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Joint formulary comment

Unless stated all guideline doses are for adults. Please refer to BNF for children’s doses.
GASTRO-INTESTINAL TRACT INFECTIONS
Indication
Duration
Helicobacter
H. pylori can be diagnosed initial y using carbon-13 urea breath test or stool First Choice
pylori eradication
• Helicobacter test and treat strategies wil benefit patients with ulcer disease, 8% Clarithromycin + of patients with functional dyspepsia, and reduce future risk of ulcer disease, gastric cancer and risks of long-term PPIs.
• Routine testing is not recommended in patients with gastro-oesophageal reflux If penicillin allergic
• Do not use clarithromycin or metronidazole if used in the past year for any Second Choice
• DU/GU relapse: retest for H. pylori using breath or stool test OR consider endoscopy for culture & susceptibility • NUD: Do not retest, offer PPI or H2RA Gastroenteritis/
• Indicate if the patient has travel ed abroad or is a known contact so that other specific pathogens are looked for. Also indicate if the patient has Infective
been on antibiotics within 4 weeks of onset so that C. difficile is looked for.
Diarrhoea
• Antibiotic therapy is not usual y indicated as it only reduces diarrhoea by 1-2 days in uncomplicated infections and can cause resistance. • If severe diarrhoea or systemical y unwel discuss with Microbiologist.
• Antibiotic therapy is contraindicated if patient is infected with E. coli O157 as it can lead to Haemolytic Uraemic Syndrome Please notify known or suspected cases of food poisoning or infectious bloody diarrhoea to, and seek advice on exclusion of patients, from the local Health Protection Unit. Send stool samples in these cases Clostridium
• Stop unnecessary antibiotics and/or PPIs 1st/2nd episodes (non
difficile
• Any of the fol owing may indicate severe infection and the patient should be Temperature >38.5°C; WCC >15 x 109/L, rising creatinine or signs/symptoms of 3rd episode
Discuss with Microbiologist
Giardiasis
• If the patient relapses consider another course of therapy and investigation of the family who may be asymptomatic excretors.
Adult & Child >10years400mg tds or Unless stated all guideline doses are for adults. Please refer to BNF for children’s doses.
Indication
Duration
Cryptosporidiosis • Infection is acquired from contact with infected humans or animals or after ingestion of contaminated water.
• Produces watery diarrhoea which can last for up to 2 to 3 weeks (or longer in immunosuppressed patients).
• No specific treatment is currently available.
This is a notifiable disease as clusters of cases warrant further investigation to exclude a common source.
• Cases should avoid using swimming pools for two weeks after the first normal stool.

Source: http://www.communityantimicrobialguide.co.uk/resources/Gastrointestinal_infections.pdf

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