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Y1S1B1: Pharmacology: Treatment of Abdominal and GI Tract Infections
Terms in this set (56)
due to disruption of normal anatomical barrier
occurs in 2 stages:
2. abscess formation
when should antimicrobial therapy begin for suspected or diagnosed intrabdominal infections?
as soon as suspected or diagnosed
-adequate drug levels MUST be mantained even during control procedures
2nd most common cause of mortality in the ICU is due to----
-if untreated, uncomplicated infection may progress to complicated infection
Primary peritonitis treatment:
-EMPERIC coverge for gram - aerobacilli and gram + cocci
-use 3RD GENERATION CEPHALOSPORINS OR
-BROAD SPECTRUM PENCILLIN/BETA LACTAMASE INHIBITOR COMBINATIONS
3rd generation cephalosporins include:
BROAD SPECTRUM PENCILLIN/BETA LACTAMASE INHIBITOR COMBINATIONS include:
once the organism is identified, what should be done to the treatment?
de-escalated to target the specific pathogen
-decreased resistance of the antibiotic
Prophylaxis for primary Peritonitis:
-prevents recurrence ( reduces recurrence from 70% to 20%)
-MONITOR RENAL FUNCTION UNDER THESE MEDS USED FOR PROPHYLAXIS:
-Be careful with PTs that have renal function deficts
Prophylactic regimens for PRIMARY BACTERIAL PERITONITIS for adults with NORMAL RENAL FXN:
.Ciprofloxacin 750 mg weekly
.Trimethoprin/sulfamethoxazole-one double strength tablet daily
What is an ADR associated with longterm administration of prophylactic regimen for primary bacterial peritonitis?
severe staphylococcal infections
What is secondary peritonitis?
peritonitis that occurs when bacteria contaminate the peritoneum as a result of spillage from an intraabdominal viscus
Prevention of secondary peritonitis:
1. GRAM - AEROBIC BACILLI
Prophylactic regimen for secondary peritonitis:
1. BROAD SPECTRUM PENCILLIN/BETA LACTAMASE INHIBITOR COMBINATIONS:
2. 3RD GENERATION CEPHALOSPORINS
Which drugs are REQUIRED for secondary peritonitis prophylaxis for patients in ICUs?
OR COMBINATIONS OF DRUGS THAT WILL TREAT THE MOST LIKELY INFECTING ORGANISM
Antimicrobial therapy done is association with surgery to(consider surgery as a treatment for peritonitis to):
-treat early bacteremia
-decrease the incidence of abscess formation
-decrease wound infection
-prevent distant spread of infection
EMPERIC coverage for Continuos Ambulatory Peritoneal Dialysis (CAPD):
-should aim at:
1. S.aureus (gram + staphylococcus)
2. Coagulase negative staphylococcus
2. Gram (-)bacilli
- FIRST GENERATION CEPHALOSPORIN (FOR GRAM +)
- A FLUOROQUINOLONE OR THIRD GENERATION CEPHALOSPORIN (FOR GRAM -)
-ADD VANCOMYCIN FOR AREAS WITH HIGH INCIDENCE OF MRSA
-use BROAD ANTIMICROBIAL coverage including VANCOMYCIN for TOXIC PTs and those with EXIT SITE INFECTIONS
What is the FIRT and PRIMARY treatment for abdominal/visceral abscess?
-drainage of the abscess
Which bacteria is linked to death in intrabdominal abscess sepsis?
gram - bacteremia
*hence EMEPRICAL THERAPY needs to cover:
1. gram - aerobic
3. anaerobic organisms
In intraabdominal abscess treatment regimen, which bacteria must be covered EVEN IF IT IS NOT ISOLATED from culture of clinical specimens?
Intraperitoneal abscess antimocrobial therapy:
-ANTIMICROBIAL THERAPY IS ADJUNCT TO DRAINAGE AND/OR SURGICAL CORRECTION of an underlying lesion/process
-ANEROBES MUST be covered even if not isolated in clinical specimen
Empirical therapy for intrabdominal abscess is the same as that for---
-BROAD SPEC PENCILLIN/BETA LACTAMASE INHIBITOR COMBINATIONS OR
-COMBINATION OF FLUOROQUINOLONE OR 3RD GEN CEPHALOSPORIN E.G CEFOTAXIME
-* PLUS METRONIDAZOLE
-DRAINAGE IS MAINSTAY THERAPY
-EMPRICAL THERAPY SAME AS THAT FOR SECONDARY PERITONITIS
-DEESACALATE ONCE CULTURE RESULTS ARE AVAILABLE
-due to HIGH mortality rates, SPLENECTOMY WITH ADJUNCTIVE ANTIBIOTICS IS STANDARD TREATMENT
-PTS UNDERGOING SPLENECTOMY SHOULD BE VACCINATED AGAINST ENCAPSULATED ORGANISMS:
1. Streptococcus pneumoniae
2. Haemophilus influenzae
3. Neisseria meningitidis
What is the most important factor in successful treatment of splenic abscesses?
Periphrenic and renal abscesses:
Drainage with adjunctive antibiotic therapy directed at the infecting agents
Treatment for Traveller's Diarrhea?
