From the Guidelines
Empiric antibiotics for Small Bowel Obstruction (SBO) should be active against enteric gram-negative aerobic and facultative bacilli and B-lactam–susceptible gram-positive cocci, as well as obligate anaerobic bacilli, such as B. fragilis.
Recommended Antibiotics
- Ampicillin/sulbactam
- Cefazolin or cefuroxime/metronidazole
- Ticarcillin/clavulanate
- Ertapenem 1
Rationale
The selection of empiric antibiotics for SBO should be based on the likely causative organisms, which include gram-negative facultative and aerobic organisms, as well as anaerobes such as B. fragilis 1. The presence of obstruction increases the risk of anaerobic infection, making coverage against these organisms essential.
Clinical Considerations
The management of SBO is largely comparable to the management of adhesive small bowel obstruction, and patients with a virgin abdomen can be treated according to existing guidelines for SBO 1. Imaging plays a key role in the diagnosis and management of SBO, and can aid in the differentiation of high-grade from low-grade obstruction, as well as the detection of related findings that may prompt surgical treatment 1.
From the Research
Empiric Antibiotics for Small Bowel Obstruction (SBO)
- The use of empiric antibiotics in SBO is supported by several studies, including 2 and 3, which highlight the importance of antibiotic prophylaxis in preventing postoperative infections.
- According to 3, cefonicid and cefoxitin are effective prophylactic antibiotics for elective colorectal surgery or operation for obstruction of the small bowel.
- The study 2 found that 83% of patients with SBO received antibiotic prophylaxis, with triggers including preoperative elevated C-reactive protein or resection of the bowel.
- However, the same study 2 found no association between antibiotic use and infectious complications, suggesting that the use of empiric antibiotics may not always be necessary.
- Other studies, such as 4 and 5, focus on the diagnosis and management of SBO, but do not specifically address the use of empiric antibiotics.
- The study 6 discusses the clinical issues and recent technical advances in partial small bowel obstruction, but does not provide information on empiric antibiotics.