Antibiotic Treatment for Patients with Intestinal Intussusception
For patients with intestinal intussusception requiring antibiotic treatment, the recommended regimen is a combination of a broad-spectrum agent such as piperacillin-tazobactam (4.5g IV every 6-8 hours) or a third-generation cephalosporin (ceftriaxone 2g IV daily) plus metronidazole (500mg IV every 6-8 hours). 1
Treatment Algorithm
Step 1: Assess Severity and Patient Status
Non-critically ill patients:
- Amoxicillin/clavulanate 1.2-2.2g IV every 6 hours, OR
- Ceftriaxone 2g IV daily + Metronidazole 500mg IV every 6 hours, OR
- Cefotaxime 2g IV every 8 hours + Metronidazole 500mg IV every 6 hours 1
Critically ill patients:
- Piperacillin/Tazobactam 4.5g IV every 6 hours, OR
- Cefepime 2g IV every 8 hours + Metronidazole 500mg IV every 6 hours 1
Step 2: Consider Beta-Lactam Allergies
- For patients with beta-lactam allergies:
- Ciprofloxacin 400mg IV every 8 hours + Metronidazole 500mg IV every 6 hours, OR
- Moxifloxacin 400mg IV every 24 hours 1
Step 3: Adjust for Risk of Resistant Organisms
- If risk of ESBL-producing organisms:
- Ertapenem 1g IV every 24 hours, OR
- Meropenem 1g IV every 8 hours, OR
- Imipenem/cilastatin 1g IV every 8 hours 1
Pediatric Considerations
For pediatric patients with intussusception requiring antibiotics:
Acceptable regimens include:
- Aminoglycoside-based regimen + metronidazole
- Carbapenem (imipenem, meropenem, or ertapenem)
- β-lactam/β-lactamase–inhibitor combination (piperacillin-tazobactam)
- Advanced-generation cephalosporin (cefotaxime, ceftriaxone) with metronidazole 1
Dosing for common agents in pediatric patients:
- Piperacillin-tazobactam: 200-300 mg/kg/day of piperacillin component divided every 6-8 hours
- Ceftriaxone: 50-75 mg/kg/day divided every 12-24 hours
- Metronidazole: 30-40 mg/kg/day divided every 8 hours 1
Duration of Therapy
Antimicrobial therapy should be continued until:
- Resolution of clinical signs of infection
- Normalization of temperature and white blood cell count
- Return of gastrointestinal function 1
Typically, this requires 5-7 days of treatment. If clinical symptoms persist beyond this period, further diagnostic investigation with CT or ultrasound imaging is warranted 1.
Important Considerations
Caution with antibiotics: There is evidence suggesting an association between antibiotic use and primary idiopathic intussusception, particularly with cephalosporins, which have been associated with a 20-fold increased risk 2. This underscores the importance of judicious antibiotic use.
Source control: Antibiotics are adjunctive therapy to appropriate surgical or radiological intervention for intussusception. The primary treatment remains reduction of the intussusception either by hydrostatic pressure or surgery 3.
Monitoring: Regular assessment of clinical response is essential, with improvement typically expected within 3 days of initiating appropriate therapy.
Oral step-down: Once clinical improvement is observed and oral intake is tolerated, consider switching to appropriate oral antibiotics to complete the course of therapy.
By following this structured approach to antibiotic selection based on patient factors and illness severity, clinicians can provide optimal antimicrobial coverage for patients with intestinal intussusception requiring antibiotic therapy.