Sandbox ID Gastrointestinal and Intraabdominal

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Anthrax, gastrointestinal

  • Gastrointestinal anthrax [1]
  • Preferred regimen: Ciprofloxacin 400 mg intravenously every 8 h OR Doxycycline 100 mg intravenously every 12 h combined with second agent: Clindamycin 600 mg intravenously every 8 h or Penicillin G 4 MU every 4-6 hours OR Meropenem 1 gm intravenously every 6-8 hours or Rifampin 300 mg every 12 h.
  • Note:Treatment for 60 days is recommended to avoid relapse or breakthrough of incubating disease. If initial therapy is intravenous, then convert to oral administration (Ciprofloxacin or Doxycycline) when clinically indicated. Steroids may be considered as an adjunct therapy for patients with severe edema and for meningitis. For pregnant women, avoid Doxycycline. Use Ciprofloxacin and switch to oral penicillin once susceptibilities are known.

Appendicitis

  • Community-acquired infection in adults
  • Mild-to-moderate severity (perforated or abscessed appendicitis and other infections of mild-to-moderate severity):
  • Single agent:
  • Combination:
  • Preferred regimen(1): Cefazolin 1–2 g every 8 h in combination with Metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h
  • Preferred regimen(2): Cefuroxime 1.5 g every 8 h in combination with Metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h
  • Preferred regimen(3): Ceftriaxone 1–2 g every 12–24 h in combination with Metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h
  • Preferred regimen(4): Cefotaxime 1–2 g every 6–8 h in combination with Metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h
  • Preferred regimen(5): Ciprofloxacin 400 mg every 12 h in combination with Metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h
  • Preferred regimen(6): Levofloxacin 750 mg every 24 h in combination with Metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h
  • High risk or severity (severe physiologic disturbance, advanced age, or immunocompromised state):
  • Single agent:
  • Combination:
  • Preferred regimen(1): Cefepime 2 g every 8–12 h in combination with Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
  • Preferred regimen(2): Ceftazidime 2 g every 8 h in combination with Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
  • Preferred regimen(3): Ciprofloxacin 400 mg every 12 h in combination with Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
  • Preferred regimen(4): Levofloxacin 750 mg every 24 h in combination with Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h

Biliary sepsis

Cholangitis

  • Community-acquired acute cholecystitis of mild-to-moderate severity
  • Community-acquired acute cholecystitis of severe physiologic disturbance, advanced age, or immunocompromised state
  • Preferred regimen(1): Imipenem-cilastatin 500 mg every 6 h OR 1 g every 8 h, in combination with metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h
  • Preferred regimen(2): Meropenem 1 g every 8 h, in combination with metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h
  • Preferred regimen(3): Doripenem 500 mg every 8 h, in combination with metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h
  • Preferred regimen(5): Ciprofloxacin 400 mg every 12 h, in combination with metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h
  • Preferred regimen(6): Levofloxacin 750 mg every 24 h, in combination with metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h
  • Preferred regimen(7): Cefepime 2 g every 8–12 h, in combination with metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h
  • Acute cholangitis following bilio-enteric anastamosis of any severity
  • Preferred regimen(1):Imipenem-cilastatin 500 mg every 6 h OR 1 g every 8 h, in combination with Metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h
  • Preferred regimen(2):Meropenem 1 g every 8 h, in combination with Metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h
  • Preferred regimen(3):Doripenem 500 mg every 8 h, in combination with Metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h
  • Preferred regimen(5):Ciprofloxacin 400 mg every 12 h, in combination with Metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h
  • Preferred regimen(6):Levofloxacin 750 mg every 24 h, in combination with Metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h
  • Preferred regimen(7):Cefepime 2 g every 8–12 h, in combination with Metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h
  • Health care-associated biliary infection of any severity
  • Preferred regimen(1): Imipenem-cilastatin 500 mg every 6 h OR 1 g every 8 h, in combination with Metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h AND Vancomycin 15–20 mg/kg every 8–12 h added to regimen
  • Preferred regimen(2): Meropenem 1 g every 8 h, in combination with Metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h AND Vancomycin 15–20 mg/kg every 8–12 h added to regimen
  • Preferred regimen(3): Doripenem 500 mg every 8 h, in combination with Metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h AND Vancomycin 15–20 mg/kg every 8–12 h added to regimen
  • Preferred regimen(5): Ciprofloxacin 400 mg every 12 h, in combination with Metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h AND Vancomycin 15–20 mg/kg every 8–12 h added to regimen
  • Preferred regimen(6): Levofloxacin 750 mg every 24 h, in combination with Metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h AND Vancomycin 15–20 mg/kg every 8–12 h added to regimen
  • Preferred regimen(7): Cefepime 2 g every 8–12 h, in combination with Metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h AND Vancomycin 15–20 mg/kg every 8–12 h added to regimen
  • Note(1): Antimicrobial therapy of established infection should be limited to 4–7 days, unless it is difficult to achieve adequate source control. Longer durations of therapy have not been associated with improved outcome.

