Small-Bowel Obstruction Medication
- Author: Brian A Nobie, MD; Chief Editor: Steven C Dronen, MD, FAAEM more...
Fluid replacement with aggressive intravenous (IV) resuscitation using isotonic saline or lactated Ringer solution is indicated. Oxygen and appropriate monitoring are also required. Antibiotics are used to cover gram-negative and anaerobic organisms. In addition, analgesia and antiemetic are administered as indicated clinically. As previously mentioned, a nonoperative trial of as many as 3 days is warranted for partial or simple obstruction. Resolution of obstruction occurs in virtually all patients with these lesions within 72 hours.
These agents are for prophylaxis in surgical intervention, if needed.
Cefazolin is a first-generation semisynthetic cephalosporin that arrests bacterial cell wall synthesis, inhibiting bacterial growth.
Cefoxitin is a second-generation cephalosporin indicated for gram-positive cocci and gram-negative rod infections. Infections caused by cephalosporin- or penicillin-resistant gram-negative bacteria may respond to cefoxitin.
Cefotetan is a second-generation cephalosporin indicated for infections caused by susceptible gram-positive cocci and gram-negative rods. Dosage and route of administration depend on the condition of patient, the severity of infection, and the susceptibility of the causative organism.
Cefuroxime is a second-generation cephalosporin that maintains the gram-positive activity of first-generation cephalosporins; it adds activity against Proteus mirabilis, Haemophilus influenzae, E coli, Klebsiella pneumoniae, and Moraxella catarrhalis. The condition of the patient, the severity of the infection, and the susceptibility of the microorganism determine the proper dose and route of administration.
Meropenem is a bactericidal, broad-spectrum carbapenem antibiotic that inhibits cell-wall synthesis. It is effective against most gram-positive and gram-negative bacteria.
These agents should be administered for symptomatic relief, usually in conjunction with GI decompression via placement of an NG tube for suction.
Promethazine is for the symptomatic treatment of nausea and vomiting. It is an antidopaminergic agent that is effective in treating emesis. Promethazine blocks postsynaptic mesolimbic dopaminergic receptors in the brain and reduces stimuli to the brainstem reticular system.
Ondansetron is a selective 5-HT3-receptor antagonist that blocks serotonin peripherally and centrally; it is used in the prevention of nausea and vomiting. Ondansetron is metabolized in the liver through the P-450 pathway.
Pain control is essential to quality patient care. Analgesics ensure patient comfort, promote pulmonary toilet, and have sedating properties, which are beneficial for patients who experience pain.
This is the drug of choice for analgesia due to its reliable and predictable effects, safety profile, and ease of reversibility with naloxone. Various IV doses are used; morphine sulfate is commonly titrated until the desired effect is obtained.
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