Pediatric Malabsorption Syndromes Medication

Updated: Oct 06, 2017
  • Author: Stefano Guandalini, MD, AGAF; Chief Editor: Carmen Cuffari, MD  more...
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Digestive enzymes

Class Summary

Pancreatic enzyme deficiency may occur because of steatorrhea secondary to malabsorption.

Pancrelipase (Ultrase, Pancrease, Creon)

Assists in digestion of protein, starch, and fat. Contains lipase, protease, and amylase.


Bile acid–binding agents

Class Summary

These agents are used in combination with antibiotics for bile acid malabsorption syndromes. Bacteria overgrowth may cause diarrhea by deconjugation and dehydroxylation of bile acids. Primary bile acid malabsorption may also occur.

Cholestyramine (Questran)

Binds bile acids, thus reducing damage to the intestinal mucosa. Also reduces induction of colonic fluid secretion. Forms a nonabsorbable complex with bile acids in the intestine, which in turn inhibits enterohepatic reuptake of intestinal bile salts.



Class Summary

Metronidazole may be considered and provides anaerobic coverage. Although the use of rifaximin in children for the indication of small intestinal bacterial overgrowth is not US Food and Drug Administration (FDA)-approved, this antibiotic is virtually nonabsorbed (< 0.4%) and has been proven useful in the treatment of small intestinal bacterial overgrowth in adults.

Metronidazole (Flagyl)

DOC for documented small bowel bacterial overgrowth. Provides good anaerobic coverage.

Rifaximin (Xifaxan)

Nonabsorbed (< 0.4%), broad-spectrum antibiotic specific for enteric pathogens of the gastrointestinal tract (ie, Gram-positive, Gram-negative, aerobic and anaerobic). Rifampin structural analog. Binds to beta-subunit of bacterial DNA-dependent RNA polymerase, thereby inhibiting RNA synthesis. Indicated for E coli (enterotoxigenic and enteroaggregative strains) associated with travelers' diarrhea.