C. difficile infection: Discuss all cases (primary or recurrent) with Microbiologist during working hours; Where possible - stop antibiotics and PPIs; maintain daily bowel chart; fluid and electrolyte monitoring; and emphasize on nutrients intake.
Common Pathogen(s)
Toxigenic E. coli;
Rotavirus;
Norovirus;
Enteric adenovirus;
Astrovirus.
Antibiotic - 1st line |
Comment
Notify Infection Control immediately Ext. 53784.
Mainstay of treatment is fluid replacement.
C difficile infection CDT toxin positive and all GDH positive cases MUST be discussed with Microbiology/ID physician during working hours and assessed for trial eligibility. Regimes below are for dosing details as directed by the above team. See CDI policy
i.e. ≤ 5 stools in 24 hours, WCC ≤15 x 109 cells/L; and no features of severe disease* (see below).
Review signs and symptoms and follow SEVERE Clostridium difficile protocol if patient has severe disease
Immunocompromised patients should be discussed with microbiologist during working hours
Pathogen(s): Clostridium difficile.
Antibiotic - 1st line |
Metronidazole 400mg PO q8h for 14 days. If no improvement in stool frequency/ consistency at 6 days, discuss with microbiologist during working hours |
2nd line |
Vancomycin should only be used in the following circumstances: Vancomycin 125mg PO/NG q6h for 14 days |
Comment
Commence bowel chart.
Daily review of nutrition, fluid and electrolyte balance.
Use Metronidazole 500mg q8h IV if Nil-By-Mouth, no NG or PEG-tube access, or if patient has ileus.(IV metronidazole is not as effective as oral for treating CDI)
*Severe disease (if any of the following below):
Critically ill;
WBC > 15 x 109 cells/L;
Acute rise serum creatinine >50% above baseline;
Temperature > 38.5ºC;
Albumin < 25g/L;
Impending ileus;
Colonic dilatation;
Abdominal pain / distension;
Pseudomembranous colitis;
Radiology: Caecal dilatation >10cm.
Number of stools maybe a less reliable indicator of severity.
Immunocompromised patients should be discussed with microbiologist during working hours
Pathogen(s): Clostridium difficile.
Antibiotic - 1st line Vancomycin 125mg PO/NG q6h 14 days. |
2nd line |
Comment
Commence bowel chart.
Daily review of nutrition, fluid and electrolyte balance.
Severe cases require MDT input from Microbiologist, Gastroenterologist and General surgeon as definitive management beyond caecal dilatation >10cm is surgical.
Antibiotic - 1st line
Discuss all recurrent episodes with Microbiologist during working hours before commencing treatment so that trial eligibility can be assessed. If not on trial
Mild/ Moderate: Vancomycin 125mg PO/NG q6h for 14 days
Severe infection: Vancomycin 125mg PO/NG q6h plus Metronidazole 500mg q8h IV for 14 days
Discuss all primary and recurrent episodes with Microbiologist at 1st opportunity during working hours.
Discuss with Consultant Microbiologist during working hours. Review regularly. If failure to respond to treatment, urgent Microbiology / Gastroenterology review required.
Indiscriminate vancomycin can result in selection of Vancomycin Resistant strains. Vancomycin Tapering Course should be used only after discussion with microbiologist during working hours Further recurrences should be treated individually. Further recurrences must be discussed with Microbiology/ Gastroenterology at 1st opportunity during working hours |
Duration 7 days
MOSTLY self-limiting AND DOES NOT REQUIRE ANTIBIOTIC TREATMENT; treat if immunocompromised or if severe infection.
1st line |
2nd line |
Pathogen(s): Helicobacter pylori.
Antibiotic - 1st line |
Antibiotic –2nd line |
Comment
Urea breath test for diagnosis.
If eradication therapy fails, discuss with Consultant Gastroenterologist.
Maintenance PPI regimes MAY be required as indicated by Gastroenterologist.
Pathogen(s): Giardia lamblia.
Antibiotic - 1st line |
2nd line |
Pathogen(s): Entamoeba histolytica.
Antibiotic - 1st line |
2nd line |
Comment
Discuss with Consultant Microbiologist during working hours if Amoebiasis suspected.
Common Pathogen(s)
Non-typhoidal Salmonella (food poisoning);
Shigella spp.
Antibiotic - 1st line Discuss with Consultant Microbiologist. |
Duration of therapy 7 days
Common Pathogen(s)
Polymicrobial gastrointestinal flora Gram-negative bacilli, including Enterobacteriaceae Anaerobes, including bacteroides
Antibiotic - 1st line 5mg/kg IV q24h (max 500mg): if <70 years and CrCl≥30mL/min or Oral step down on ward: amoxicillin 500mg-1g PO q8h plus metronidazole 400mg PO q8h and review and discuss with microbiologist during working hours. |
2nd line 5mg/kg IV q24h (max 500mg): if <70 years and CrCl≥30mL/min or Or if gentamicin contraindicated - cefuroxime 1.5g IV q8h plus metronidazole 500mg IV q8h |
Comment
Gentamicin*: 5mg/ kg but for elderly patients or with moderate/severe renal impairment (CrCl <30ml/min), may require 3mg/ kg or shorter duration treatment.