Medication Summary

In addition to definitive therapy, urgently administer a regimen of antibiotics (eg, ampicillin, gentamicin, and clindamycin or cefotetan) whenever acute Meckel diverticulitis, strangulation, perforation, or signs of small bowel obstruction or sepsis are present.

Class Summary

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

Ampicillin (Omnipen, Marcillin)

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Interferes with bacterial cell wall synthesis during active replication, causing bactericidal activity against susceptible organisms.

Clindamycin (Cleocin, Cleocin Pediatric, ClindaMax Vaginal)

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Useful treatment for serious skin and soft tissue infections caused by most staphylococci strains. Also effective against entericaerobic and anaerobic flora, except enterococci. Inhibits bacterial protein synthesis by inhibiting peptide chain initiation at the bacterial ribosome, where it preferentially binds to the 50S ribosomal subunit, causing bacterial replication inhibition.

Gentamicin (Gentacidin, Garamycin)

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If used in combination with an antianaerobic agent, such as clindamycin or metronidazole, provides broad gram-negative and anaerobic coverage. Dosing regimens are numerous and adjusted on the basis of creatinine clearance and changes in distribution volume.

Cefotetan (Cefotan)

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Second-generation cephalosporin used as single-drug therapy to provide broad gram-negative coverage and anaerobic coverage. Half-life is 3.5 h. Inhibits bacterial cell wall synthesis by binding to ≥ 1 of the penicillin-binding proteins; inhibits final transpeptidation step of peptidoglycan synthesis, resulting in cell wall death.

Antibiotics have proven effective in decreasing rate of postoperative wound infection and improving outcome in patients with intraperitoneal infection and septicemia.

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Pediatric Meckel Diverticulum. Anteroposterior view of an abdominal radiograph showing multiple dilated loops of a small bowel with air-fluid levels.

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Author

Simon S Rabinowitz, MD, PhD, FAAP Professor of Clinical Pediatrics, Vice Chairman, Clinical Practice Development, Pediatric Gastroenterology, Hepatology, and Nutrition, State University of New York Downstate College of Medicine, The Children's Hospital at Downstate

Simon S Rabinowitz, MD, PhD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American College of Gastroenterology, American Gastroenterological Association, American Medical Association, New York Academy of Sciences, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, Phi Beta Kappa, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Coauthor(s)

Minoti Haribhai, MBChB Resident Physician, Department of Pediatrics, State University of New York Downstate College of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Carmen Cuffari, MD Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine

Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, Royal College of Physicians and Surgeons of Canada

Disclosure: Received honoraria from Prometheus Laboratories for speaking and teaching; Received honoraria from Abbott Nutritionals for speaking and teaching. for: Abbott Nutritional, Abbvie, speakers' bureau.

Additional Contributors

Neha Ahuja, MD Fellow in Pediatric Gastroenterology, State University of New York Downstate College of Medicine

Neha Ahuja, MD is a member of the following medical societies: American Academy of Pediatrics, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Disclosure: Nothing to disclose.

Nonyelum Erica Ebigbo, MBBS Resident Physician, Department of Pediatrics, Richmond University Medical Center

Nonyelum Erica Ebigbo, MBBS is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, Prem Shukla, MD; Pauline Mills, MD; Madhavi Katturupalli, MD; and Hongye Li, MD, to the development and writing of this article. The authors would also like to thank Dori Harasek for her assistance in the preparation of this article.