Decontamination intestinal

Runyon BA, Borzio M, Young S, Squier SU, Guarner C, Runyon MA Effect of selective intestinal decontamination with norfloxacin on spontaneous bacterial peritonitis, translocation, and survival in an animal model of cirrhosis. Hepatology 1995,21 1719-1724. 

Rasaratnam B, Kaye D, Jennings G, Dudley F, Chin-Dusting J The effect of selective intestinal decontamination on the hyperdynamic circulatory state in cirrhosis. Ann Intern Med 2003 139 186-193. 

Recommended antibiotic prophylactic measures include neomycin (1 g), colistin (1.5 million units) or nystatin (1 million units) four times a day. Antibiotics which have been tried and tested are norfloxacin (400 mg/day), cefotaxime and ceftriaxone. They result in selective intestinal decontamination as well as bactericidal action in the serum, ascitic fluid and urine. Because of the possible impact of norfloxacin on the central nervous system, special caution should be exercised during the initial stages of HE. Primary prevention with norfloxacin in high-risk patients yielded a reduction in SBP frequency from 17% to 2% and from 32% to 0%. (72, 82, 87, 89, 94, 98)... 

Llovet, JJM., Rodrignez-Igleslas, R, Moltlnho, E., Planas, R, Bataller, R., Navasa, M., Menacho, M., Pardo, A., Castells, A., Cabre, E., Arroyo, V., GassnU, MA., Rodes, J. Spontaneous bacterial peritonitis in patients with cirrhosis undergoing selective intestinal decontamination. X Hepatol. 1997 26 88-95... 

Soriano, G., Guarner, C., Telxldo, M., Such, J., Barrios, J., Enriquez, J., Vllardell, F. Selective intestinal decontamination prevents spontaneous bacterial peritonitis. Gastroenterology 1991 100 477 - 481... 

Salmeron, J.M., Tito, L., Rimola, A., Mas, A., Navasa, M.A., Llach, J., Gines, A., Gines, P., Arroyo, V., Rodes, X Selective intestinal decontamination in the prevention of bacterial infection in patients with acute liver failure. X Hepatol. 1992 14 280 - 285... 

Llovet J, Rodriguez-lglesias P, Moitinho E, et al. Spontaneous bacterial peritonitis in patients with cirrhosis undergoing selective intestinal decontamination. A retrospective study of 229 spontaneous bacterial peritonitis episodes. J Hepatol 1997 26 88-95. 

Gentamicin/Polymyxin 20 capsules Selective intestinal decontamination... 

A phase I study that evaluated 17 patients on a combination of irinofecan and cefpodoxime reported that the dose of irinotecan was able to be increased with the use of an oral cephalosporin to ameliorate diarrhoea by way of intestinal decontamination. This practice may increase tolerability of irinotecan, thereby allowing increased exposure to its chemotherapeutic effect [64 ]. 

Table 3 Characteristics of Studies Using Intestinal Decontamination in Critically 111 Patients...

Weinstein RA. Selective intestinal decontamination—an infection control measure whose time has come Ann Intern Med 1989 110 853-855. 

Godard J, Guillaume C, Reverdy ME, et al. Intestinal decontamination in a polyvalent ICU a double-blind study. Intens Care Med 1990 16 307-311. 

Brun-Buisson C, Legrand P, Rauss A, et al. Intestinal decontamination for control of nosocomial multiresistant gram-negative bacilli study of an outbreak in an intensive care unit. Ann Intern Med 1989 110 873-881. 

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... 

Feed with formic and propionic acids has been found to reduce Salmonella colonization in broilers (Thomson and Hinton, 1997), whereas decontamination of chicken carcasses with acetic or lactic acid reduced Campylobacter on carcasses or meat (Van Netten et al., 1994 Chaveerach et al., 2002). Organic acids, when added to feeds, should be protected to avoid dissociation in the crop and in the intestine that are known to possess higher pH and to reach far into the GIT, where the targeted bacterial population is situated (Gauthier, 2005). 

An in vitro study with amphotericin B found that it became markedly and irreversibly bound to sucralfate at the pH values found in the gut. This suggests that efficacy for intestinal candidiasis or gut decontamination might be decreased, but no study appears to have been conducted to establish this. 

It is not known how important this interaction is likely to be in practice, but the efficacy of amphotericin B for intestinal candidiasis or gut decontamination may be decreased. Separating the dosages might not be effective in some postoperative patients because their gastric function may not return to normal for up to 5 days, and some sucralfate might still be present when the next dose is given. This study was conducted more than a decade ago, and nobody appears to have conducted a clinical study to establish its hypothesis. If both sucralfate and oral amphotericin are required, it would seem prudent to monitor concurrent use carefully, being alert for any evidence of reduced effects. 

Selective decontamination of the digestive tract is based on the concept of colonization resistance. Studies in mice revealed that the autochthonous intestinal flora protects against colonization with exogenous flora... 

The use of the combination of intestinal and oropharyngeal decontamination still did not significantly reduce the overall incidence of respiratory tract infections (27), because a large proportion of respiratory tract infections occurred within the first 4 days of mechanical ventilation, before decontamination was established. These cases of early-onset pneumonia were caused by pathogens that had already contaminated patients lower respiratory tract in the period shortly before, or after, ICU admission, and therefore could not be eradicated by intestinal and oropharyngeal decontamination. Addition of 3 to 7 days (28) of systemic prophylaxis to the SDD regimen resulted in a further reduction of the early-onset infections (27), presumably as a result of preemptive therapy of incubating pneumonia. 

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