GI antibiotics
Revision as of 17:56, 7 May 2016 by Rossdonaldson1 (talk | contribs) (→Peritonitis/Intra-Abdominal Sepsis)
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:
- Cefoxitin 2g IV q6 hours OR
- Cefotetan 2g IV q12 hours OR
- Moxifloxacin 400mg IV once daily OR
- Ertapenem 1g IV once daily
Pediatric Simple Appendicitis
Options:
- Cefoxitin 40mg/kg IV q6 hours
- Cefotetan 40mg/kg IV q12 hours
- Gentamicin 2.5mg/kg IV q8hrs +
- Metronidazole 7.5mg/kg IV 16hrs OR
- Clindamycin 10mg/kg IV q8hrs
Complicated Appendicitis
Defined as perforation, abscess, or phlegmon
Options:
- Metronidazole 500 mg IV q8hrs +
- Cefepime 50 mg/kg IV q12hrs OR
- Ciprofloxacin 400 mg IV q12hrs OR
- Levofloxacin 750 mg IV q24hrs OR
- Aztreonam 30 mg/kg IV q8hrs
- Imipenem/Cilastatin 25 mg/kg IV q6hrs (max 500mg)
- Meropenem 20 mg/kg IV q8hrs (max 1g)
- Piperacillin/Tazobactam 100 mg/kg (max 4.5g) IV q8hrs
Cautious use should be applied to use of fluoroquinolones in complicated pediatric appendicitis due to the risk of tendon injury
Cholecystitis
Most often isolated organisms are Escherichia coli, Klebsiella pneumonia, and anaerobes, especially Bacteroides fragilis
Uncomplicated
Pathogenicity of Enterococci remains unclear and specific coverage is not routinely suggested for community-acquired infections[1]
- Ertapenem 1g IV once daily OR
- Metronidazole 500mg IV q8hrs PLUS
- Ciprofloxacin 400mg IV q12 hrs OR
- Levofloxacin 750mg IV q24hrs OR
- Ceftriaxone 1g IV q24hrs
Complicated or Healthcare Associated
Examples of complication include severe sepsis or hemodynamic instability
- Vancomycin 15-20mg/kg PLUS any of the following options
Options:
- Metronidazole 500mg IV q8hrs PLUS Ciprofloxacin 400mg IV q12hrs
- Piperacillin/Tazobactam 4.5g IV q8hrs
- Imipenem/Cilastin 500mg IV q6hrs
- Doripenem 500mg IV q8hrs
- Meropenem 1g IV q8hrs
Clostridium Difficile
Moderate Infection
- Vancomycin 125 mg PO four times daily for 10 days
- Fidaxomicin 200 mg PO two times daily for 10 days
- Metronidazole 500mg PO or IV four times daily for 10 days (third line therapy)
Serous Infection
- Vancomycin 125 mg PO four times daily for 10 days
- Fidaxomicin 200 mg PO two times daily for 10 days
Diverticulitis
Uncomplicated
Options:
- Metronidazole 500mg PO Q8hrs AND Ciprofloxacin 500mg PO BID x5days
- Amoxicillin/Clavulanate 875/125 PO Q8hrs x5days (or Augmentin XR 2 tablets BID [each tablet 1gm amoxicillin 62.5mg clavulanate])[2][3]
- Trimethoprim/Sulfamethoxazole, one double-strength tablet bid, and Metronidazole 500 mg Q8h
- Moxifloxacin 400mg PO QDaily[4]
Complicated
Options:
- Ticarcillin/Clavulanate 3.1 g IV Q6h or
- Piperacillin/Tazobactam 3.375 g IV q6 hours x 7-10 days
- Ciprofloxacin 400 mg IV q12h and metronidazole 1 g IV Q12h
- Ampicillin 2 g IV Q6h and Metronidazole 500 mg IV q6h Plus (Gentamicin 7 mg/kg Q24h or Ciprofloxacin 400 mg IV Q12h)
- Imipenem 500 mg IV Q6h
Intra-Abdominal Sepsis/Peritonitis
| Harbor-UCLA | Santa Monica-UCLA | Other | |
| Primary |
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| Allergy or prior exposure |
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Infectious Diarrhea
Campylobacter jejuni
- Erythromycin 500mg PO BID x 5 days
- Ciprofloxacin 500mg PO BID x 5 days OR
- Azithromycin 500mg PO once daily x 5 days
Entamoeba Histolytica
- Metronidazole 750mg PO three times daily for 5-10 days PLUS
- Paromomycin 500mg q8hrs for 7 days OR
- Iodoquinol 650mg q 8hrs daily 20 days
Giardia lamblia
- Metronidazole 250mg PO q8hrs for 7-10days
- Tinidazole 2g PO once
Microsporidium
- Albendazole 400mg PO BID x 21 days + HAART therapy if HIV positive
