Treatment protocols

1. Outpatient IV antibiotics with or without oral antibiotics after appropriate period of observation

A. Monotherapy or Combination therapy as listed above.

B. IV antibiotics followed by oral therapy

2. Oral therapy

A. Ciprofloxacin 500-750 mg PO Q12H +/- Amoxicillin/ clavulanate 875 mg PO Q12H

B. Ciprofloxacin +/- Clindamycin 150-450 mg PO Q6H in penicillin-allergic patients

REF: Rolston. Clin Infect Dis 1999; 29:515-521

Ramphal. Clin Infect Dis 1999; 29:508-514

Feld. Clin Infect Dis 1999; 29:503-507

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Side Effect Management

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APPETITE STIMULANTS

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Dexamethasone G.75 mg

PO OID

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OR

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Megestrol acetate BGG mg

PO OD

3

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- many start at 16G mg OD

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REF: Loprinzi et al. J Clin Oncol 1999; 17:3299-3306

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CONSTIPATION

a

Bisacodyl (Dulcolax)

10-15 mg PO prn

S

10 mg supp PR prn

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Castor oil

10-15 cc PO prn

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Docusate calcium (Surfak)

240 mg PO QD

fD

Docusate/casanthranol (Pericolace)

1-2 capsules PO QHS prn

B &J

X tr> 3

15-30 cc PO QHS prn

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oo

Docusate sodium (Colace)

100-200 mg PO BID

o era

Glycerin

1 supp PR prn

o

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Lactulose

g

Magnesium citrate

150-300 cc PO BID prn

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n

o

Magnesium hydroxide (MOM)

30-60 cc PO BID prn

Methylcellulose (Citrucel)

1 heaping tablespoon in 8 oz. H2O TID prn

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Mineral oil

15-45 cc PO prn

s

120 cc enema PR prn

Polycarbophil (FiberCon)

1 gram PO QID prn

Polyethylene glycol (MiraLax)

17 gms (1 heaping tbs) in 8 oz. H20 QD

Psyllium (Metamucil)

1 teaspoon in liquid, 1 packet in liquid, or 1-2 wafers PO TID prn

Sodium bisphosphate (Fleet) Sorbitol

2 tabs or 1 teaspoon of granules or 10-15 cc syrup PO QHS prn

1 supp PR QHS prn

1 enema PR prn

30-150 cc PO prn

DIARRHEA

Kaolin and pectin (Kaopectate) Loperamide (Imodium)

15-30 cc PO Q4H prn

4 mg PO after first loose BM, then 2 mg PO after each loose BM

-should not to exceed 6 doses per 24 hours Diphenoxylate/atropine (Lomotil) 1-2 tabs PO Q4H prn Octreotide 0.05-0.1 mg SQ TID

-may be helpful for 5-FU induced diarrhea

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