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Pediatric Small-Bowel Obstruction Medication

  • Author: Jaime Shalkow, MD, FACS; Chief Editor: Carmen Cuffari, MD  more...
Updated: Dec 11, 2015

Medication Summary

Bowel obstructions often require surgical interventions, but start antibiotic administration in the emergency department first. Antibiotic coverage must include gram-negative aerobic and gram-negative anaerobic organisms. (The following list of antibiotics is not all-inclusive.) In addition, broad-spectrum antibiotics should be administered in pediatric small-bowel obstruction when necrosis or perforation is suspected. In NEC, direct antimicrobial therapy is aimed at enteric bacteria (eg, Escherichia coli, Klebsiella species, Enterococcus species, anaerobic colonic flora [Clostridia species]).



Class Summary

Antibiotic therapy must cover all likely pathogens in the clinical setting.

Clindamycin (Cleocin)


Clindamycin is a lincosamide that is useful in treating serious skin and soft tissue infections caused by most staphylococcal strains. It is also effective against aerobic and anaerobic streptococci, except enterococci.

Clindamycin inhibits bacterial protein synthesis by inhibiting peptide chain initiation at the bacterial ribosome, where it preferentially binds to the 50S ribosomal subunit, inhibiting bacterial growth.

Metronidazole (Flagyl)


Metronidazole is an imidazole, ring-based antibiotic that is active against various anaerobic bacteria and protozoa. It is used in combination with other antimicrobial agents (although it is used alone in Clostridium difficile enterocolitis).

Aztreonam (Azactam)


Aztreonam is a monobactam that inhibits cell wall synthesis during bacterial growth. It is active against gram-negative bacilli. Aztreonam is effective against aerobic gram-negative organisms.

Cefoxitin (Mefoxin)


Cefoxitin is a second-generation cephalosporin that is used to treat infections caused by susceptible gram-positive cocci and gram-negative rods. It is effective against aerobic and anaerobic gram-negative organisms.



Cefotetan is a second-generation cephalosporin that is used to treat infections caused by susceptible gram-positive cocci and gram-negative rods. It is not approved by the US Food and Drug Administration (FDA) for use in children.

Imipenem and cilastatin (Primaxin)


This agent is effective against aerobic and anaerobic gram-negative organisms.

Ticarcillin and clavulanate potassium (Timentin)


This agent inhibits the biosynthesis of cell wall mucopeptide and is effective during the active growth stage. It is an antipseudomonal penicillin plus a beta-lactamase inhibitor, that provides coverage against most gram-positive, gram-negative, and anaerobic organisms.

Contributor Information and Disclosures

Jaime Shalkow, MD, FACS Director, National Pediatric Cancer Program, National Center for Pediatric and Adolescent Health (CeNSIA); Attending Pediatric Surgical Oncologist, Cancer Center at the American British Cowdray Medical Center

Jaime Shalkow, MD, FACS is a member of the following medical societies: American College of Surgeons, International Society of Paediatric Surgical Oncology, Pacific Association of Pediatric Surgery, Mexican Association of Pediatric Surgery, Mexican Society of Oncology, Mexican Association of Pediatrics

Disclosure: Nothing to disclose.


Adrian Florens, MD, FAAP Neonatologist, KIDZ Medical Services; Clinical Instructor of Pediatrics, Florida International University and Florida Atlantic University

Adrian Florens, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Eduardo Fastag Guttman, MD Medical Assistant Physician, Anesthesiology Integral

Disclosure: Nothing to disclose.

Issac Octavio Vargas Olmos Universidad Anahuac, Mexico

Disclosure: Nothing to disclose.

Chief Editor

Carmen Cuffari, MD Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine

Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, Royal College of Physicians and Surgeons of Canada

Disclosure: Received honoraria from Prometheus Laboratories for speaking and teaching; Received honoraria from Abbott Nutritionals for speaking and teaching.

Additional Contributors

Joyce Vazquez-Braverman, MD Instructor of ACLS, BLS, and Heartsavers, American Heart Assocation

Joyce Vazquez-Braverman, MD is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.


Jose Asz, MD Professor of Embryology, Assistant Professor of Surgery and Pediatrics, Faculty of Medicine, Universidad Nacional Autonoma de Mexico; Consulting Staff, Department of General Surgery, National Institute of Pediatrics, Mexico

Disclosure: Nothing to disclose.

B UK Li, MD Professor of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Director, Pediatric Fellowships and Gastroenterology Fellowship, Medical Director, Functional Gastrointestinal Disorders and Cyclic Vomiting Program, Medical College of Wisconsin; Attending Gastroenterologist, Children's Hospital of Wisconsin

B UK Li, MD is a member of the following medical societies: Alpha Omega Alpha, American Gastroenterological Association, and North American Society for Pediatric Gastroenterology and Nutrition

Disclosure: Nothing to disclose.

