Module 4: Management of GI infections

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35 Terms

1
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What is the leading cause of infectious diarrhea?

Virus: Noroviruses (Dr. Karst’s lab)

2
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what is the difference b/w inflammatory vs watery diarrhea?

  • inflammatory: due to mucosal invasion by BACTERIA
    • bloody diarrhea and fever
    • Common causes: CHEESY pathogen
  • watery: toxins lead to decreased absorption of water
    • dehydration and electrolyte imbalance
    • Common cause: virus, vibrio cholera, enterotoxigenic E.coli
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what CHEESY pathogen include?

  • CHEESY pathogen:
    • Campylobacter, Hemorrhagic E. coli, Enteroinvasive E. coli
    • Salmonella, Shigella, Yersinia
4
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which population are recommended to get blood culture?

  1. infants < 3mo

  2. anyone with systemic manifestations

    1. immunocompromised
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what we should do if diarrhea lasts > 14 days?

conduct parasitic studies

6
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what pathogens need specialized stool test?

STEC

C. diff

7
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what are the goals of rehydration therapy?

resolve fluid losses

correct electrolyte imbalances

correct metabolic acidosis

8
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should breastfeeding continue for infants?

No

9
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what food we should avoid with rehydration?

foods high in fiber, salt, sugar, which can create more fluid loss

→ lead to osmotic diarrhea

10
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what is the dosage of ORT?

adults: 50-100 mL/kg over first 3-4hrs

  • ongoing losses: can continue in a smaller amount
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what are the benefits of using Abx for diarrhea in infection?

shorten duration of sx. lessen severity of sx, shorten duration of fecal shedding

12
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who we should give Abx?

  • infants < 3mo
  • International travelers with bloody diarrhea + fever, and/or signs of sepsis
  • immunocompromised with severe illness and bloody diarrhea
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what is the 1st line Abx for adults and children?

Azithromycin (same for moderate and severe TD )

  • 3rd gen cep (for <3 mo)

  • Check local resistance patterns and travel history

14
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when we should avoid to give anti-motility agents for sx relief?

when the infection is toxin-mediated

  • avoid if bloody diarrhea or high fever is present

Generally not recommended in children

15
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who and how should we administer Zn

Children 6mo-5 years with malnutrition in developing countries

20mg/day for 1-2 weeks

ADE: metallic taste, vomitting

16
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what is the main cause for TD Infection?

bacteria, accounting for 80-90% of cases

17
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What is the Abx of choice for TD prophylaxis?

Rifaximin

  • only for immunocom. and unavoidable trips

can use BSS as an alternative (AE: blackening of the tongue and stool)

18
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which of the following is NOT Risk factor for C.dif

  • Age greater than 65 yo
  • Chemo or immunosuppression
  • Severe morbidity
  • GI surgery
  • PPI: especially long-term use
  • No history of Abx use
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What 2 meds that have highest risk of CDI

Clindamycin

FQ

20
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which dx tests are commonly used for CDI?

  • GDH
  • EIA Toxin A and B
21
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Dosage of Metro in CDI trx

500mg PO/IV q8hr

Systemically absorbed

High collateral damage

IV for severe infection

22
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is Vanco PO and Fidaxomicin Systemically absorbed?

No

23
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How frequent vanco is used in CDI?

q6h

125mg POPO q6h (NOT IV)

vs Fidaxomicin 200mg PO q12hr

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what is the advantage of using Fidaxomicin over Vanco in CDI?

less recurrence b.c of having narrower spectrum

  • BUT MUCH MORE expensive
  • difference NOT maintained for pts with BI/NAP1/027 strains
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what is the level of WBC and SCr in severe CDI?

  • WBC: > 15k
  • SrCr > 1.5mg/dL
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How long do we treat CDI?

10 days

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How differently fulminant CDI is treated than mild/moderate or severe stage?

  • Metronidazole IV is used along with Van 500 mg (NOT 125mg) PO
    • Both are 500 mg
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what is the preferred option for CDI recurrence?

Fidaxomicin 200 mg PO BID for 10 days

29
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What is NOT exclusion criteria for FTM donor?

Abx in last 6 mo

  • should be last 3 mos
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What is Rebyota?

Fecal microbiota suspension for rectal administration

  • apply rectally AFTER completion of CDI Abx (usually after 2-3 days) for pt who have at least 1 recurrence
31
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what is MOA of Bezlotoxumab?

binds to toxin B and neutralizes it

  • need to give WITH Abx
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which populations should we give Bezlotoxumab?

Second CDI in 6 mo

The elderly

Immunocom.

Severe CDI

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In which condition probiotics are proved to be effective?

Abx- associated diarrhea

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What Kefir contains and when it should be used?

  • Include: fermented milk, yeast, probiotics
  • Indication: in recurrent CDI, given with staggered, taperd metro, vanco regimen (for 8 weeks)
    • inconclusive result
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