Nonabsorbable antibiotics

Because the development of antibiotic resistance will continue to be a problem, the development of effective alternative treatments is imperative. Immunization, probiotics, antisecretory agents, improved oral rehydration and nutrition therapy and nonabsorbable antibiotics are being considered by clinicians and researchers. Novel... 

Marotta F, Geng TC, Wu CC, Barbi G Bacterial translocation in the course of acute pancreatitis Beneficial role of nonabsorbable antibiotics and lactitol enemas. Digestion 1996 57 446-452. 

Rifaximin appeared to be effective and safe in both adults and children. Not only do these data support the efficacy of a nonabsorbable antibiotic in the treatment of diarrhea, the lack of absorption and degree of safety reported to date support the likelihood that rifaximin will be safe to use in pregnant women. Currently, the drugs of choice for the treatment of bacterial diarrhea, especially travelers diarrhea, are the fluoroquinolones, which are contraindicated in pregnancy. While rifaximin will likely never be adequately studied in pregnancy, it should be safe. 

Haltalin KC, Nelson JD, Hinton LV, Kusmiesz HT, Sladoje M Comparison of orally absorbable and nonabsorbable antibiotics in shigellosis. A double-blind study with ampicillin and neomycin. J Pediatr 1968 72 708-720. 

Nonabsorbable antibiotics are appealing because they have fewer systemic side effects and may be safer for children and pregnant women as well as in patients with renal and hepatic dysfunction. One such antibiotic, aztreonam, showed little effect on anaerobic flora in human volunteers, producing most of its effect on the aerobic flora [49, 50], A trial showed efficacy of aztreonam for traveler s diarrhea, where most pathogens are aerobes [51]. While there are no data on rates of AAD for nonabsorbable antibiotics and C. difficile, these would likely be decreased. Given the preservation of the anaerobic flora, another poorly absorbed antibiotic, bicozamycin, has efficacy in traveler s diarrhea with its major effect being on fecal aerobes [52],... 

Rifaximin Small intestine bacterial overgrowth Therapy Nonabsorbable antibiotics... 

Di Stefano M, Pezzimenti D, Veneto G, Missa-nelli A, Corazza GR Absorbable vs. nonabsorbable antibiotics in the therapy of small intestine bacterial overgrowth (SIBO) in patients with blind loop syndrome. Dig Liver Dis 2001 33 A93. 

Rifaximin, a virtually nonabsorbed antibiotic, is a semisynthetic rifamycin derivative, with a broad antimicrobial spectrum that includes most Gram-positive and Gram-negative bacteria, both aerobes and anaerobes [1, 2], Unlike systemically available antibiotics, this antimicrobial allows localized targeting (e.g. enteric or cutaneous) of pathogens and is associated with a minimal risk of systemic toxicity or side effects [3, 4], Provided that nonabsorbed antibiotics are as effective as systemically absorbed drugs for the target illness, their safety and toler-... 

Brand name Neo-Fradin Class Nonabsorbed antibiotics Manufacturer Generic... 

Treatment is largely empirical, based on observations that intestinal bacteria and protein loads in the intestinal tract are important in the symptoms of hepatic encephalopathy. Lactulose has long been recognized to reduce the symptoms in chronic hepatic encephalopathy. Antibiotic treatment with a nonabsorbable antibiotic such as neomycin reduces the number of bacteria and is especially helpful in patients with GI bleeding. Protein reduction in the diet also improves encephalopathy reducing dietary protein to the less than 40g/day often needed to improve symptoms may compromise nutrition. Patients with acute encephalopathy require... 

The bowel, one of the largest and most metabolically active organs, contains bacteria that may change the chemical composition of the human body. In renal failure the altered bacterial flora cause the accumulation of aliphatic amines in the gut (09, S25). Bacteria transform part of the choline in the gut to trimethylamine, which is reabsorbed and then either oxidized or demethylated to dimethylamine in the liver (S24). Dimethylamine enters the circulation and is excreted in the bile and urine. The trimethylamine and dimethylamine in the exhaled air of uremic patients may contribute to the classic fishy breath, which can be improved by hemodialysis or by gut sterilization with nonabsorbable antibiotics (S23, S25). The overall role of these compounds as uremic toxins, however, remains to be defined. 

Medical personnel should institute therapy that sterilizes the gut with nonabsorbable antibiotics at the onset of leukopenia.16 Cellular replacement, either peripheral or marrow, may also be successful. 

Combinations of local and systemic antibiotics for selective decontamination of the digestive tract (SDD) have been advocated to reduce or prevent HAP and other nosocomial infections (108-114). The SDD often uses combinations of nonabsorbable antibiotics, such as aminoglycoside, polymyxin B, and amphotericin B in a paste, which is applied to the oropharynx, and a liquid, which is given orally, with and without systemic cefotaxime, trimethoprim, or... 

Gastinne H, Wolff M, Delatour F, Faurisson F, Chevret S. A controlled trial in intensive care units of selective decontamination of the digestive tract with nonabsorbable antibiotics. N Engl J Med 1992 326 594-599. 

Stoutenbeek CP, van Saene HKF, Miranda DR, Zandstra DF, Langrehr D. The effect of oropharyngeal decontamination using topical nonabsorbable antibiotics on the incidence of nosocomial respiratory tract infections in multiple trauma patients. J Trauma 1987 27 357-364. 

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