Hirschsprung Disease Medication

Updated: May 03, 2017
  • Author: Justin P Wagner, MD; Chief Editor: BS Anand, MD  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to eradicate infection, to reduce morbidity, and to prevent complications.

Immediately after the diverting colostomy is created or a definitive pull-through procedure is performed, patients often remain on broad-spectrum intravenous antibiotics (eg, ampicillin, gentamicin, and metronidazole) until bowel function has returned and feeding goals are achieved.

After a definitive pull-through procedure is performed and normal bowel function is obtained, no additional medication is required.

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Antibiotics

Class Summary

Empiric antimicrobial therapy must be comprehensive and cover all likely pathogens in the context of this clinical setting. Antibiotic selection should be guided by blood culture sensitivity whenever feasible.

Ampicillin (Marcillin, Omnipen, Principen)

Bactericidal activity against susceptible organisms. Alternative to amoxicillin when unable to take medication orally.

Gentamicin (Garamycin, Jenamicin)

Aminoglycoside antibiotic for gram-negative coverage. Used in combination with both an agent against gram-positive organisms and one that covers anaerobes. Not the DOC. Consider if penicillins or other less-toxic drugs are contraindicated, when clinically indicated, and in mixed infections caused by susceptible staphylococci and gram-negative organisms.

Dosing regimens are numerous; adjust dose based on CrCl and changes in volume of distribution. May be administered IV/IM.

Metronidazole (Flagyl)

Imidazole ring-based antibiotic active against various anaerobic bacteria and protozoa. Used in combination with other antimicrobial agents (except for Clostridium difficile enterocolitis).

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Toxins

Class Summary

Induce more normal patterns of bowel movements in postoperative patients with enterocolitis.

OnabotulinumtoxinA (BOTOX®)

Binds to receptor sites on motor nerve terminals and inhibits release of acetylcholine, which in turn inhibits transmission of impulses in neuromuscular tissue.

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