Treatment of GI Infections (Dr. Pogue)

  1. True or false. Normal flora mainly consists of anaerobes.
  2. What are the 3 main anaerobes found in normal flora?
    • Bacteroides
    • Clostridium
    • Peptostreptococci
  3. Which normal flora anaerobe is the most resistant and what are the drugs of choice?
    B. fragilis; beta-lactams/beta-lactamses inhibitors, cefoxitin and metronidazole
  4. What are the main differences between community-acquired and hospital-acquired GI infestions, in terms of infectious organisms?
    • Community-acquired
    • Susceptible Gram- organisms
    • Anaerobes
    • Enterococcus spp.
    • Hospital-acquired
    • P. aeruginosa (most common)
    • Enterococcus spp.
    • Candida spp.
  5. Spontaneous bacterial peritonitis (SBP) is most commonly found in what patients?
    Alcoholic patients
  6. What are the 3 most common organisms involved in spontaneous bacterial peritonitis (SBP)?
    • E. coli
    • Streptococcus spp.
    • Klebsiella spp.
  7. What is the best treatment for spontaneous bacterial peritonitis (SBP)?
    3rd generation cephalosporins (ceftriaxone, etc.)
  8. What is the best treatment for prophylaxis bacterial peritonitis (SBP)?
    Bactrim (TMP/SMX)
  9. What are the 2 best treatment regimens for community-acquired abscesses, ruptured bowel or cholangitis?
    • 1st/2nd/3rd generation cephalosporins w/ metrodinazole
    • Fluoroquinolone w/ metronidazole
  10. What are the 4 best treatment regimens for nosocomial (hospital-acquired) abscesses, ruptured bowel or cholangitis, and why is there a need to use these vs. comunity-acquired abscesses, ruptured bowel or cholangitis?
    • cefepime w/ metrodinazole
    • piperacillin/tazobactum
    • carbapenem
    • fluoroquinolones w/ metrodinazole
    • Expanded coverage for P. aeruginosa!
  11. True or false. Acute cholecystitis is often an inflammatory condition, not an infectious one.
  12. What is the suggested duration of therapy for intra-abdominal infections?
    4-7 days; may d/c if there is a resolution of clinical signs/symptoms
  13. What is the initial step in the treatment of infectious diarrhea?
  14. What is the best treatment option for infectious diarrhea caused by Salmonella? Duration of treatment?
    Ciprofloxacin (FQ) although not routinely recommended for treatment; 5-7 days (longer for immunocompromised patients)
  15. What is the best treatment option for infectious diarrhea caused by Shigella? Duration of treatment?
    Ciprofloxacin (FQ); 3-5 days (longer for immunocompromised patients)
  16. What is the best treatment option for infectious diarrhea caused by E. coli? Duration of treatment?
    Ciprofloxacin (FQ); 3 days
  17. What are the 2 treatment options for infectious diarrhea caused by Aeromonas?
    • Bactrim (TMP/SMX)
    • Ciprofloxacin (FQ)
  18. What is the best treatment option for infectious diarrhea caused by V. cholera? Duration of treatment?
    Doxycycline (tetracycline); 3 days
  19. What is the best treatment option for C. difficile diarrhea? Duration of treatment?
    Metronidazole; 10-14 days
  20. What is one of the side effects of nitazoxanide and which organism does it target in GI infections?
    Diarrhea; Giardia
  21. True or false. Ciprofloxacin can be used to treat Giardia GI infections.
    False,fluoroquinolones are not effective.
  22. What new drug was released in 2011 for the treatment of C. difficle diarrhea? What is its mechanism of action?
    Fidaxomicin; inhibits RNA synthesis by inhibiting RNA polymerases
  23. What is the best treatment option for HBV? What other types of meds are used?
    IFN-alpha; HIV meds
  24. What is the mechanism of action for IFN-alpha? and what 2 forms does it come in?
    inhibition of viral protein synthesis, viral penetration (and/or uncoating) and boost of immune system; SubQ or IM
  25. What is the most important psychological side effect of IFN-alpha?
    Severe depression
  26. What is the best combo treatment option for HCV? What is the mechanism of action? Most common side effects?
    IFN-alpha w/ ribavirin; inhibition of viral RNA synthesis by mimicking guanine; hemolytic anemia and renal toxicity
  27. What is the most recent addition to HCV therapy and what is its most common adverse drug effects?
    protease inhibitors; avoid in liver failure (CYPA4/5 inhibitor and metabolite)
Card Set
Treatment of GI Infections (Dr. Pogue)