Cholecystitis

  • Community-acquired acute cholecystitis of mild-to-moderate severity
  • Community-acquired acute cholecystitis of severe physiologic disturbance, advanced age, or immunocompromised state
  • Preferred regimen(1): Imipenem-cilastatin 500 mg every 6 h OR 1 g every 8 h, in combination with metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h
  • Preferred regimen(2): Meropenem 1 g every 8 h, in combination with metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h
  • Preferred regimen(3): Doripenem 500 mg every 8 h, in combination with metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h
  • Preferred regimen(5): Ciprofloxacin 400 mg every 12 h, in combination with metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h
  • Preferred regimen(6): Levofloxacin 750 mg every 24 h, in combination with metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h
  • Preferred regimen(7): Cefepime 2 g every 8–12 h, in combination with metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h
  • Acute cholangitis following bilio-enteric anastamosis of any severity
  • Preferred regimen(1):Imipenem-cilastatin 500 mg every 6 h OR 1 g every 8 h, in combination with Metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h
  • Preferred regimen(2):Meropenem 1 g every 8 h, in combination with Metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h
  • Preferred regimen(3):Doripenem 500 mg every 8 h, in combination with Metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h
  • Preferred regimen(5):Ciprofloxacin 400 mg every 12 h, in combination with Metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h
  • Preferred regimen(6):Levofloxacin 750 mg every 24 h, in combination with Metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h
  • Preferred regimen(7):Cefepime 2 g every 8–12 h, in combination with Metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h
  • Health care-associated biliary infection of any severity
  • Preferred regimen(1): Imipenem-cilastatin 500 mg every 6 h OR 1 g every 8 h, in combination with Metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h AND Vancomycin 15–20 mg/kg every 8–12 h added to regimen
  • Preferred regimen(2): Meropenem 1 g every 8 h, in combination with Metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h AND Vancomycin 15–20 mg/kg every 8–12 h added to regimen
  • Preferred regimen(3): Doripenem 500 mg every 8 h, in combination with Metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h AND Vancomycin 15–20 mg/kg every 8–12 h added to regimen
  • Preferred regimen(5): Ciprofloxacin 400 mg every 12 h, in combination with Metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h AND Vancomycin 15–20 mg/kg every 8–12 h added to regimen
  • Preferred regimen(6): Levofloxacin 750 mg every 24 h, in combination with Metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h AND Vancomycin 15–20 mg/kg every 8–12 h added to regimen
  • Preferred regimen(7): Cefepime 2 g every 8–12 h, in combination with Metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h AND Vancomycin 15–20 mg/kg every 8–12 h added to regimen
  • Note(1): Antimicrobial therapy of established infection should be limited to 4–7 days, unless it is difficult to achieve adequate source control. Longer durations of therapy have not been associated with improved outcome.
  • Note(2): Patients undergoing cholecystectomy for acute cholecystitis should have antimicrobial therapy discontinued within 24 h unless there is evidence of infection outside the wall of the gallbladder.

Diverticulitis

Esophagitis

The selection of pharmacologic agent should be directed against the specific causative pathogen.

  • Preferred regimen
  • Fluconazole 100–200 mg/day PO/IV for 14-21 days AND
  • Maintenance therapy with Fluconazole 100–200 mg/day PO in AIDS patients
  • Herpes simplex virus[2]
  • Preferred regimen: Acyclovir 5 mg/kg IV q8h for 7–14 days OR Acyclovir 400 mg 5 times daily PO for 14–21 days OR Valacyclovir 1 g PO tid for 14–21 days ± maintenance therapy
  • Alternative regimen: Famciclovir 500 mg bid PO for 14–21 days OR Foscarnet 90 mg/kg q12h IV for 7–14 days
  • Cytomegalovirus[2]
  • Preferred regimen
  • Ganciclovir 5 mg/kg IV q12h for 14–21 days AND
  • Maintenance therapy with Ganciclovir 5 mg/kg/day IV or 6 mg/kg/day IV 5 days per week in AIDS patients
  • Alternative regimen: Foscarnet 90 mg/kg IV q12h for 14–21 days, then Foscarnet 90–120 mg/kg/day IV for maintenance in AIDS patients OR Valganciclovir 900 mg PO bid, then 900 mg PO qd for maintenance in AIDS patients
  • Aphthous ulceration in immunocompromised hosts[2]
  • Preferred regimen: Prednisone 40 mg/day PO for 14 days, tapered over 4–8 weeks

