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.
National Alliance on Mental Illness page printed from http://www.nami.org/ Bipolar Disorder What is bipolar disorder? Bipolar disorder, or manic depression, is a medical illness that causes extreme shifts in mood, energy, and functioning. These changes may be subtle or dramatic and typically vary greatly over the course of a person’s life as well as among individuals. Over 10 mi
Conseil Scientifique du LOOF Recommandations concernant la l’amyloïdose rénale Mars 2007 Préambule : L'amyloïdose rénale est une maladie grave, assez rare, inéluctablement fatale, génétique mais dont le mode de transmission, à l'heure actuelle, est incomplètement connu. De ce fait, le gène muté n'étant pas encore – semble-t-il - isolé, un test diagnostic génétiqu