Adjunct Diagnostic Or Therapeutic Measures And Comments

Gastrointestinal Infections by An Duodenal Gastric ulcer, gastnc cancel. MALT lymphomas (not 7 NSAIDs) (NEJM 347 1175.2002. Call J 17 2SB.2003)

atomic Site: Esophagus to Helicobacter pylori

Soo Common! Prevalence ol pre-tioatmem resistance increasing

Rectum (continuod) Rx q12h po lor 14 days: lOmoprazole <> raboprazole CO mg)' + amox 1 ;/ti • darithro 500 mg Elticacy 80-95%

Rx po lor 14 days: Bismuth MtooinoW'; ixsmuth subsalicylale 2 !abs<*d tetracycline SOO mg qri - metro 500 mg tid • omeprazole' 20 mg bid Efficacy 90-99%

Dx: Stool antigen J0% sens 4 specific Cheap & practxal Raro la'si- ()os due lo other Hilcobactcr spooes (BMJ 320 148. 2000) Other tests Urea breath test, if ondoscopod. tapid mease &/ot histology &/or aiture. Antimicrobial realsUnce: Predicts ra (allure (MM 139 463. 2033) Geogiaplvc dilloronces but overall lesislance amox & tetra uncommon, datitlvo 10%. metto 30-50%

Treatment aucceaa: Corteliitns with active drugs & pi com|><i incc Suggested»* duration v.inos botween 7 14 days, we^suggest bid legmen limos 14 days lo T compliance & hopeluHy dlicocy (7-9% t cutes Willi 14 days) (Aliment Pharmacol Thin 14 603, 2000).

Test of cure: Repeat tilod animan 6 wks posl-lteatmenl

Small Intestlno: Whipple's diseaso

Soo Infective ondocardtrs. culture-nectatlw. page 23

i Pen G 6-24 million units IVq24h • streptomycin 1 gm IM/1V q24h) OR ceftriaxone 2 gm IV


Then, for a TMP-SMX-DS • po bid

M4 days

TMP-SMX-DS 1 lab po bid pprox. 1 year iDoxy t00mgpohid)ot cetixime -100 mg po bKll or Pon VK 500 mr^po c|dl

Rx leglmen based on empitlasm and letiospeclive analyses 1MP-SMX CNS "'lapstm during TMP-SMX fx loported

Interesting in vitro susceptibility sludy combination ol doxy & tiydfaxychloroquinu bacloncidaf/AAC 48 747. 2004)

Cultivated liom CSF In pts with intestinal disease and no neurdogic lindlngs (JID 188 797 i 801. 2003)

Inflammatory bowel disease:

Ulcerative coMis. Crohn's disease MM to moderate Ret Ln 359-331. 2002


Sulfasalazine 1 gm po q6hc meaalamlne (5ASA) t gm po q6h

Coated mesalamine

(Asacof) 800 mg tad ot qid equally effective Corticosteroid enemas

Check stod lor E IvstdySca

Try nminosofecylales t in rralcVmod dsease See teview article for more aggressive thorapy

In randomized controlled Inal. CIP * metio had no benelil (Gastro 123.33, 2002)

Sevcao Crdm's




Screen lor latont TBc beloio blooung TNF (MMWfí S3 683. 2004) Oday anti-TNF drugs urattl TBc gtopbylaxis complete For othor anti TNF risks NEJM 351 42.2004

Diverticulitis, perirectal abscesa, peritonitis

Atso see Pentoriii/s. pago 34 CIO 1in press)

Enlerohacletiaceae. occ P aeruginosa, Bademidos sp. entaococci

Outpatient rx—mild dive rectal abscesa:

iiTMP-SMX-DS :>d) ot iCIP 750 mil hid t Lovo 750mgq24h)| • metro 500 mn q€fi All polîmes 7-10 days

rticulitis. drained peri-

AM-CL-ER 1000/62 5 mg 2 lobs po bid times 7-10 days

Musi "cover"IñthGm-ñóg aadxc arid Gm-tieg añaaiobic boctaffil Drugs active only va anaerobic Gm-nog. bacilli: clinda. metro Druga activo only va aerobic Gm-nog. bocllll: APAG' P Ceph 2/3/4 ajjteonam APP"i. C1P Levo.Gnl Drugs activo va both aorobic anaerobic Gm-nog. bactoria:

cefoxitin, celololan TC-CL. PIP-TZ AM-SB, ERTA IMP. MER. & Mow. Ilgecydtne Increasing resistance ol Baderoides specios

Cefoxitin Cetototan Clindamycin

% Resistant 4-25 17 67 16-44 Resistance lo metro. PIP-TZ tare 1CID 35(Supp/ 1):S126, 2002] Few case (confirmed on noxl page)

' Can substitute ollwt proton pump Inhibitors omeprazole or rabeprozde—all bid esomeprazole 20 mg (FDA-approved) lonsopro/de 30 mg (FDA-apptcved) pantoproide 40 mg (nor FDA-atxxwea for this irxtcaiwi)

* 3 bismuth preparation»'. (I) In US biamuth subsalicylate (Pepto-Blamd) 262 mg tabs, addt dose lor hefccobactur is 2 labs (524 mg) qkl (2) Outside U S. colloidal bremuth subotrate (De-Nol) 120 mg chewablo tablets; dose is 1 towel qKf (3) Another treatment ootion Rarntidino lusmuth citrate 400 mg gr.e with metio 500 mg and clanthro 500 mg—a! bid limes 7 days Woiked despite mdio/darithro resistance (Gastro 1I4A323. I998J

' APAG - antlpseudomonal amlnogtycoeldlc aminoglycoside, e.g., amikacin, gontamicin, tobramycin

Abbreviations on pnqo 2 NOTE M dosage recommendations ate for aduSs (imtess oOxnwso indicated) and assume norma/ tenal function




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