WBC > 15 or SCr > 1.5

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14
Q

Fulminant is….

A

associated with hypotension or shock or ileum or megacolon

essentially icu

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15
Q

How to treat initial Fulminant

A

Vancomycin 500mg PO/via GT q6h

if ileum, + PR Vanco +/- metronidazole IV

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16
Q

Initial C.diff treatment if non-severe or severe?

A

Preferred: Fidaxomicin 200mg PO BID X 10 days
Alternative: Vancomycin 125mg PO q6H X 10 days

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17
Q

Can you use IV vanco for C.diff??

A

nah, use PO

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18
Q

What to use for non-severe C.diff if no fidaxomicin/vanco available?

A

Metronidazole 500mg PO TID X 10-14 days

cant use for severe

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19
Q

1st recurrence (2nd episode) C.diff treatment

A
  1. Fidaxomicin 200mg BID X 10days
  2. prolonged tapered and pulsed vanco regiment
  3. vanco 125mg Q6h X 10 days; opinion if metronidazole used for 1st episode

adjunctive: bezlotoxumab 10mg/kg IV x 1 w/ antibiotics. caution in pts with congestive HF

20
Q

2nd recurrence (3+ episode)

A
  1. fidaxomicin 200mg PO BID X 10 days or fidaxomicin 200mg X5 days then every other 20days
  2. vanco tapered and pulsed
  3. vanco 125mg q6h x 10 days followed by rifaximin 400mg q8h x 20 days
  4. fecal microbiota transplantation

adjunctive: bezlotoxumab 10mg/kg IV x 1 w/ antibitoics. caution in pts w/ congestive HF

21
Q

Prophylaxis for recurrent C.diff

A

insufficient evidence for/against

IF using: Vanco 125mg BID during abx txm then atleast 1 day following d/c of abx

Metronidazole/fidaxomicin are not recommended

22
Q

vanco MOA

A

inhibit cell wall synthesis, bacteriostatic against C.diff

23
Q

Fidaxomicin MOA

A

Macrolide, bind 50S ribosomal subunit leading to protein synthesis inhibition
Bactericidal

24
Q

Metronidazole MOA

A

DNA disruption, inhibits nucleic acid synthesis thus damaging bacterial cells

** peripheral neuropathy inc with inc dose over time ***

25
Q

who should not get probiotics

A

no immunocompromised
critically ill
impaired intestinal barrier

26
Q

Fecal microbiota transplantation

A

move poop from one person to another

super effective

27
Q

H.pylori risk factors

A

male gender
diet
food prep methods
stress

28
Q

Med interactions for Endoscopic testing

A

Hold PPI for 2 weeks before
Abx can alter sensitivity, wait 4 weeks

29
Q

OG H.pylori recommended treatment

A

Clarithromycin Triple therapy for 14 days

** if resistance < 15% and no macrolide exposure for any reason **

PPI/H2RA + Clarith 500 BID + Amoox 1g BID/ Metronidazole 500 TID if allergy (Prevpac)

30
Q

Bismuth-based Quadruple therapy

A

10-14 days, often 14
** option if macrolide exposure or penicillin allergy **

PPI/H2RA + Bismuth subsal QID + Metronidazole 250 QID or 500 TID/QID + tetracycline 500mg QID

Prilosec + Pylera

31
Q

Concomitant therapy

A

10-14 days
** option if clarithromycin resistance > 15% or repeated exposure **

PPI BID + Amox 1g BID + Metronidazole 500mg BID + Clarithromycin 500mg BID

32
Q

Sequential therapy

A

PPI + Amox/ Levo if allergy + metronidazole (after amoxicillin) + clarithromycin (after amoxicillin)

33
Q

Hybrid Therapy

A

PPI + amoxicillin + metronidazole (days 8-14) + clarithromycin (days 8-14)

34
Q

levofloxacin Triple Therapy

A

PPI + amoxicillin + levofloxacin

35
Q

Levofloxacin sequential therapy

A

PPI + amoxicillin + Levo (days 7+) + metronidazole (days 7+)

36
Q

If PCN allergy + no macrolide exposure, what are options?

A

Bismuth-based quadruple
Calrithromycin triple w/ metronidazole

37
Q

If PCN allergy + Macrolide exposure, what are options?

A

Bismuth based quadruple

38
Q

No PCN allergy + Macrolide exposure, what are options?

A

Bismuth-based quadruple
Levo triple
Levo sequential
Concomitant, hybrid, LOAD

39
Q

No PCN allergy + No macrolide exposure, what are options?

A

All of them

40
Q

H.pylori Salvage treatment

A

confirm eradication in high risk groups
can use UBT, SAT or endoscopy test, have to wait 4weeks after abx to retest

refer to specialist if still positive to H.pylori

41
Q

Salvage Treatment Regimens

A

Bismuth-based Quadruple therapy*
Levoflox triple therapy*

Concomitant therapy for 10-14 days
Rifabutin Triple therapy for 10 days
High dose Dual therapy for 14 days

42
Q

Rifabutin Triple Therapy

A

PPI + amoxicillin + rifabutin

43
Q

High dose dual therapy

A

PPI + Amox

44
Q

Salvage therapy if started clarithromycin-triple

A

bismuth-based quad start

45
Q

Salvage therapy if started bismuth-quad

A

levo triple start

46
Q

Talicia

A

Rifabutin Based Therapy

Admin: 4 tabs q8hrs w/ food for 14 days
avoid use in creatine clearance < 30

combo of omeprazole, amoxicillin, rifabutin

CDM 3 Exam 2 (11 decks)

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