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Giardia: Clinical Syndromes

After ingestion of G lamblia cysts, 5-15% of patients will have asymptomatic cyst passage, and 25-50% of patients will have diarrhea. From 35% to 70% of these patients will have no evidence of infection. The three manifestations of infection include asymptomatic cyst passage, self-limited diarrhea, and chronic diarrhea with associated malabsorption and weight loss. Factors related to each of these manifestations are unknown but are believed to be related to specific host factors, parasite load, and virulence variation among G lamblia isolates.

Vibrio & Campylobacter

Cholera is a disease of antiquity and probably represents some of the diarrheal illnesses described by Hippocrates and other early physicians. Robert Koch discovered V cholerae in 1884. Since the 17th century, at least eight epidemics of cholera have swept the globe. At least seven of the eight pandemics originated from the Ganges River delta, where cholera is endemic.

Cholera

An acute infectious disease caused by Vibrio cholerae (El Tor type is responsible for current epidemic, the other type, classic, is found only in Bangladesh). (New serotype now in Bangladesh, India (0139). Important because of lack of efficacy of standard vaccine.) Characteristics include severe diarrhea with extreme fluid and electrolyte depletion, and vomiting, muscle cramps and prostration.

Bacterial Infections

Enterotoxigenic (cholera-like) Diarrhea. Escherichia coli. Pseudomembranous Colitis (Clostridium difficile).

Toxicity of Antimicrobial Therapy

The mechanisms associated with common adverse reactions to antimicrobials include dose-related toxicity that occurs in a certain fraction of patients when a critical plasma concentration or total dose is exceeded, and toxicity that is unpredictable and mediated through allergic or idiosyncratic mechanisms. For example, certain classes of drugs such as the aminoglycosides are associated with dose-related toxicity.

Tetracyclines General Statement: Uses

Tetracyclines are used principally in the treatment of infections caused by susceptible Rickettsia, Chlamydia, Mycoplasma, and a variety of uncommon gram-negative and gram-positive bacteria.

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Co-trimoxazole is used for the treatment of urinary tract infections (UTIs) caused by susceptible strains of E. coli, Proteus (indole-positive or -negative), Klebsiella, Morganella morganii, or Enterobacter. Co-trimoxazole, given in single doses, as 3-day therapy, or for 7-10 days, is effective in the treatment of acute uncomplicated UTIs. Some clinicians consider a 3-day regimen of co-trimoxazole the treatment of choice for the empiric treatment of acute uncomplicated UTIs. Co-trimoxazole also is used for the treatment of acute complicated UTIs (e.g., UTIs associated with abnormalities of the urinary tract or neurogenic bladder), but other anti-infectives are preferred by most clinicians.

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Norfloxacin also has been used in adults for the treatment of various GI infections caused by susceptible organisms. Because only low serum concentrations of norfloxacin are attained after oral administration of usual dosages, use of the drug is generally limited to genitourinary or GI tract infections. Prior to initiation of norfloxacin therapy, appropriate specimens should be obtained for identification of the causative organism and in vitro susceptibility tests.

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Ciprofloxacin also is used orally for the treatment of acute sinusitis, uncomplicated cervical and urethral gonorrhea, typhoid fever, and GI infections caused by susceptible bacteria. Ciprofloxacin is used in conjunction with metronidazole for the treatment of complicated intra-abdominal infections caused by E. coli, Ps. aeruginosa, P. mirabilis, K. pneumoniae, or Bacteroides fragilis. Because ciprofloxacin is inactive against most anaerobic bacteria, the drug is ineffective in and should not be used alone if a mixed aerobic-anaerobic bacterial infection is suspected. IV ciprofloxacin is used in conjunction with IV piperacillin sodium (no longer commercially available in the US as a single-entity preparation) for empiric anti-infective therapy in febrile neutropenic patients.

Dosage forms of Furazolidone:
Furazolidone powder

Synonyms of Furazolidone:

Nitrofurazolidone, Nitrofurazolidonum, USAF EA-1

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Therapeutic classes of Furazolidone:

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