GI antibiotics

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

Mild/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

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

Peritoneal Dialysis Associated Peritonitis

Empiric Therapy (IP)

10- to 14-day course of intraperitoneal (IP) antibiotics that are administered by the patient on an outpatient basis or IV antibiotics and intraperitoneal for admitted patients
  • Vancomycin 30mg/kg loading followed by 0.6 mg/kg IP daily PLUS[1]
  • Ceftazidime 1g IP daily OR
  • Gentamycin 0.6mg/kg daily
  • Catheter removal/exchange is usually only done if IP antibiotics fail (fungal, pseudomonal), and should be done in consultation with a nephrologist[2]

Empiric Tharapy (IV)

Although IP antibiotics are preferred IV antibiotics can be considered with coordination with nephrology for dosing. Coverage should be the same as IP antibiotics [3][4]

Traveler's Diarrhea

Options for Adults:

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. Li PK, et al: Peritoneal dialysis-related infections recommendations: 2010 update. Perit Dial Int 2010; 30:393 Fulltext
  2. Akoh JA. Peritoneal dialysis associated infections: An update on diagnosis and management. World J Nephrol. 2012 Aug 6; 1(4): 106–122.
  3. Manley HJ, Bailie GR, Frye RF, McGoldrick MD. Intravenous vancomycin pharmacokinetics in automated peritoneal dialysis patients. Perit Dial Int 2001;21 :378-85
  4. Wong et al. Intravenous Antibiotics with Adjunctive Lavage in Refractory Peritonitis. Intravenous Antibiotics with Adjunctive Lavage in Refractory Peritonitis
  5. Hoge CW. et al. Trends in antibiotic resistance among diarrheal pathogens isolated in Thailand over 15 years. Clin Infect Dis. 1998;26:341–5
  6. Steffen R, et al. Traveler’s Diarrhea: A Clinical Review. JAMA. 2015;313(1):71-80. doi:10.1001/jama.2014.17006
  7. 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
  8. Steffen R, et al. Traveler’s Diarrhea: A Clinical Review. JAMA. 2015;313(1):71-80. doi:10.1001/jama.2014.17006
  9. Steffen R, et al. Traveler’s Diarrhea: A Clinical Review. JAMA. 2015;313(1):71-80. doi:10.1001/jama.2014.17006
  10. 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