Gastrointestinal

All household members should be treated and/or provided with hygiene measure advice

Adults (not pregnant / breastfeeding) and children > 6 months old:

Mebendazole dose

   >6 months to <2 years old: Off-label
   >2 years old: Treatment can be accessed from community pharmacy via the Pharmacy First service

Adults (pregnant / breastfeeding) and children < 6 months old:

Hygiene measures alone for 6 weeks

Pregnant / breastfeeding adults:
Treatment with mebendazole is contraindicated in the first trimester of pregnancy and the manufacturer recommends avoidance throughout pregnancy and caution when breastfeeding.
Mebendazole therapy can be considered in pregnancy if hygiene measures fail, as per UKTIS.

Systemically well: consider management with analgesia and not antibiotics (NICE CKS: Acute Diverticulitis)

Systemically unwell but not requiring hospital admission

Co-trimoxazole dose + metronidazole dose

Second line: Co-amoxiclav dose

Second line (with mild penicillin allergy): Cefalexin dose + Metronidazole dose

Duration: 5 days

Antibiotic treatment is NOT routinely required

Antibiotics increase the risk of haemolytic uraemic syndrome in E. coli O157

Antidiarrhoeal (or antimotility) drugs, antiemetics, and probiotics are NOT routinely recommended

Consider stool culture if ongoing symptoms and/or blood / mucous is present. Provide relevant clinical details including risk factors (e.g. farmer), travel destinations and/or potential food poisoning source (e.g. oysters, chicken)

For returned travellers please give details on locations and, if possible, potential source of food poisoning (e.g. oysters).

Notify suspected cases of food poisoning to public health, and seek advice on exclusion of patients from work.

Advise on hygiene measures to reduce spread of infection and oral rehydration salts (ORS).

Children:

Refer to: Hospital: Paediatrics Antimicrobial Formulary (Gastrointestinal, Gastroenteritis)

Adults:

Stool culture confirms a specific microbiological cause (e.g. Campylobacter, Giardia):
Refer to NICE/CKS Guidelines: Adult Gastroenteritis (How should I manage gastroenteritis due to a confirmed microbiological cause?) for further management advice.

If additional clinical advice is required, contact on call Microbiology Consultant.

Adults

Omeprazole 20mg BD + Amoxicillin 1g BD + Metronidazole 400mg BD

Second line: Omeprazole 20mg BD + Amoxicillin 1g BD + Clarithromycin 500mg BD


Penicillin allergy: Omeprazole 20mg BD + Clarithromycin 500mg BD + Metronidazole 400mg BD

Penicillin allergy (Second line): Omeprazole 20mg BD + Metronidazole 400mg BD + Tetracycline hydrochloride 500mg QDS + Bismuth subsalicylate 525mg QDS

Duration: 7 days

For additional treatment regimens, refer to BNF Treatment Summaries: Helicobacter pylori infection.

Assess severity of C. difficile infection daily 

Stop/rationalise non-Clostridial antibiotics

Stop antimotility agents and PPIs

Diarrhoea may take 1 to 2 weeks to resolve, even with appropriate antibiotic therapy. Use clinical judgement to determine whether antibiotic treatment is ineffective.

Patients who fail to improve or worsen with oral vancomycin should be discussed with an infection specialist. Treatment will depend on severity and clinical setting.

First line (regardless of severity): Oral vancomycin dose

Second line / Relapse / Recurrence: Refer to Additional Resources: SAPG: Infection-specific guidance page for national SAPG CDI guidance in adults and children. 

Duration: 10 days