Clostridium difficile:
Stop current antibiotics and PPIs if possible.
Not severe: (WCC<15x109 /L, albumin>25g/L): oral Metronidazole 400mg TDS for 14 days. If unresolved after 7 days switch to oral Vancomycin 125mg QDS for 14 days. Refer to hospital if diarrhoea is still present after toxin result reported and any of the following symptoms are present: fever, dehydration, sepsis, severe abdominal pain, abdominal distension or vomiting
Severe: Underlying inflammatory bowel disease or passing >8 stools in 24 hours with WCC>15x109 /L, albumin<25g/L, temperature >38.50C refer to hospital.
Acute Cholecystitis:
For mild cases, co-amoxiclav 625mg TDS for 10 days.
If penicillin allergic seek microbiology advice
Diverticulitis:
Co-amoxiclav 625mg TDS or a combination of ofloxacin and metronidazole (if allergic to penicillin) for at least 7 days.
Prescribe paracetamol for pain. Recommend clear liquids only. Gradually reintroduce solid food as symptoms improve over 2–3 days.
Review within 48 hours, or sooner if symptoms deteriorate. Arrange admission if symptoms persist or deteriorate.
Eradication of Helicobacter pylori:
Eradication is beneficial in DU, GU, but NOT in GORD. In non-ulcer dyspepsia, 8% of patients benefit. Triple treatment attains >85% eradication. Do not use clarithromycin or metronidazole if used in the past year for any infection.
1st line: Omeprazole 20mg BD PLUS Clarithromycin 250mg BD PLUS Amoxicillin 1g BD. All for 7 days
2nd line: Omeprazole 20mg BD PLUS Clarithromycin 250mg BD PLUS Metronidazole 400mg BD. All for 7 days
When managing symptomatic relapse in DU/GU: Retest (using breath test) for Helicobacter if symptomatic
When managing symptomatic relapse in non-ulcer dyspepsia: Do not retest, treat as functional dyspepsia
In treatment failure, consider endoscopy for culture & susceptibility. When patients have failed a previous eradication regime:
All for 14 days - Omeprazole 20mg BD PLUS bismuth chelate 1 tablet QDS PLUS two unused antibiotics FROM:
Amoxicillin 1g BD, Metronidazole 400mg TDS, Tetracycline 500mg QDS.
Gastroenteritis:
Antibiotic therapy is not usually indicated. Campylobacter infections form 12% of GP consultations for gastroenteritis. Antibiotic treatment should be initiated only if the patient remains unwell and when sensitivities are known. All suspected cases of food poisoning should be notified to the local authority. Seek advice on exclusion of patients from work from the Health Protection Unit: 01726 627881
Giardiasis:
Metronidazole 2g daily for 3 days. Avoid using the 2g dose in pregnancy.
Threadworm:
Treat all household contacts at the same time PLUS advise hygiene measures.
Aged over 2yrs: Mebendazole 100mg stat OR
Child 1-6 yrs: 5ml Pripsen powder in the morning, repeat after 14 days
Infant 3-12 months: 2.5ml Pripsen powder in the morning, repeat after 14 days
Note: 1 sachet Pripsen = 7.5ml powder. Dose to be stirred into small glass of milk or water and drink immediately.
Roundworm:
Mebendazole 100mg BD for 3 days