Makindo Medical Notes

Important: Tazocin (Piperacillin/Tazobactam) is contraindicated in patients with a penicillin allergy. Always verify allergy status before prescribing.

1. Simple Gastroenteritis

• Causes: Typically caused by Salmonella (non-typhoid), Shigella, Campylobacter, and E. coli O157.
• Symptoms: Diarrhea, abdominal pain, fever, and dehydration.
• Management: Usually self-limiting; antibiotics are generally not recommended as they may prolong the carrier state in Salmonella and increase the risk of complications in E. coli O157.
• Severe Cases: For severe symptoms or immunocompromised patients, consult a Consultant Microbiologist for antibiotic guidance. Note that this is a notifiable disease in many jurisdictions.

2. Parasitic Infestations

• Commonly includes Giardiasis and Amoebiasis. Cryptosporidium and Microsporidium may also be encountered, especially in immunocompromised patients.
• Management:
  • For Giardiasis: Metronidazole 250-500mg PO tds for 5-7 days.
  • For Amoebiasis: Metronidazole 500-750mg PO tds for 7-10 days, followed by a luminal agent such as Paromomycin.
  • No specific treatment is available for Cryptosporidium and Microsporidium infections; focus on supportive care and rehydration.

3. Viral Gastroenteritis

• Caused primarily by Norovirus, Rotavirus, and occasionally Adenovirus.
• Symptoms: Watery diarrhoea, vomiting, abdominal cramps, and fever.
• Management: Self-limiting; focus on rehydration therapy to prevent dehydration, especially in children and the elderly.

4. Clostridioides difficile Colitis

• First-line Therapy: Metronidazole 400mg PO tds for 10-14 days for mild to moderate cases.
• Second-line Therapy: Vancomycin 125mg PO qds for 10-14 days for severe or recurrent cases.
• Considerations: For recurrent cases, consult a Consultant Microbiologist for possible fecal microbiota transplant or alternative therapies. Review concurrent and future antibiotics as patients are at lifelong risk for recurrence.

5. Helicobacter pylori Eradication

• Triple Therapy: Lansoprazole 30mg bd + Clarithromycin 500mg bd + Amoxicillin 1g bd for 7 days.
• Penicillin Allergy: Substitute Amoxicillin with Metronidazole 400mg bd.
• Ensure adherence to the full course, as incomplete treatment can lead to resistance and treatment failure.

6. Peritonitis and Abdominal Sepsis

• Commonly caused by mixed gut flora, including coliforms, anaerobes, and occasionally enterococci.
• Initial Treatment: Tazocin 2.25g IV tds plus a single dose of Gentamicin IV for shocked patients.
• Penicillin Allergy: Use Tigecycline 100mg IV initially, followed by 50mg IV bd.
• Considerations: Early source control (surgical intervention) is critical; review antibiotic therapy based on culture results.

7. Spontaneous Bacterial Peritonitis (in Cirrhosis and Ascites)

• Common pathogens include coliforms (E. coli, Klebsiella) and Streptococcus pneumoniae.
• Treatment: Tazocin 2.25g IV tds for 10-14 days.
• Penicillin Allergy: Consult a Microbiologist for alternative therapy.
• Prophylaxis: Long-term prophylaxis with Norfloxacin may be considered in high-risk cirrhotic patients to prevent recurrence.

8. Liver Abscess

• Caused by coliforms, streptococci, anaerobes, and occasionally parasitic agents (e.g., Entamoeba histolytica).
• Treatment: Tazocin 2.25g IV tds; adjust based on drainage and microbiological culture results.
• Penicillin Allergy: Consult a Microbiologist.
• Considerations: Percutaneous or surgical drainage may be required for effective management.

9. Cholecystitis

• Caused by coliforms and anaerobes.
• Treatment: Tazocin 2.25g IV tds with reassessment after 48 hours; consider switch to Co-Amoxiclav 625mg PO tds.
• Penicillin Allergy: Consult a Microbiologist for guidance.

10. Empyema of Gallbladder

• Typically requires surgical drainage in addition to antibiotic therapy, similar to liver abscess.

11. Ascending Cholangitis

• Due to mixed gut flora including coliforms and anaerobes.
• Treatment: Tazocin 4.5g IV tds for 7-10 days; review after culture results.
• Penicillin Allergy: Consult a Microbiologist for alternative therapy.
• Considerations: Urgent biliary decompression is often required (e.g., via ERCP or surgical intervention).

12. Necrotising Pancreatitis

• Antibiotics are only indicated for confirmed or highly suspected severe necrotising disease; routine prophylaxis is not recommended in mild cases.
• Treatment: Tazocin 4.5g IV tds or Meropenem 500mg IV qds for up to 2 weeks.
• Penicillin Allergy: Consult a Microbiologist.

13. Diverticulitis

• Typically caused by mixed gut flora.
• Severe Cases: Metronidazole 500mg IV tds.
• Mild Cases: Metronidazole 400mg PO tds for 5 days total.
• Considerations: Surgery may be required for complications such as abscess or perforation.

14. Cirrhosis with Acute GI Bleeding (with/without Ligation)

• Due to translocation of gut flora.
• Treatment: Tazocin 2.25g IV tds for 5 days.
• Penicillin Allergy: Consult a Microbiologist.
• Prophylaxis: Consider short-term prophylaxis in patients with a high risk of infection during GI bleeding episodes.