Bowel decontamination

Perioperative prophylaxis Bowel decontamination Donor culture results Penicillin allergy vancomycin... 

Rifaximin Rifamycin Antibiotic Gut bacteria Enteric infection Diarrhea, infectious Hepatic encephalopathy Small intestine bacterial overgrowth Inflammatory bowel disease Colonic diverticular disease Irritable bowel syndrome Constipation Clostridium difficile infection Helicobacter pylori infection Colorectal surgery Bowel decontamination, selective Pancreatitis, acute Bacterial peritonitis, spontaneous Nonsteroidal anti-inflammatory drug enteropathy... 

Selective bowel decontamination in acute pancreatitis Prevention of SBP in cirrhosis Prevention of NSAID intestinal injury Extra-GI indications Skin infections Bacterial vaginosis Periodontal disease... 

The route of antibiotic administration might be crucial. Animal studies [193, 194] have shown that enteral administration (either by oral or rectal route) of antimicrobials reduces the rate of bacterial translocation and early mortality in rats or mice with experimentally induced pancreatitis. Indeed, in patients with ANP, selective bowel decontamination with oral and rectal antibiotics decreased the infection rate [195]. 

In addition to ANP where it is associated with GI dys-motility [198, 199], SIBO is present in a significant proportion of patients with chronic pancreatitis [200, 201], Short-term rifaximin therapy was able to normalize the hydrogen breath test and improve symptoms (i.e. diarrhea and fecal fat excretion) in all patients studied (fig. 9) [201]. Bowel decontamination via administration of this topical antibiotic could, therefore, be beneficial in both acute and chronic pancreatitis. Double-blind, placebo-controlled studies are to be performed to explore the rifaximin potential in this indication. 

Diarrhea is a well-known complication of antibiotic therapy. Rates of antibiotic-associated diarrhea (AAD) vary from 5 to 25%. Some antibiotics are more likely to cause diarrhea than others, specifically, those that are broad spectrum and those that target anaerobic flora. This paper reviews the effects of antibiotics on the fecal flora as well as host factors which contribute to AAD. Clinical features and treatment of AAD are also described. Prevention of AAD rests on wise antibiotic policies, the use of probiotics and prevention of acquisition in the hospital setting. Data from clinical trials suggest that poorly absorbed antimicrobials might have a decreased risk of causing AAD and Clostridium difficile-associated disease, as concluded from studies of antibiotics used for preoperative bowel decontamination and poorly absorbed antibiotics used for traveler s diarrhea. Controlled trials would prove this but are not yet available. Probiotics may be a good adjunct to poorly absorbed antibiotics to minimize the risk of diarrhea associated with antibiotics. 

Neomycin is too toxic for parenteral use. Its only use is via the oral route for pre-operative sterilization of the bowel or for selective decontamination in hematologic patients. However absorption may be increased significantly if there is inflammation of the bowel wall and such absorption can pose problems for the patient. 

General supportive care should be provided. Aggressive gut decontamination should be carried out using repeated doses of activated charcoal and whole bowel irrigation. Propranolol or other blockers (eg, esmolol) are useful antidotes for B-mediated hypotension and tachycardia. Phenobarbital is preferred over phenytoin for convulsions most anticonvulsants are ineffective. Hemodialysis is indicated for serum concentrations greater than 100 mg/L and for intractable seizures in patients with lower levels. 

Internal Decontamination. The most recommended methods of internal decontamination Include gastric lavage, whole bowel irrigation and administration of activated charcoal. 

Swanson-Biearman, B., Dean, B.S., Krenzelok, E.P. (1992). Failure of whole bowel irrigation to decontaminate the GI tract following massive jequirity bean ingestion [abst.]. Vet. Hum. Toxicol. 34 352-7. 

Topical uses. Neomycin and framycetin, whilst too toxic for systemic use, are effective for topical treatment of infections of the conjunctiva or external ear. They are sometimes used in antimicrobial combinations selectively to decontaminate the bowel of patients who are to receive intense immunosuppressive therapy. Tobramycin is given by inhalation for therapy of infective exacerbations of cystic fibrosis. 

Previously popular, primary decontamination with gastric lavage, emetics, whole bowel irrigation and cathartics may not be effective in preventing or delaying enteric absorption of poisons [9-12]. In contrast, multiple-dose oral activated charcoal is an effective method of enteric decontamination for a wide variety of ingestions [13]. However, all enteric decontamination procedures are contraindicated in petroleum distillate and caustic ingestions. 

No specific treatment is available for toxalbumin exposure. Aggressive gastric decontamination such as whole bowel irrigation is recommended. It is unlikely... 

The use of ipecac syrup, gastric lavage, and cathartics has fallen out of favor as routine therapies, whereas activated charcoal and whole-bowel irrigation are still useful for the gastric decontamination of appropriate patients. 

Polyethylene glycol electrolyte solutions, such as GoLytely and Colyte, are used routinely as whole-bowel irrigants prior to colonoscopy and bowel surgery. These solutions also can be used as a means to decontaminate the gastrointestinal tract of ingested toxins. " Large volumes of these osmotically balanced solutions... 

Cholinomimetic dmgs (carbamate, organophosphate inhibitors of acetylcholinesterase) Anxiety, agitation, seizures, coma, bradycardia or tachycardia, pinpoint pupils, salivation, sweating, hyperactive bowel, muscle fasciculations, then paralysis Support respiration. Treat with atropine and pralidoxime. Decontaminate... 

Activated charcoal is effective in decreasing theophylline absorption from the gastrointestinal tract, and whole bowel irrigation is especially useful for decontamination of orally administered sustained-release formulations of the drug. Hypotension is often managed by saline infusion, though vasopressors may be required. The blood levels of theophylline are decreased by charcoal hemoperfusion or by hemodialysis. Ipecac fluid extract contains cardiotoxic alkaloids and should never be used as an emetic. The answer is (D). 

Whole-bowel irrigation (see p 52) may enhance gut decontamination, especially in cases involving sustained-release preparations that are not likely to dissolve readily during the lavage procedure. 

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