GI antibiotics

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Appendicitis

Coverage should extend to E. coli, Klebsiella, Proteus, and Bacteroides (an anaerobe)

Adult Simple Appendicitis

Antibiotic prophylaxis should be coordinated with surgical consult

Options:

Pediatric Simple Appendicitis

Options:

Complicated Appendicitis

Defined as perforation, abscess, or phlegmon

Options:

Cautious use should be applied to use of fluoroquinolones in complicated pediatric appendicitis due to the risk of tendon injury

Cholecystitis

Coverage is targeted at E. coli, Enterococcus, Bacteroides, and Clostridium (anerobic)

Uncomplicated Cholecystitis

Complicated

Complicated disease such as severe sepsis or hemodynamic instability

  • Vancomycin 15-20mg/kg PLUS any of the following options

Options:

Clostridium Difficile

Moderate Infection

Serous Infection

  • Vancomycin 125-250mg PO q6hr x10d (IV form is not effective)
  • Add Metronidazole 500mg IV q6hr if ileus or patient cannot tolerate PO

Diverticulitis

Uncomplicated

Options:

Complicated

Options:

General Sick

Intra-Abdominal Sepsis/Peritonitis

Harbor-UCLA Santa Monica-UCLA Other
Primary
Allergy or prior exposure

Infectious Diarrhea

Campylobacter jejuni

Entamoeba Histolytica

Giardia lamblia

Microsporidium

Cryptosporidium

  • Paromomycin 500mg PO q8hrs x 14-28days +HAART therapy if HIV positive

Salmonella (non typhoid)

  • Treatment is not recommended routinely but should be considered if:
  • Immunocompromised
  • Age<6 mo or >50yo
  • Has any prostheses
  • Valvular heart disease
  • Severe Atherosclerosis
  • Active Malignancy
  • Uremic

Options: Immunocompromised patients should have 14 days of therapy

Shigella

Treatment extended for 10 days if immunocompromised'

Vibrio Cholerae

Yersinia enterocolitica

Antibiotics are not required unless patient is immunocompromised or systemically ill


Traveler's Diarrhea

Options for Adults:

  • Ciprofloxacin 750mg PO once daily x 1-3 days[1]
    • First choice for use except in South and Southeast Asia[2]
  • Azithromycin 500mg PO q24h x 3 days OR 1000mg PO x 1[3]
    • Nausea is a frequent adverse event[4]
    • First choice for use in South and Southeast Asia[5]
  • Rifaximin 200mg PO TID x 3 days[6]

Typhoid Fever

Oral therapy with Quinolone Susceptibility

Parenteral Therapy with Quinolone Susceptibility

Parenteral Therapy with Quinolone Resistance

if nalidixic acid resistant, assume fluoroquinolone resistant
OR
  • Cefixime 10-15 mg/kg IV q 12 hrs x 8 days

Oral Therapy with Quinolone Resistance

See Also

Antibiotics by diagnosis

For antibiotics by organism see Microbiology (Main)

References

  1. Hoge CW. et al. Trends in antibiotic resistance among diarrheal pathogens isolated in Thailand over 15 years. Clin Infect Dis. 1998;26:341–5
  2. Steffen R, et al. Traveler’s Diarrhea: A Clinical Review. JAMA. 2015;313(1):71-80. doi:10.1001/jama.2014.17006
  3. Sanders JW. et al. An observational clinic-based study of diarrheal illness in deployed United States military personnel in Thailand: presentation and outcome of Campylobacter infection. Am J Trop Med Hyg. 2002;67:533–8
  4. Steffen R, et al. Traveler’s Diarrhea: A Clinical Review. JAMA. 2015;313(1):71-80. doi:10.1001/jama.2014.17006
  5. Steffen R, et al. Traveler’s Diarrhea: A Clinical Review. JAMA. 2015;313(1):71-80. doi:10.1001/jama.2014.17006
  6. DuPont HL. et al. Rifaximin versus ciprofloxacin for the treatment of traveler’s diarrhea: a randomized, double-blind clinical trial. Clin Infect Dis. 2001;33:1807–15