Pediatric Small Bowel Obstruction Medication

Updated: Oct 27, 2020
  • Author: Pranit Chotai, MD; Chief Editor: Carmen Cuffari, MD  more...
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Medication

Medication Summary

Immediately administer empiric broad-spectrum antibiotics when managing a pediatric small bowel obstruction in which compromised bowel with necrosis or perforation is suspected. Infants with necrotizing enterocolitis are treated with antibiotics regardless of whether or not their disease progresses to requiring surgery. In addition, perioperative prophylactic antibiotics should be given whenever there is reasonable expectation of intraoperative entry into the gastrointestinal tract (making the wound classification at minimum "clean contaminated"). The exact antibiotics utilized vary between institutions based upon local antibiograms and provider preferences.

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Antibiotics

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

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.

Ampicillin (Ampi, Omnipen, Penglobe)

Ampicillin is a broad-spectrum penicillin. It interferes with bacterial cell wall synthesis during active replication, causing bactericidal activity against susceptible organisms. Ampicillin is an alternative to amoxicillin when patients are unable to take medication orally.

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.

Piperacillin/tazobactam (Zosyn)

The combination of piperacillin/tazobactam comprises an antipseudomonal penicillin plus a beta-lactamase inhibitor. This agent inhibits biosynthesis of cell wall mucopeptide synthesis by binding to one or more of the penicillin-binding proteins and is effective during active-multiplication stage. 

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