Bruining, MD Consultant, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
What should you recommend that she try first
Akkermansia muciniphila bacteria: A new perspective on the management of obesity: An updated review
Recommended Antimicrobial Agents for Diarrhea Pathogen First choice Alternative Comments Bacteria Campylobacter Nontyphoidal Salmonella entericab Azithromycin Usually not indicated for uncomplicated infection Ciprofloxacin NA Salmonella enterica Typhi or Paratyphib Shigellaa Ceftriaxone or ciprofloxacin Ampicillin or TMP-SMX, or azithromycin TMP-SMX or ampicillin if susceptible Vibrio cholerae Doxycyclinee NonVibrio choleraee For noninvasive disease: usually not indicated, but single-agent therapy if treated For invasive disease: ceftriaxone with doxycycline TMP-SMX Ciprofloxacin, azithromycin, or ceftriaxone For noninvasive disease: usually not indicated, but single-agent therapy if treated For invasive disease: TMP-SMX with an aminoglycoside Cefotaxime or ciprofloxacin Nitazoxanide (HIV-uninfected, HIV-infected in combination with effective cART) TMP-SMX Effective cART: immune reconstitution may lead to microbiologic and clinical response Nitazoxanide (limited data) Giardia lamblia Tinidazole (data from HIV- uninfected children) Nitazoxanide Metronidazole (data from HIV-uninfected children) Cystoisospora belli TMP-SMX Trichinella spp Albendazole Pyrimethamine Potential second-line alternatives: ciprofloxacin, nitazoxanide Mebendazole a Yersinia enterocolitica Parasites Cryptosporidium spp Cyclospora cayetanensis Azithromycinc or ciprofloxacina, or ceftriaxone Antimicrobial therapy should be considered for groups at increased risk for invasive infection: neonates (3 mo old)
This constant use makes rest nearly impossible and explains why these injuries become chronic so easily
