Gastrointestinal Infections Infection Comments First Line Agents Penicillin Allergy History of multiresistant Campylobacter Antibiotics not recommended. Erythromycin 250mg PO 6 Alternative to first N/A If very unwell or symptoms line treatment: persist for >7 days they may be Ciprofloxacin 500mg of benefit. PO 12 Clostridium Difficile Severity Assessment: any one of below is present: WCC >15x109/l Temperature >38 o C Serum Creatinine >50% above baseline Serum albumin <25g/l Clinical Radiological evidence of colitis Patient on ICU Pseudomembranes seen on endoscopy. First Episode of CDI: If at high risk of recurrent CDI (ie >75 years PLUS concomitant antibiotics): Fidaxomicin 200mg PO 12 If NOT at high risk of recurrent CDI then treat according to disease severity: Non-Severe Disease: Metronidazole 400mg PO 8 N/A 7 days 10-14 days Review - If no improvement within 3 days or clinical deterioration, contact Microbiology. N.B. Clearance stools are not required See full trust infection control guideline on intranet *Avoid metronidazole liquid nasogastric tube in situ, instead the tablets should be crushed. Severe Disease: Vancomycin 125mg PO 6 (use injection solution orally when an inpatient) Life-threatening/Fulminant disease: Vancomycin 500mg PO 6 nasogastric PLUS IV 8
Infection Comments First Line Agents Penicillin Allergy History of multiresistant Clostridium Difficile See above Recurrence of infection: N/A Fidaxomicin 200mg PO 12 irrespective of severity of infection Enteric fever (also *Notifiable disease* Ceftriaxone 2g IV daily If Anaphylaxis to Resistance to known as Typhoid High risk areas: Indian Penicillin: multiple antibiotics fever) subcontinent, Asia, Africa, No travel to Asia/ is increasing among (Causative : Central & South America and Middle East: enteric fever causing Salmonella Typhi, the Middle East. Ciprofloxacin 750mg Salmonella spp. Salmonella Paratyphi A, PO/400mg IV 12 B, C and Salmonella choleraesuis) Symptoms may include: diarrhoea, constipation, abdominal pain, chills, anorexia, cough and weakness. Signs may include: fever, relative bradycardia, rose spots, abdominal tenderness and hepatosplenomegaly. Samples: Blood cultures and Stool cultures. Ensure travel history and danger of infection are marked on the request form. Travel to Asia/ Middle East: Able to take PO: Azithromycin 1g PO stat, then 500mg PO daily Unable to take PO: Chloramphenicol 12.5 mg/kg every 6 hours Reduced susceptibility to fluoroquinolones (e.g. ciprofloxacin) and the emergence of multidrugresistance especially in infections acquired in South Asia can pose treatment challenges. See above will depend on the antibiotic and presence of complications. Discuss with the Microbiologist. Gastroenteritis Cryptosporidia E. coli 0157 Salmonella NB. Prior vaccination does not exclude the possibility of S.typhi infection. Most cases are self-limiting, antibiotic therapy is not usually indicated as it can cause antibiotic resistance, and may be associated with side effects. Symptoms may last for 1-3 weeks in healthy individuals, and resolve slowly and spontaneously. Many cases of gastroenteritis are viral in origin. Cryptosporidia is a coccoidal protozoa that causes diarrhoea. Infection is common in children and young adults. Fluid replacement essential. In severe cases seek advice from the consultant microbiologist. Notify suspected cases of food
Shigellosis poisoning to, and seek advice on exclusion of patients, from Public Health England 0113 3860300.
Infection Comments First Line Agents Penicillin Allergy History of multiresistant Prophylactic Co-amoxiclav1.2g IV 8 Mild Penicillin Antibiotics for Allergy: Gastrointestinal Bleed Cefuroxime 1.5g IV 8 in Cirrhotic Patients PLUS IV 8 If Anaphylaxis to Penicillin: Ciprofloxacin 400mg IV/500mg PO 12 PLUS IV 8 Giardiasis Metronidazole 2g PO OD 3 days Helicobacter pylori 7 days Eradication Confirm presence of H.pylori prior to starting eradication therapy using stool antigen test. There is normally no need to continue proton pump inhibitors or H 2 -receptor antagonists unless the ulcer is complicated by haemorrhage or perforation Lansoprazole 30mg PO 12 or Omeprazole 20mg PO 12 PLUS Clarithromycin 500mg PO 12 PLUS Amoxicillin 1000mg PO 12 Lansoprazole 30mg PO 12 or Omeprazole 20mg PO 12 PLUS Clarithromycin 500mg PO 12 PLUS Metronidazole 400mg PO 12 If eradication has failed with this treatment: Check that the original treatment indications were valid. Check that failure of eradication has been confirmed with C 13 urea breath test or stool antigen. Check that patient is strongly motivated (treatment failure is often due to poor compliance). If treatment failure has still occurred despite the above - seek further advice from Gastroenterologists. 48-72 hours.
Infection Comments First Line Agents Penicillin Allergy History of multiresistant Intra-abdominal Co-amoxiclav 1.2g IV 8 Sepsis: Biliary Tract Infection Diverticulitis Post Operative GI infection Pancreatitis* *Pancreatitis- antibiotics are indicated for patient who are septic OR those with severe acute pancreatitis and evidence of severe pancreatic necrosis Oral switch to Co-amoxiclav 625mg 8 after 48-72 hours if clinically indicated. If Mild Penicillin Allergy: Cefuroxime 1.5g IV 8 PLUS IV 8 If Anaphylaxis to Penicillin: Gentamicin IV (7mg/kg as per guideline) PLUS IV 8 If History of MRSA: ADD Vancomycin IV if not already included in regimen If History of ESBL: Meropenem 1g IV 8 Biliary Tract Infection: 7 days Diverticulitis: 7 days Post Operative GI infection: 5-7 days Pancreatitis: 7-10 days Spontaneous Bacterial peritonitis (SBP) See full trust gastroenterology guideline on intranet In patients with an ascitic fluid neutrophil count of >250 cells/mm 3, empiric antibiotic therapy should be started. If oral therapy suitable: Co-amoxiclav 625mg PO 8 If Parenteral therapy required: Co-amoxiclav 1.2g IV 8 Patients recovering from one episode of SBP should receive Continuous prophylaxis: Ciprofloxacin 500mg daily If Mild Penicillin Allergy: Cefuroxime 1.5g IV 8 PLUS IV 8 If Anaphylaxis: Ciprofloxacin 400mg IV/ 500mg PO 12 PLUS IV 8 5 days