Common GI pathogens

BACTERIA
Clostridium difficile  part of microflora that is in low population; potentially
pathogenic
 Antibiotics that upset the balance of the normal flora can
favor both infection by exogenous pathogens and overgrowth
by endogenous pathogens
 If the bowel wall is breached, enteric bacteria can escape into
the peritoneum and cause peritonitis and abscesses
Vibrio cholerae  colonize the upper bowel and cause watery diarrhea by
producing an enterotoxin that stimulates mucosal cells to
secrete fluid via an increase in intracellular AMP.
enterotoxigenic  colonize the upper bowel and cause watery diarrhea by
Escherichia coli (ETEC) producing an enterotoxin that stimulates mucosal cells to
secrete fluid via an increase in intracellular AMP.
Shigella  invasive bacteria; penetrate the intestinal mucosa. A bloody,
mucoid diarrheal stool with inflammatory exudate is
produced.
Campylobacter  invasive bacteria; penetrate the intestinal mucosa. A bloody,
mucoid diarrheal stool with inflammatory exudate is
produced.
Salmonella  main site of attack is the lower ileum, where the salmonellae
cause mucosal ulceration. They rapidly make their way
through the epithelial surface into the lamina propria and
enter the lymphatics and bloodstream.
 At least two virulence factors are associated with intestinal
infection: one responsible for mucosal invasion, and the other
causing secretion of fluid and electrolytes into the bowel.
VIRUS
Rotavirus  Rotavirus diarrhea affects mostly young children
Calicivirus (Norwalk)  Calicivirus diarrhea affects all age groups
PROTOZOA
Entamoeba histolytica 
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 Class Example
Cephalosporin, PO  decreased activity against gram-positive cocci
3rd Gen  Cefixime except for S. pneumoniae
 Cefdinir  active against methicillin-susceptible
(-ime, -one)  Cefditoren staphylococci
 Ceftibuten  major advantage of third-generation drugs is their
 Cefpodoxime enhanced activity against gram-negative rods
proxetil (P. aeruginosa)
 o useful in the management of hospital-
IV acquired gram-negative bacteremia
 Cefotaxime  ability to reach the CNS and to appear in the
 Ceftizoxime spinal fluid in sufficient concentrations to treat
 Ceftriaxone meningitis caused by gram-negative rods (except
 Ceftazidime Cefoperazone)
 Cefoperazone
 Moxalactam

 Cefotaxime, ceftriaxone, or ceftizoxime given

intravenously may be used for management of
gram-negative bacterial sepsis and meningitis.

Broad spectrum activity against gram negatives.

Ceftriaxone/cefotaxime offer excellent coverage against
Streptococcus pneumoniae and good coverage of
methicillin sensitive S. aureus. Only ceftazidime is active
against Pseudomonas aeruginosa. Useful for CNS
infections.

ceftriaxone (IV/IM): 80 mg/kg/day IV given once daily

Meningitis: IV/IM: 100mg/kg/DAY divided q12h or q24h
(Max: 2g/DOSE)
Other infections: IV/IM: 50-75 mg/kg q24h (MAX: 2
g/DAY)

ceftazidime: Active against Pseudomonas aeruginosa:

IV: 150 mg/kg/DAY ÷ q8h (MAX: 6 g/DAY)

cefotaxime:Meningitis: IV: 200-225mg/kg/DAY ÷ q6h; up

to 300mg/kg/DAY ÷ q6h may be used in infants and older
children for this indication (MAX: 12 g/DAY) Other
infections: IV: 100-200 mg/kg/DAY ÷ q6-8h (MAX: 6
g/DAY)
 150 mg/kg/day IV divided in 3 doses
Cephalosporin,  Cefepime  has enhanced activity against Enterobacter and
4th Gen  Cefpirome Citrobacter species that are resistant to third-
generation cephalosporins
 activity against P. aeruginosa plus greater
activity against streptococci and methicillin-
susceptible staphylococci

“extended spectrum”
Piperacillin  Piperacillin is more effective against aerobic
(ureidopenicillin) gram-negative rods, especially pseudomonads.
 Piperacillin combined with the β-lactamase
inhibitor tazobactam has increased activity
against some β-lactamase–producing gram-
negative rods

Ureidopenicillin: broad spectrum; Penicillinase sensitive

Tazobactam: Enhances spectrum; β-lactamase inhibitor

Piperacillin (IV): For documented Pseudomonas

aeruginosa infections; 200-300 mg/kg/DAY ÷ q6h (MAX:
16 g/DAY)
Fluoroquinolone  ciprofloxacin  spectrum of activity varies from one drug to
 ofloxacin another
 levofloxacin  highly active against Enterobacteriaceae,
 moxifloxacin including those resistant to third-generation
 gemifloxacin cephalosporins, Haemophilus species,
neisseriae and chlamydiae
 quinolones vary in their activity against gram-
positive pathogens.
o Gemifloxacin, levofloxacin, and
moxifloxacin have the best activity
against gram-positive organisms,
including penicillin-resistant S.
pneumoniae and methicillin-susceptible
S. aureus.
 may also have activity against M tuberculosis, M
fortuitum, Mycobacterium kansasii, and
sometimes M chelonei

Enteric GNB, including most ESBL and Pseudomonas.

Levofloxacin also has excellent coverage against S.
pneumoniae.

The use of quinolones in situations of antibiotic

resistance where no other agent is available is
reasonable, weighing the benefits of treatment against
the low risk of toxicity of this class of antibiotics. Another
situation would be where there are no other orally
administered antibiotics available.

reserved for infections caused by Pseudomonas

aeruginosa or other resistant gram negative bacilli

ciprofloxacin (PO/IV): 30 mg/kg/day PO or IV divided in

2 doses; tablet: 250mg, 500mg, 750mg

levofloxacin: 20 mg/kg/day PO divided in 2 doses

Meropenem  good activity against many gram-negative rods,
(carbapenem) gram-positive organisms, and anaerobes
o Aerobic gram-positive microorganisms:
S. aureus including penicillinase-
producing strains, Group D
streptococcus including Enterococcus
spp., Streptococcus pneumoniae, S.
pyogenes, S. viridans group
o Aerobic gram-negative microorganisms:
Acinetobacter spp., Citrobacter spp.,
Enterobacter cloacae, E. coli, H.
influenzae, K. pneumoniae, P.
aeruginosa
o Anaerobic gram-positive
microorganisms: Peptostreptococcus
spp
o Anaerobic gram-negative
microorganisms: Bacteroides spp.,
Fusobacterium spp.

Very broad-spectrum antibiotics (coverage against GP,

GN and anaerobes including extended beta-lactamase
producing strains of GN); no coverage against MRSA
 Meningitis (severe infection): 40mg/kg/DOSE IV
q8h (MAX: 2g/DOSE)
 Other infections: 20mg/kg/DOSE IV q8h (usual
MAX: 1g/DOSE)
PUD
GI Antibiotics

Sepsis
 ceftriaxone + vancomycin
 can consider piperacillin‐tazobactam if require coverage for anaerobes (eg. GI infection)
or pseudomonas