Acute infectieuze diarree (AID)

Initiatief: SWAB Aantal modules: 22

AID door Cyclospora

Uitgangsvraag

Acute Infectieuze Diarree als gevolg van Cyclospora parasieten.

Aanbeveling

Geadviseerd wordt om te behandelen met TMP-SMZ in een dosering van 2dd 960 mg gedurende 7-10 dagen. Bij immuungecompromitteerden dient eveneens secundaire profylaxe te worden gegeven met hetzelfde middel zolang het CD4 getal < 150x109/l is.

Overwegingen

Er zijn voor deze richtlijn geen overwegingen opgesteld.

Onderbouwing

Niveau 1

Cyclospora kunnen ook bij immuuncompetente personen ziekte veroorzaken en zijn belangrijke verwekkers van diarree bij reizigers. Behandeling met TMP-SMZ, 2 dd 960 mg gedurende 7 dagen, is effectief.

 

A2 Hoge 214, Madico 215

Cyclospora kunnen bij immuuncompetente personen ziekte veroorzaken en zijn belangrijke verwekkers van diarree bij reizigers.De behandeling bestaat uit TMP-SMZ, 2 dd 960 mg gedurende 7 dagen.[214; 215] Immuungecompromitteerden, zoals AIDS patiënten, moeten 10 dagen worden behandeld en ook bij deze verwekker geldt dat secundaire profylaxe moet worden gegeven zolang het CD4 getal <150x106/l is.[216a; 213] Ciprofloxacine zou een alternatief kunnen zijn bij deze groep patienten wanneer er sprake is van een sulfa allergie.

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Autorisatiedatum en geldigheid

Laatst beoordeeld  : 01-02-2014

Laatst geautoriseerd  : 01-02-2014

De geldigheid van de richtlijn is 5 jaar; in 2019 of zoveel eerder als nodig is zal de richtlijn ge-reëvalueerd worden.

Initiatief en autorisatie

Initiatief:
  • Stichting Werkgroep Antibioticabeleid

Algemene gegevens

De richtlijn is opgesteld en goedgekeurd door vertegenwoordigers van de in de inleiding en methoden genoemde beroepsverenigingen, en verwoordt de geldende professionele standaard in februari 2014. De richtlijn bevat aanbevelingen van algemene aard. Het is mogelijk dat deze aanbevelingen in een individueel geval niet van toepassing zijn. De toepasbaarheid van de richtlijn in de praktijk is de verantwoordelijkheid van de behandelend arts. Er kunnen zich feiten of omstandigheden voordoen waardoor, in het belang van een goede zorg voor de patiënt, afwijking van de richtlijn wenselijk is.

 

De totstandkoming van deze richtlijn werd gefinancierd door subsidie van het Ministerie van VWS/RIVM-CIb aan de SWAB.

Doel en doelgroep

Doel

De Stichting Werkgroep Antibioticabeleid (SWAB) ontwikkelt richtlijnen voor het gebruik van antibiotica bij volwassenen in het ziekenhuis met als doel het antibioticabeleid te optimaliseren en zo een bijdrage te leveren aan de beheersing van kosten en resistentieontwikkeling.

 

Doelgroep

De richtlijnen dienen als raamwerk voor de commissies die antibioticaformularia opstellen in ziekenhuizen.

Samenstelling werkgroep

Voorbereidingscommissie:

  • Mw. drs. J.C. Bos (internist-infectioloog)
  • Mw. dr. C. Schultsz (arts-microbioloog)
  • Dr. T. Van Gool (arts-microbioloog, parasitoloog)
  • Drs. M. P. Bauer (internist-infectioloog)
  • Prof. dr. J.M. Prins (internist-infectioloog)

 

Wij zijn dank verschuldigd aan mevr. Heleen Dyserinck, (voormalig) bibliothecaresse van de Medische Bibliotheek van het AMC voor haar bijdrage aan de tot stand koming van de zoekstrategie.

Belangenverklaringen

De leden van de voorbereidingscommissie hebben de volgende potentiële belangenconflicten gemeld: M. Bauer heeft op uitnodiging van Astellas een Clostridium-symposium bezocht in Londen, UK. De overige auteurs hebben gemeld geen belangenconflicten te hebben.

Methode ontwikkeling

Evidence based

Werkwijze

Tabel 1. Methodologische kwaliteit van individuele studies [2]

Classificatie

Definitie

A1

A2

Systematische review obv tenminste twee onafhankelijke A2 studies

Randomised Controlled Trial (RCT) van voldoende methodologische kwaliteit en power

of

Prospectieve cohort studie met voldoende power en adekwate correctie voor confounders

B

Vergelijkende studie zonder de methodologische kwaliteit zoals genoemd bij A2 (inclusief patient gecontroleerde studies en cohort studies)

of

Prospectieve cohort studie zonder de methodologische kwaliteit zoals genoemd bij A2, retrospectieve cohort studie of patient gecontroleerde studie

C

Niet vergelijkende studie

D

Bewijs obv de mening van leden van de richtlijn commissie

* NethMap/ISIS surveillance data zijn niet goed te graderen omdat geen gebruik gemaakt kan worden van levels of evidence zoals gebruikt in deze richtlijn. Er wordt echter wel veel gewicht aan de methodologische kwaliteit van deze data toegekend, omdat ze betrekking hebben op zo’n 30% van de Nederlandse bevolking. Ditzelfde geldt voor de MARAN data.

 

Tabel 2. Bewijsniveaus

Bewijsniveaus

Definitie

Niveau 1

Één A1 studie of tenminste twee onafhankelijke A2 studies

Niveau 2

Één A2 studie of tenminste twee onafhankelijke B studie

Niveau 3

Één B of C studie

Niveau 4

Expert opinion

Zoekverantwoording

Zoekacties zijn opvraagbaar. Neem hiervoor contact op met de Richtlijnendatabase.

Volgende:
Empirische therapie bij AID