What antibiotics (abx) should be used to treat redness at a gastrostomy tube (G-tube) site?

Treatment of G-Tube Site Redness

For redness at a G-tube site, start with topical antimicrobial agents applied to the entry site and surrounding tissue, and if infection persists after 5-7 days, add oral broad-spectrum antibiotics for 5-7 days. 1, 2

Initial Assessment

Before starting treatment, evaluate the severity of infection:

• Look for true infection signs: erythema, purulent/malodorous drainage, fever, and pain 1, 2
• Obtain cultures: Swab the site for both bacterial and fungal cultures before starting antimicrobials to guide targeted therapy 1, 2
• Check bolster tension: Ensure approximately 1 cm of play between the skin and external bolster, as excessive pressure increases infection risk 1, 3

Treatment Algorithm

Step 1: Topical Antimicrobial Treatment (First-Line)

• Apply antimicrobial ointment or sustained-release antimicrobial dressing to the entry site and surrounding tissue 1, 2
• Clean the site at least once daily using an antimicrobial cleanser 1, 2
• Avoid topical antibiotics (like neomycin or bacitracin alone) as they promote resistance; use antimicrobial ointments instead 3, 2

Step 2: Add Systemic Antibiotics if Needed

• If infection doesn't resolve with topical treatment alone: Add oral broad-spectrum antibiotics for 5-7 days 4, 1
• If systemic signs present (fever, elevated WBC, hypotension): Initiate intravenous broad-spectrum antibiotics coupled with local wound care 4, 1

Adjunctive Wound Care

• Apply zinc oxide or stoma adhesive powder to prevent local skin irritation from gastric drainage 4, 1
• Use foam dressings rather than gauze to lift drainage away from skin and reduce irritation 4, 1, 2
• Consider barrier films, pastes, or creams containing zinc oxide to protect skin from leaking gastric contents 2

High-Risk Patients Requiring Closer Monitoring

Patients with the following conditions face elevated infection risk and may need earlier escalation to systemic antibiotics: 4, 1, 3

• Diabetes
• Obesity
• Poor nutritional status
• Chronic corticosteroid or immunosuppressive therapy

Red Flags Requiring Urgent Intervention

• Signs of peritonitis: Requires surgical consultation 4, 2
• Bacteremia confirmed on blood cultures: Consider tube removal and replacement at different site with IV antibiotics 3
• Persistent infection despite appropriate treatment: May necessitate tube removal and replacement 1

Common Pitfalls to Avoid

• Don't overtighten the external bolster: This is associated with higher infection rates and can lead to tissue necrosis 4, 1, 3
• Don't use topical antibiotics alone: They promote resistance; use antimicrobial ointments or sustained-release dressings instead 3, 2
• Don't delay systemic antibiotics: If topical treatment fails after 5-7 days or systemic signs develop, escalate promptly 4, 1