Nicholas A Shorter, MD Professor of Clinical Surgery and Clinical Pediatrics, State University of New York Downstate University; Division Chief, Department of Surgery, Division of Pediatric Surgery, State University of New York Downstate Medical Center

Disclosure: Nothing to disclose.

Jorge H Vargas, MD Professor of Pediatrics and Clinical Professor of Pediatric Gastroenterology, David Geffen School of Medicine, University of California at Los Angeles; Consulting Physician, Department of Pediatrics, University of California at Los Angeles Health System

Jorge H Vargas, MD is a member of the following medical societies: American Liver Foundation, American Society for Gastrointestinal Endoscopy, American Society for Parenteral and Enteral Nutrition, Latin American Society of Pediatric Gastroenterology, Hepatology & Nutrition, and North American Society for Pediatric Gastroenterology and Nutrition

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

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Small-bowel obstruction visible on plain radiograph caused by intussusception in a 5-month-old patient.
Barium enema revealing a coil spring appearance caused by the tracking of barium around the lumen of the edematous intestine in intussusception.
Small-bowel obstruction caused by an incarcerated inguinal hernia in a 2-month-old infant with bilateral inguinal hernias as well as an umbilical hernia.
Radiograph depicting the double-bubble sign characteristic of duodenal atresia.
Upper GI contrast study demonstrating a jejunal atresia with a proximal dilated atretic bowel and lack of passage of contrast into the distal small bowel.
Surgical photograph of the patient in the previous image depicting the proximal dilated atretic jejunum.
Upper GI contrast study showing a malrotation with lack of normal C-shaped duodenum and the small bowel "hanging" on the right side of the abdomen.
Contrast enema with an abnormally located cecum in a patient with malrotation.
Surgical photograph of necrotic bowel in a patient with midgut volvulus.
Necrotic bowel after surgical reduction of an intussusception.
Surgical photograph of a transition zone in an infant with small bowel obstruction.
Incarcerated left inguinal hernia.
Mesocolic hernia.
Surgical image of a laparotomy on a 7-month-old girl with ileocolic intussusception. An edematous and erythematous cecal appendix was found to be acting as a lead point.
Surgical image of a laparotomy on a 2-day-old female patient with congenital small bowel obstruction. A type I jejunal atresia without mesenteric gap and a grossly dilated proximal intestine is seen.
A barium enema on a 1-year-old male patient depicts an ileocolic intussusception.
Clinical photograph of a 5-month-old male patient with characteristic currant-jelly stools due to intussusception.
Plain abdominal film on a 3-day-old newborn depicting the classic double-bubble sign for duodenal atresia.
Contrast-enhanced upper gastrointestinal film showing a duodenal atresia on a 2-day-old newborn.
Surgical photograph of a 3-year-old male patient with an obstructive, noncommunicating ileal duplication.
Plain abdominal film of a 6-year-old male patient with MRCP (mental retardation and cerebral palsy), with organo-axial gastric volvulus. Note the grossly dilated and obstructed stomach. A gastrostomy feeding tube can be seen in place. Surgical staplers from a previous laparoscopic fundoplication are seen near the diaphragmatic crura.
Surgical photograph of an 8-month-old patient with ileocolic intussusception.
Plain abdominal film of a premature baby born at 28 weeks of gestation with necrotizing enterocolitis. Note the "railroad sign" (pneumatosis intestinalis) in the hepatic flexure and soap-bubbles in the descending colon.
Clinical image of a micro-premature baby boy with discoloration on the right lower quadrant of the abdomen, due to intestinal perforation secondary to necrotizing enterocolitis. An umbilical catheter is in place.
Plain abdominal film on a premature baby girl with necrotizing enterocolitis. Note the air in the biliary tree and the grossly dilated bowel.
Surgical photograph of a 1-year-old male patient who previously underwent a right radical nephrectomy for Wilms tumor. He presented to the emergency department with signs of a mechanical small bowel obstruction. A transition zone is clearly seen at the point where the small bowel is trapped on an internal hernia through a mesenteric gap.
Image of intussusception by ultrasound on a 9-month-old male patient.
Surgical photograph of an 8-month-old boy with intussusception. The surgeon's finger is inserted into the intussusceptum, and the intussuscipiens is seen entering the distal bowel. No leading point was identified.
Surgical photograph depicting loops of bowel passing through a mesenteric defect. The bowel segment proximal to the obstruction is dilated, purplish, distended and hypoperistaltic. The bowel distal to the obstruction is decompressed and normal-looking.
Surgical photograph of a newborn with a type III jejunal atresia. Note the dilated proximal bowel pouch, the mesenteric V-shaped defect, and the thin, nondilated distal jejunum.
Surgical photograph of a Meckel diverticulum.
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