Intestinal Obstruction in the Newborn Medication

Updated: Feb 17, 2020
  • Author: James Goodwin Glasser, MD, MA, FACS; Chief Editor: Muhammad Aslam, MD  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to facilitate evacuation, reduce morbidity, and prevent complications.

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Laxatives, Osmotic

Class Summary

An enema with a high osmolality solution should be performed to facilitate evacuation.

Diatrizoate enema (Hypaque Sodium)

An enema with a high osmolality solution should be performed to facilitate evacuation. Diatrizoate enema has the advantage of acting as an osmotic laxative, which may aid in the evacuation of the colonic contents. Contrast radiography is diagnostic, and the diatrizoate enema has remarkable efficacy in loosening the sticky meconium and facilitating evacuation (>50% success rate).

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Prokinetic Agents

Class Summary

Two promotility pharmacologic agents are useful: metoclopramide and erythromycin. Randomized controlled trials of these agents have produced variable results compared with placebo, and each has adverse effects that may render them unacceptable. Many clinicians justify the use of these medications with anecdotal reports or by personal experience, rather than according to evidence-based medicine.

Metoclopramide (Metozolv)

Metoclopramide is a dopamine antagonist that stimulates acetylcholine release in the myenteric plexus. Metoclopramide enhances gastrointestinal motility and accelerates gastric emptying time.

Erythromycin (E.E.S., Erythrocin)

Erythromycin has a prokinetic effect on the GI tract at a dose that is about a quarter less of the antibiotic dose, which may be mediated by stimulating cholinergic neurons. High doses may directly stimulate a motilin muscular receptor in the GI tract.

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Antibiotics, Other

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

Vancomycin

Vancomycin is a potent antibiotic directed against gram-positive organisms; in addition, it is active against Enterococcus species. It is useful in the treatment of gram-positive septicemia and soft-tissue infections. Vancomycin is indicated for patients who are allergic to penicillin or cephalosporin, or whose infections have not responded to these agents. Creatinine clearance may be used to adjust the dosage in patients with renal impairment.

Metronidazole (Flagyl)

Metronidazole causes a chemical reduction reaction in anaerobic bacteria and sensitive protozoa. It is readily absorbed and permeates all tissues, including cerebrospinal fluid (CSF), breast milk, and alveolar bone. It is metabolized and excreted in the liver and kidneys. 

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