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Pediatric Short Bowel Syndrome Medication

  • Author: Carmen Cuffari, MD; Chief Editor: Jatinder Bhatia, MBBS, FAAP  more...
 
Updated: Jul 08, 2016
 

Antibiotics

Class Summary

These agents are used sparingly to prevent small-bowel bacterial overgrowth. They are used on a biweekly basis to prevent bacterial resistance.

Metronidazole (Flagyl)

 

Used to prevent intestinal small-bowel bacterial overgrowth.

Gentamicin (Garamycin, Gentacidin)

 

Aminoglycoside antibiotic for gram-negative coverage. May be used to prevent bacterial overgrowth in children with SBS.

Consider if penicillins or other less toxic drugs are contraindicated.

Gentamicin works well when administered PO to prevent intestinal overgrowth.

Drug interactions and precautions are likely to be clinically insignificant because PO gentamicin has minimal systemic absorption.

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H2 blockers

Class Summary

This agent is one of two treatment modalities used for gastric acid hypersecretion.

Ranitidine (Zantac)

 

Inhibits histamine stimulation of the H2 receptor in gastric parietal cells, which in turn reduces gastric acid secretion, gastric volume, and hydrogen concentrations.

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Proton pump inhibitors

Class Summary

This agent is one of two treatment modalities used for gastric acid hypersecretion.

Omeprazole (Prilosec)

 

Decreases gastric acid secretion by inhibiting parietal cell H+/K+ -ATP pump.

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Choleretic agents

Class Summary

These agents improve biliary flow and prevent total parenteral nutrition (TPN)-induced liver disease.

Ursodiol (Actigall, Urso)

 

Also called ursodeoxycholic acid. Improves bile acid–dependent bile flow.

Phenobarbital (Barbita, Luminal, Solfoton)

 

Improves bile acid–independent flow.

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Bile salt binders

Class Summary

These agents decrease choleretic diarrhea.

Cholestyramine (Prevalite, Questran)

 

Forms a nonabsorbable complex with bile acids in the intestine, which in turn inhibits enterohepatic reuptake of intestinal bile salts. Effective in reducing the choleretic diarrhea in patients with SBS.

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Antisecretin agents

Class Summary

These agents decrease intestinal secretions.

Octreotide (Sandostatin)

 

Acts primarily on somatostatin receptor subtypes II and V. Inhibits GH secretion and has multitude of other endocrine and nonendocrine effects, including inhibition of glucagon, VIP, and GI peptides.

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Hypomotility agents

Class Summary

These agents increase intestinal transit time.

Loperamide (Imodium, Kaopectate)

 

Acts on intestinal muscles to inhibit peristalsis and slow intestinal motility. Prolongs movement of electrolytes and fluid through bowel and increases viscosity and loss of fluids and electrolytes.

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Fat-soluble vitamins

Class Summary

These agents supplement fat-soluble vitamins A, D, E, and K.

Vitamins A, D, E, K (ADEKs Pediatric Drops, Sunkist Multi-Vitamins, Centrum)

 

Vitamin supplementation in patients with malabsorption. Available in various formulations in multivitamins. Check label for precise ingredients.

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Contributor Information and Disclosures
Author

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.

Specialty Editor Board

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.

David A Piccoli, MD Chief of Pediatric Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia; Professor, University of Pennsylvania School of Medicine

David A Piccoli, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Disclosure: Nothing to disclose.

Chief Editor

Jatinder Bhatia, MBBS, FAAP Professor of Pediatrics, Medical College of Georgia, Georgia Regents University; Chief, Division of Neonatology, Director, Fellowship Program in Neonatal-Perinatal Medicine, Director, Transport/ECMO/Nutrition, Vice Chair, Clinical Research, Department of Pediatrics, Children's Hospital of Georgia

Jatinder Bhatia, MBBS, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American Pediatric Society, American Society for Nutrition, American Society for Parenteral and Enteral Nutrition, Academy of Nutrition and Dietetics, Society for Pediatric Research, Southern Society for Pediatric Research

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Gerber.

Additional Contributors

Jorge H Vargas, MD Professor of Pediatrics and Clinical Professor of Pediatric Gastroenterology, University of California, Los Angeles, David Geffen School of Medicine; 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, Latin American Society of Pediatric Gastroenterology, Hepatology & Nutrition, American Society for Gastrointestinal Endoscopy, American Society for Parenteral and Enteral Nutrition, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Disclosure: Nothing to disclose.

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Small-bowel obstruction caused by intussusception in a 5-month-old patient is visible on plain radiograph.
 
 
 
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