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