Hepatic abscess

Hepatitis A

  • The treatment should be conservative and supportive. There is no specific medication for HAV infection. Hygiene is very important, hands should always be washed after bathroom use. The management should focus on treating the symptoms and identifying the small proportion of patients with a particular risk of developing fulminant hepatic failure. Patients over the age of 40 and those with underlying chronic liver disease are most at risk.
  • Contacts should be vaccinated.
  • Oral contraceptive treatment and hormone replacement therapy should be stopped to avoid cholestasis.
  • Alcohol consumption is not advised.[3]

Hepatitis B

  • Acute Hepatitis B
  • Management
  • Spontaneous recovery occurs after acute infection with HBV occurs in 95-99% of previously healthy adults. Antiviral therapy is not therefore likely to improve the rate of recovery and is not required unless the disease is accompanied by a nonhepatic complication such as periarteritis nodosa. In such cases, and in immunocompromised individuals (e.g., those with chronic renal failure), antiviral therapy with lamivudine may be recommended.
  • Full recovery with development of anti-HBs provides long-term protection.
  • Prevention
  • Vaccination (available since the early 1980s) continues to be the best way for dealing with the condition. Hepatitis B is preventable, and universal vaccination is probably best soloution in countries with a high prevalence.
  • Preexposure vaccination:
  • This is especially relevant in high-risk groups. There are a number of recombinant vaccines with similar efficacy, although the dosage may differ — for example:
  • Recombivax HB (10 µg of HBsAg)
  • Child < 11 y with an HbsAg-negative mother: 2.5 µg (babies at birth)
  • Child < 11 y with an HBsAg-positive mother: 5 µg
  • Child 11–19: 5 µg
  • Immunocompetent adult: 10 µg
  • Immunosuppressed person: 40 µg
  • Renal dialysis patient: 40 µg
  • Engerix-B (20 µg of HBsAg)
  • Child < 10 y: 10 µg (babies at birth)
  • Child > 10 y: 20 µg
  • Adult: 20 µg
  • Immunosuppressed person: 40 µg
  • Dialysis patient: 40 µg 4.6.2
  • Postexposure vaccination
  • A combination of hepatitis B immunoglobulin (HBIg), when available, and HBV vaccine is recommended. If HBIg is available (in most countries it is not), it should be given to all children of HBs-positive mothers at the time of delivery. This is particularly important in neonates, in whom an immediate start of postexposure immunization will prevent infection in infants of HBV-infected mothers. It is important to vaccinate within 24 hours. There is no evidence of a protective effect if the vaccine is given more than 7 days after delivery.
  • Direct exposure (percutaneous inoculation or transmucosal exposure) to HBsAg positive body fluid (e.g., needlestick injury):
  • HBIg single intramuscular dose of 0.06 mL/kg (as soon as possible)
  • Followed by a complete course of HBV vaccination (initiated within 7 days)
  • Direct exposure following sexual contact with an individual with HBV:
  • HBIg single intramuscular dose of 0.06 mL/kg (within 14 days; very expensive and not affordable in most places)
  • Accompanied by a complete course of HBV vaccination (do not wait!).
  • Contraindications and side effects
  • There are very few contraindications:
  • Severe allergic reaction to previous doses
  • If the patient has a severe allergic reaction to baker’s yeast, plasma-derived HBV vaccine can be used instead
  • Fever > 38.5 °C
  • The following are not contraindications to administering HBV vaccine:
  • Any minor illness, such as respiratory tract infection or diarrhea with a temperature below 38.5 °C
  • Allergy or asthma
  • Treatment with antibiotics
  • Human immunodeficiency virus (HIV) infection; however more information is needed on the efficacy of HBV vaccination in neonates or infants who are infected with HIV.
  • Breastfeeding
  • History of seizures
  • Chronic illnesses
  • Stable neurological conditions
  • Prematurity or low birth weight
  • History of jaundice at birth
  • Pregnancy (although not generally recommended)