-REHYDRATION is key
-use oral rehydration solutions similar to those recommended by WHO
-IV rehydration if needed
* early on, may not be advisable to stop the diarrhea as it is a means for the bacteria/infective agent to exit the body
Drugs that can treat Traveller's diarrhea/dysentery:
-use w/caution if cause of dysentery is unknown
-AVOID IN PTs w/likely C.DIFFICILE (those taking prophylactic antibiotics) due to risk of development of MEGACOLON
Effect of ANTIMOTILITY agents:
-CAN PROLONG DURATION OF SOME ENTERIC INFECTIONS:
-DISCRIMINATE USE CAUSES SEVERE PROBLESM LIKE:
.disseminated intravascular coagulation
When do we NOT use ANTIMOTILITY agents to treat enteric infections?
WHEN FEVER OR BLOOD DIARRHEA IS PRESENT
What are the most common causes of Traveller's diarrhea?
-E. coli ( ETEC)
-enteroagressive E coli (EAEC)
* EFFECTIVE ANTIBIOTIC THERAPY REDUCES THE DURATION OF THIS AGENTS
Which antibiotics are less effective in treating Traveller's diarrhea as a result of resistance?
Which drugs are RECOMMENDED for treatment of Traveller's Diarrhea?
Which antibiotic is effective against ETEC and may ultimately become the emperic antibiotic for NON-DYSENTERIC TRAVELLER'S DIARRHEA?
-EFFECTIVE AGAINST ETEC
-NO BLOOD IN STOOL
-1/2 UNFROMED STOOLS/DAY
-NO DISTRESSING ENTERIC SYMPTOMS
ORAL FLUIDS AND SALTINE CRACKERS
-Flavored mineral water
-NO BLOOD IN STOOL
-1/2 UNFORMED STOOLS/DAY
-WITH DISTRESSING ENTERIC SYMPTOMS
-BISMUTH SUBSALICYLATE (adults)
-drugs can be taken for 2 DAYS
-FEVER >37.8 DEGREES
-FLUOROQUINOLONE, AZITHROMYCIN, OR RIFAXIMIN (ADULTS)
-only these two for kids!
-BOTH adults and kids should take fluids and eat crackers
-BISMUTH SALICYLATE (for adults)
. fluids and electrolytes
.contnue feeding esp. with breast milk
. SEE DOC for:
-fever lasting >24h
-diarrhea lasting more than several days
DIARRHEA IN PREGNANT WOMEN:
-fluids and electrolytes
-CONSIDER ATTAPULGITE 3g INITIALLY
-REPEAT DOSAGE AFTER PASSAGE OF EACH UNFORMED STOOL OR EVERY 2H (WHICHEVER IS EARLIER) FOR TOTAL DOSE OF 9g/d
-SEEK MEDICAL ATTENTION FOR PERSISTENT OR SEVERE SYMPTOMS
DIARRHEA DESPITE TRIMETHOPRIM-SULFAMETHOXAZOLE PROPHYLAXIS
1. If NO FEVER and NO BLOOD IN STOOLS:
USE FLUOROQUINOLONE-WITH LOPERAMIDE
DIARRHEA DESPITE FLUOROQUINOLONES PROPHYLAXIS
-MILD TO MODERARE DISEASE
-SEE DOC FOR SEVERE TO MODERATE PERSISTENT DISEASE
What are the pharmacological agents for the treatment of Traveller's Diarrhea?
-Diphenoxylate PLUS Atropine (Lomotil)
-Bismuth Subsalicylate (Helidac)
What are the treatments for C-diff?
Treatment for MILD C-diff?
Treatment for SEVERE C-diff?
Treatments for RECURRENT C-diff?
-Fidaxomycin (macrolide, on bacterialRNAP Polymerase)
.Poor bioavailabilty, oral admin makes it stay in GI hence very effective
*these drugs MAY CAUSE C DIFF if used inappropriately
Vancomycin for recurrent C-diff:
-administer in a pulse tapered fashion for management of RECURRENT C-diff
-INTERMITTENT therapy-allows for treatment when spores have germinated and are sensitive to antibiotics
Fidaxomicin for recurrent C-diff: MOA
-BINDS TO AND PREVENTS MOVEMENT OF THE SWITH REGIONS OF BACTERIAL RNAP POLYMERASE WHICH IS IMPORTANT IN RNA TRANSCRIPTION
-minimal systemic absorption
-BACTERICIDAL against C-diff
Fidaxomicin has----antimicrobial spectrum than Metrinidazole or Vancomycin
RIFAMIXIN-a rifamycin for recurrent C-difficile: MOA
Inhibition of bacterial DNA-dependent RNA synthesis. This is due to the high affinity of rifamycins for the prokaryotic RNA polymerase.
-poor oral bioavailability hence stays in gut
RIFAMIXIN-a rifamycin for recurrent C-difficile:
sequential therapy with VANCOMYCIN, followed by RIFAXIMIN may be effective for treatment of recurrent CDI
-ADR: May actually cause C-diff in some PTs
Non-Antibiotic C-difficile Therapy:
1. Fecal bacteriotherapy
2. Monoclonal antibodies
3. Probiotic therapy
Fecal bacteriotherapy for C-dificcile:
-beneficial for recurring C-Diff
-fecal microbiota administered via different routes
Monoclonal antibodies for C-difficile
-Adjunctive use w/ antibiotic therapy against Toxins A and B
-Reduces recurrence rate of C-diff
-not available for routine clinical use yet
-USED IN CONJUCTION WITH METRONIDAZOLE OR VANCOMYCIN
Probiotic therapy for C-difficile
-Diphenoxylate plus Atropine (Lomotil)
-Bismuth Subsalicylate (Helidac)
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