Medication Summary
Bowel obstruction frequently necessitates surgical intervention. However, antibiotics should be started in the emergency department. Coverage must include gram-negative aerobic and gram-negative anaerobic organisms. The following antibiotics do not represent an all-inclusive list.
Antibiotics
Class Summary
Antibiotic therapy must cover all likely pathogens in the context of this clinical setting.
Clindamycin (Cleocin)
Clindamycin is a lincosamide that is useful in treating serious skin and soft-tissue infections caused by most staphylococcal strains. This agent is also effective against aerobic and anaerobic streptococci, except enterococci.
Clindamycin acts by inhibiting bacterial protein synthesis via inhibition of the peptide chain initiation at the bacterial ribosome, where it preferentially binds to 50S ribosomal subunit, thereby inhibiting bacterial growth.
Metronidazole (Flagyl)
Metronidazole is an imidazole ring-based antibiotic active against various anaerobic bacteria and protozoa. This agent is used in combination with other antimicrobial agents (but used alone in Clostridium difficile enterocolitis).
Cefoxitin (Mefoxin)
Cefoxitin is a second-generation cephalosporin that is indicated for the management of infections caused by susceptible gram-positive cocci and gram-negative rods. This agent is effective against aerobic and anaerobic gram-negative organisms.
Cefotetan
Second-generation cephalosporin indicated for management of infections caused by susceptible gram-positive cocci and gram-negative rods.
Imipenem and cilastatin (Primaxin)
The combination of imipenem and cilastatin is effective against aerobic and anaerobic gram-negative organisms.
Meropenem (Merrem I.V.)
Meropenem is a bactericidal broad-spectrum carbapenem antibiotic that inhibits cell-wall synthesis. This agent is effective against most gram-positive and gram-negative bacteria
Piperacillin-tazobactam (Zosyn)
Piperacillin-tazobactam inhibits the biosynthesis of cell wall mucopeptide and is effective during the stage of active multiplication. It has antipseudomonal activity.
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This chest radiograph demonstrates free air under the diaphragm, indicating bowel perforation in a patient with large-bowel obstruction. Radiograph courtesy of Charles J McCabe, MD†.
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Abdominal (kidney-ureter-bladder [KUB]) film of a patient with obstipation. Dilatation of the colon is associated with large-bowel obstruction. Radiograph courtesy of Charles J McCabe, MD†.
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Gastrografin study in a patient with obstipation reveals colonic obstruction at the rectosigmoid level. Radiograph courtesy of Charles J McCabe, MD†.
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Contrast study demonstrates colonic obstruction at the level of the splenic flexure, in this case due to carcinoma. Radiograph courtesy of Charles J McCabe, MD†.
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Abdominal (kidney-ureter-bladder [KUB]) radiograph depicting massive dilatation of the colon due to a cecal volvulus. Radiograph courtesy of Charles J McCabe, MD†.
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Contrast study of patient with cecal volvulus. The column of contrast ends in a "bird's beak" at the level of the volvulus. Radiograph courtesy of Charles J McCabe, MD†.
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Massive dilatation of the colon due to a sigmoid volvulus. Radiograph courtesy of Charles J McCabe, MD†.