Hepatitis C

Acute Hepatitis C

  • Most cases of acute hepatitis C are asymptomatic and seldom diagnosed. Nonetheless, acute hepatitis C represents an opportunity to offer effective therapy. Acute hepatitis C is usually diagnosed under three circumstances: documented seroconversion, known exposure (eg, needle-stick exposure) and acute, clinical hepatitis.
  • There has been a high rate of spontaneous clearance of virus following acute hepatitis C, which was more than 50% in some studies. The younger the age of the infection, the more likely is spontaneous clearance of the virus. Icteric hepatitis predicts spontaneous clearance with a high accuracy. Clearance usually occurs within 14 weeks of exposure. Most patients clear virus within 12 weeks. However, a single negative HCV RNA is insufficient to confirm clearance, and the test should be repeated at least once.
  • Because seroconversion is unpredictable, treatment should be considered in all patients. Treatment is most effective when started before 12 weeks. Sustained virological response (SVR) rates of greater than 90% have been described using pegylated interferon (PEG IFN) monotherapy.
  • Recommendations:
  • Patients with acute, icteric hepatitis C can be observed for up to 12 weeks to determine whether spontaneous clearance occurs. If clearance has not occurred, treatment should be initiated by 12 weeks.
  • In patients with acute, nonicteric hepatitis C, the likelihood of spontaneous clearance is lower, so treatment should start soon after diagnosis.
  • Treatment is with PEG IFN-alpha monotherapy. Genotypes 2 and 3 should be treated for 12 weeks, and genotype 1 should be treated for 24 weeks.

Chronic Hepatitis C

Hepatitis D

Hepatitis E

Infectious diarrhea

Immunocompetent

  • Shigella species
  • Preferred regimen:
  • Preferred regimen:
  • Non-typhi species of Salmonella
  • Preferred regimen: Not recommended routinely, but if severe or patient is younger than 6 monthes or older than 50 year old or has prostheses, valvular heart disease, severe atherosclerosis, malignancy, or uremia, TMP-SMZ (if susceptible) OR Fluoroquinolone, bid for 5 to 7 days; Ceftriaxone, 100 mg/kg/d in 1 or 2 divided doses
  • Campylobacter species
  • Escherichia coli species
  • Enterotoxigenic
  • Enteropathogenic
  • Enteroinvasive
  • Enterohemorrhagic
  • Preferred regimen: Avoid antimotility drugs; role of antibiotics unclear, and administration should be avoided.
  • Aeromonas/Plesiomonas
  • Yersinia species
  • Vibrio cholerae O1 or O139
  • Toxigenic Clostridium difficile
  • Preferred regimen: Offending antibiotic should be withdrawn if possible; Metronidazole, 250 mg qid to 500 mg tid for 3 to 10 days
  • Giardia
  • Cryptosporidium species
  • Preferred regimen: If severe, consider Paromomycin, 500 mg tid for 7 days
  • Isospora species
  • Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, bid for 7 to 10 days
  • Cyclospora species
  • Preferred regimen: TMP/SMZ, 160 and 800 mg, respectively, bid for 7 days
  • Microsporidium species
  • Preferred regimen: Not determined
  • Entamoeba histolytica

Immunocompromised

  • Shigella species:
  • Preferred regimen:
  • Preferred regimen:
  • Non-typhi species of Salmonella
  • Preferred regimen: Not recommended routinely, but if severe or patient is younger than 6 monthes or older than 50 old or has prostheses, valvular heart disease, severe atherosclerosis, malignancy, or uremia, TMP-SMZ (if susceptible) OR Fluoroquinolone, bid for 14 days (or longer if relapsing); ceftriaxone, 100 mg/kg/d in 1 or 2 divided doses
  • Campylobacter species
  • Preferred regimen:Erythromycin, 500 mg bid for 5 days (may require prolonged treatment)
  • Escherichia coli species
  • Enterotoxigenic
  • Enteropathogenic
  • Enteroinvasive
  • Enterohemorrhagic
  • Preferred regimen: Avoid antimotility drugs; role of antibiotics unclear, and administration should be avoided.
  • Aeromonas/Plesiomonas
  • Yersinia species
  • Vibrio cholerae O1 or O139
  • Toxigenic Clostridium difficile
  • Preferred regimen: Offending antibiotic should be withdrawn if possible; Metronidazole, 250 mg qid to 500 mg tid for 3 to 10 days
  • Giardia
  • Cryptosporidium species
  • Preferred regimen: Paromomycin, 500 mg tid for 14 to 28 days, then bid if needed; highly active antiretroviral therapy including a protease inhibitor is warranted for patients with AIDS
  • Isospora species
  • Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, qid for 10 days, followed by TMP-SMZ thrice weekly, or weekly Sulfadoxine (500 mg) and Pyrimethamine (25 mg) indefinitely for patients with AIDS
  • Cyclospora species
  • Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, qid for 10 days, followed by TMP-SMZ thrice weekly indefinitely
  • Microsporidium species
  • Preferred regimen: Albendazole, 400 mg bid for 3 weeks; highly active antiretroviral therapy including a protease inhibitor is warranted for patients with AIDS
  • Entamoeba histolytica