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
- TMP/SMX 1 DS tab PO BID x 5 days
- Ceftriaxone 2g IV once daily x 5 days
- Levofloxacin 500mg PO once daily x 5 days
- Ciprofloxacin 500mg PO BID x 5 days
Shigella
Treatment extended for 10 days if immunocompromised'
- Ciprofloxacin 500mg PO BID x 5 days
- TMP/SMX 1 DS tab PO BID x 5 days
- Levofloxacin 500mg PO once daily x 5 days
- Azithromycin 500mg PO daily x 5 days
Vibrio Cholerae
- Doxycycline 300mg PO as single dose
- TMP/SMX 1 tablet (5mg/kg) PO BID daily x 3 daily
- Azithromycin 20mg/kg (1g) PO once
Yersinia enterocolitica
Antibiotics are not required unless patient is immunocompromised or systemically ill
- Ciprofloxacin 500mg PO BID daily
- Levofloxacin 500mg PO once daily
- TMP/SMX 1 DS tab (5mg/kg) PO BID
Traveler's Diarrhea
Options for Adults:
- Ciprofloxacin 750mg PO once daily x 1-3 days[5]
- First choice for use except in South and Southeast Asia[6]
- Azithromycin 500mg PO q24h x 3 days OR 1000mg PO x 1[7]
- Rifaximin 200mg PO TID x 3 days[10]
- Ineffective against mucosally invasive pathogens (Shigella, Salmonella, Campylobacter)
- Considered very safe as it is not absorbed
Typhoid Fever
Oral therapy with Quinolone Susceptibility
- Ciprofloxacin 500-750 mg PO q 12 hrs x 14 days
Parenteral Therapy with Quinolone Susceptibility
- Ciprofloxacin 400 mg IV q 12 hrs x 10 days
Parenteral Therapy with Quinolone Resistance
- if nalidixic acid resistant, assume fluoroquinolone resistant
- Ceftriaxone 2mg IV q 24 hrs x 14 days
- OR
- Cefixime 10-15 mg/kg IV q 12 hrs x 8 days
Oral Therapy with Quinolone Resistance
- Azithromycin 1 g PO daily x 5 days
See Also
Antibiotics by diagnosis
- Bone and joint antibiotics
- Cardiovascular antibiotics
- ENT antibiotics
- Eye antibiotics
- GI antibiotics
- GU antibiotics
- Neuro antibiotics
- OB/GYN antibiotics
- Pulmonary antibiotics
- Skin and soft tissue antibiotics
- Bioterrorism antibiotics
- Environmental exposure antibiotics
- Immunocompromised antibiotics
- Post exposure prophylaxis antibiotics
- Pediatric antibiotics
- Sepsis antibiotics
- Arthropod and parasitic antibiotics
For antibiotics by organism see Microbiology (Main)
References
- ↑ Ansaloni L, et al. 2016 WSES guidelines on acute calculous cholecystitis. World Journal of Surgery. (2016) 11:25. DOI 10.1186/s13017-016-0082-5
- ↑ Balasubramanian I et al. Out-Patient Management of Mild or Uncomplicated Diverticulitis: A Systematic Review. Dig Surg. 2017;34(2):151-160.
- ↑ The STAND trial: Jaung R, Nisbet S, Gosselink MP, Di Re A, Keane C, Lin A, Milne T, Su’a B, Rajaratnam S, Ctercteko G, Hsee L, Rowbotham D, Hill A, Bissett I. Antibiotics Do Not Reduce Length of Hospital Stay for Uncomplicated Diverticulitis in a Pragmatic Double-Blind Randomized Trial. Clin Gastroenterol Hepatol. 2020 Mar 30:S1542-3565(20)30426-2. doi: 10.1016/j.cgh.2020.03.049. PMID: 32240832
- ↑ Wilkins T et al. Diagnosis and Management of Acute Diverticulitis. Am Fam Physician. 2013 May 1;87(9):612-620.
- ↑ Hoge CW. et al. Trends in antibiotic resistance among diarrheal pathogens isolated in Thailand over 15 years. Clin Infect Dis. 1998;26:341–5
- ↑ Steffen R, et al. Traveler’s Diarrhea: A Clinical Review. JAMA. 2015;313(1):71-80. doi:10.1001/jama.2014.17006
- ↑ 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
- ↑ Steffen R, et al. Traveler’s Diarrhea: A Clinical Review. JAMA. 2015;313(1):71-80. doi:10.1001/jama.2014.17006
- ↑ Steffen R, et al. Traveler’s Diarrhea: A Clinical Review. JAMA. 2015;313(1):71-80. doi:10.1001/jama.2014.17006
- ↑ 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