Leptospirosis

  • Management
  • Early treatment with antibiotics.
  • Severe cases usually treated with high doses of IV Benzylpenicillin (30 mg/kg up to 1.2 g IV 6-hourly for 5-7 days).
  • Less severe cases treated orally with antibiotics such as Doxycycline (2 mg/kg up to 100 mg 12-hourly for 5-7 days), Tetracycline, Ampicillin or Amoxicillin.
  • Third-generation cephalosporins, such as Ceftriaxone and Cefotaxime, and Quinolone antibiotics may also be effective.
  • Jarisch-Herxheimer reactions may occur after the start of antimicrobial therapy.
  • Monitoring and supportive care as appropriate, e.g. dialysis, mechanical ventilation.[5]
  • Prevention
  • Preventing infection or disease in human hosts:
  • Antibiotic prophylaxis of exposed persons in areas of high exposures may be effective, e.g. soldiers (Doxycycline 200mg in one weekly dose)
  • Raising awareness of the disease and its of modes of transmission.[6]

Pancreatitis

Peliosis hepatitis

Peptic ulcer disease

Peritonitis, secondary to bowel perforation

Peritonitis, secondary to dialysis

Peritonitis, secondary to ruptured appendix

Peritonitis, secondary to ruptured diverticula

Peritonitis, spontaneous bacterial

Post-transplant infected biloma

Splenic abscess

Tropical sprue

  • Preferred regimen: Folic acid 5 mg PO bid for 2 weeks, followed by 1 mg PO tid AND (Tetracycline 250 mg PO qid OR Doxycycline 100 mg PO qd for 4–6 weeks, up to 6 months in residents of the tropics who have had long-term disease)
  • Alternative regimen: Folic acid 5 mg PO bid for 2 weeks, followed by 1 mg PO tid AND Ampicillin 500 mg bid for ≥ 4 weeks
Note: Vitamin B12 deficiency may be corrected with Vitamin B12 1000 mcg IM weekly for 4 weeks, followed by monthly for 3 to 6 months.

Typhlitis

Variceal bleeding, prophylaxis

Whipple's disease

References

  1. ↑ Sweeney DA, Hicks CW, Cui X, Li Y, Eichacker PQ (2011). "Anthrax infection". Am J Respir Crit Care Med. 184 (12): 1333–41. doi:10.1164/rccm.201102-0209CI. PMC 3361358. PMID 21852539.
  2. ↑ 2.0 2.1 2.2 2.3 Dellon ES, Gonsalves N, Hirano I, Furuta GT, Liacouras CA, Katzka DA; et al. (2013). "ACG clinical guideline: Evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE)". Am J Gastroenterol. 108 (5): 679–92, quiz 693. doi:10.1038/ajg.2013.71. PMID 23567357.
  3. ↑ http://www.worldgastroenterology.org/assets/downloads/en/pdf/guidelines/02_acute_hepatitis.pdf
  4. ↑ 4.0 4.1 4.2 4.3 Guerrant RL, Van Gilder T, Steiner TS, Thielman NM, Slutsker L, Tauxe RV; et al. (2001). "Practice guidelines for the management of infectious diarrhea". Clin Infect Dis. 32 (3): 331–51. doi:10.1086/318514. PMID 11170940.
  5. ↑ http://www.who.int/zoonoses/diseases/Leptospirosissurveillance.pdf
  6. ↑ http://www.who.int/zoonoses/diseases/Leptospirosissurveillance.pdf
  7. ↑ Talley NJ, Vakil N, Practice Parameters Committee of the American College of Gastroenterology (2005). "Guidelines for the management of dyspepsia". Am J Gastroenterol. 100 (10): 2324–37. doi:10.1111/j.1572-0241.2005.00225.x. PMID 16181387.
  8. ↑ Guerra, R.; Wheby, M. S.; Bayless, T. M. (1965-10). "Long-term antibiotic therapy in tropical sprue". Annals of Internal Medicine. 63 (4): 619–634. ISSN 0003-4819. PMID 5838328. Check date values in: |date= (help)
  9. ↑ Ferri, Fred (2015). Ferri's Clinical Advisor 2016 5 Books in 1. City: Elsevier Science Health Science. ISBN 978-0323280471.
  10. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
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